Combined hormonal contraception

Glasier, Anna

doi:10.1383/wohm.2005.2.5.1

Next »Women's Health Medicine
Volume 2, Issue 5 , Pages 1-6, September 2005

Combined hormonal contraception

Anna Glasier is an Honorary Professor in the Department of Obstetrics and Gynaecology at the University of Edinburgh, and in the Department of Public Health and Policy at the University of London School of Hygiene and Tropical Medicine, UK. She is the Director of Family Planning and Well Woman Services and has recently been appointed the Lead Clinician for Sexual Health in NHS Lothian. She qualified from the University of Bristol, and trained in obstetrics and gynaecology, specializing in reproductive medicine. Her research interests are contraception, including emergency contraception, and reproductive healthcare.

Abstract

Combined oral contraception is now available as oral, transdermal, vaginal and injectable preparations. Only the pill and patch are currently marketed in the UK. Most of the data come from the oral preparation – the combined pill – which has been marketed for over 40 years and is used by millions of women. Used perfectly combined hormonal contraception is highly effective (failure rate 1 in 1000) as it works by inhibiting ovulation. In typical use, however, mistakes are made and pill failure rates are around 8%. Serious cardiovascular side effects – heart attack, stroke and venous thromboembolism (VTE) – are rare. The risk of VTE varies with the type of progestogen. Breast and cervical cancer are both increased among users although the absolute risk is small. Prescribing should not be over-medicalized.

Keywords: contraception , arterial disease , cancer , combined oral contraceptive (COC) , injectable , oestrogen , patch , progestogen , vaginal ring , venous disease