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 more than 40 years and used by millions of women. Used perfectly, combined hormonal contraception is highly effective (failure rate 1/1000), because it works by inhibiting ovulation. In typical use, however, mistakes are made, and pill failure rates are about 8%. Serious cardiovascular side-effects (heart attack, stroke and venous thromboembolism) are rare. The risk of venous thromboembolism varies with the type of progestogen. Breast and cervical cancer are both increased in users, though the absolute risk is small. Prescribing should not be over-medicalized.
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Anna Glasier is Honorary Professor in the Department of Obstetrics and Gynaecology at the University of Edinburgh, UK and in the Department of Public Health and Policy at the University of London School of Hygiene and Tropical Medicine, London, and Director of Family Planning and Well Woman Services for 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 health care. Conflicts of interest: none declared.
This article has been reproduced from: Medicine 2006; 34(1): 1–5.
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