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  • Title: Noncontraceptive health benefits of oral steroidal contraceptives.
    Author: Mishell DR.
    Journal: Am J Obstet Gynecol; 1982 Mar 15; 142(6 Pt 2):809-16. PubMed ID: 7065059.
    Abstract:
    Prospective and retrospective epidemiologic studies involving oral contraceptives have been reviewed to determine the existence and extent of their benefits other than prevention of pregnancy. There is less menstrual blood loss, which reduces the risk of iron deficiency anemia by about 50%. The incidence of menorrhagia, irregular menses, and intermenstrual bleeding is also significantly reduced in users of oral contraceptives. Studies have shown an approximate 50% reduction in risk of endometrial cancer in oral contraceptive users, as well as a significant reduction in various types of benign breast disease. Because oral contraceptives inhibit ovulation, functional ovarian cysts are nearly eliminated, and the incidence of dysmenorrhea and premenstrual tension is significantly reduced. Oral contraceptives also protect women from developing ovarian carcinoma, rheumatoid arthritis, and salpingitis. From this review we conclude that the benefits of oral contraceptives in young healthy women for far outweight their more widely publicized, infrequent risks. A review of prospective and retrospective epidemiologic studies of oral contraceptives (OCs) shows that in addition to pregnancy prevention, OCs provide other health benefits resulting from the antiestrogenic action of the progestin in the pills and from its main action, inhibition of ovulation. The antiestrogenic effects include reduction of risk of iron deficiency anemia by about 50% because of reduced menstrual blood loss. The Royal College of General Practitioners (RCGP) study reports that OCs protect about 7 of 1000 pill users/year from iron deficiency anemia, and that OC use significantly reduces the incidence of menstrual disorders (menorrhagia, irregular menses, intermenstrual bleeding). Other studies report elimination of endometrial hyperplasia (Sturdee et al.), 50% reduction in risk of endometrial cancer (Weiss and Sayvetz, Boston University Epidemiologic Survey), and reduction in incidence of benign breast diseases (at least 12 published studies). The noncontraceptive benefits resulting from inhibition of ovulation include significant reduction in the incidences of dysmenorrhea (RCGP study), functional ovarian cysts (RCGP study, Boston Collaborative Surveillance Program, Ory), and ovarian cancer (Beral et al., Casagrande et al.) OCs are also found to protect against rheumatoid arthritis (RCGP, Rochester Epidemiologic Project), and salpingitis or pelvic inflammatory disease (PID). 6 epidemiologic studies show that the relative risk of developing PID among pill users compared with nonusers ranges from 0.3 - 0.9. Increased OC use by the population at greatest risk--sexually active women between 15-24 years old--would significantly reduce PID with its high cost of treatment and resulting infertility. It is hoped that healthy young women will realize that OCs provide benefits (including prevention of unwanted pregnancy) that far outweigh their more widely publicized, infrequent risks.
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