References

Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Ann Epidemiol.. 2015; 25:(3)193-200 https://doi.org/10.1016/j.annepidem.2014.11.004

Beral V, Doll R, Hermon C, Peto R, Reeves G Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23 257 women with ovarian cancer and 87 303 controls. Lancet. 2008; 371:(9609)303-314 https://doi.org/10.1016/S0140-6736(08)60167-1

Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2011; 84:(8)918-924

Brinton LA, Vessey MP, Flavel R, Yeates D. Risk factors for benign breast disease. Am J Epidemiol.. 1981; 113:(3)203-214 https://doi.org/10.1093/oxfordjournals.aje.a113089

Coffee AL, Kuehl TJ, Willis S, Sulak PJ. Oral contraceptives and premenstrual symptoms: comparison of a 21/7 and extended regimen. Am J Obstet Gynecol.. 2006; 195:(5)1311-1319 https://doi.org/10.1016/j.ajog.2006.05.012

Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Lancet Oncol.. 2015; 16:(9)1061-1070 https://doi.org/10.1016/S1470-2045(15)00212-0

Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol.. 2012; 119:(6)1143-1150 https://doi.org/10.1097/AOG.0b013e318257217a

Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev.. 2014; (7) https://doi.org/10.1002/14651858.CD004695.pub3

Combined Hormonal Contraception. 2019a. https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/ (accessed 11 July 2019)

Progestogen-only Injectable Contraception. 2019b. https://www.fsrh.org/standards-and-guidance//documents/cec-ceu-guidance-injectables-dec-2014/ (accessed 11 July 2019)

Ford O, Lethaby A, Roberts H, Mol BW. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev.. 2012; (3)

Gambacciani M, Ciaponi M, Cappagli B, Benussi C, Genazzani AR. Longitudinal evaluation of perimenopausal femoral bone loss: effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism. Osteoporos Int.. 2000; 11:(6)544-548 https://doi.org/10.1007/s001980070099

Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev.. 2014; (4) https://doi.org/10.1002/14651858.CD006134.pub5

Havrilesky LJ, Moorman PG, Lowery WJ Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis. Obstet Gynecol.. 2013; 122:(1)139-147 https://doi.org/10.1097/AOG.0b013e318291c235

Hubacher D, Lopez L, Steiner MJ, Dorflinger L. Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. Contraception. 2009; 80:(2)113-118 https://doi.org/10.1016/j.contraception.2009.02.008

Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev.. 2007; (3)

Legro RS, Arslanian SA, Ehrmann DA Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.. 2013; 98:(12)4565-4592 https://doi.org/10.1210/jc.2013-2350

Lopez LM, Grimes DA, Schulz KF, Curtis KM, Chen M. Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev.. 2014; (6) https://doi.org/10.1002/14651858.CD006033.pub5

Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev.. 2012; (2) https://doi.org/10.1002/14651858.CD006586.pub4

Luan NN, Wu L, Gong TT, Wang YL, Lin B, Wu QJ. Nonlinear reduction in risk for colorectal cancer by oral contraceptive use: a meta-analysis of epidemiological studies. Cancer Causes Control.. 2015; 26:(1)65-78 https://doi.org/10.1007/s10552-014-0483-2

Michels KA, Pfeiffer RM, Brinton LA, Trabert B. Modification of the Associations Between Duration of Oral Contraceptive Use and Ovarian, Endometrial, Breast, and Colorectal Cancers. JAMA Oncol.. 2018; 4:(4)516-521 https://doi.org/10.1001/jamaoncol.2017.4942

Montz FJ, Bristow RE, Bovicelli A, Tomacruz R, Kurman RJ. Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol.. 2002; 186:(4)651-657 https://doi.org/10.1067/mob.2002.122130

Muzii L, Di Tucci C, Achilli C Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis. Am J Obstet Gynecol.. 2016; 214:(2)203-211 https://doi.org/10.1016/j.ajog.2015.08.074

Endometriosis: diagnosis and management. NG73. 2017. https://www.nice.org.uk/guidance/cg30 (accessed 11 July 2019)

Heavy Menstrual Bleeding. NG88. 2018a. https://www.nice.org.uk/guidance/ng88/chapter/Recommendations#management-of-hmb (accessed 11 July 2019)

Management of acne vulgaris in Primary Care. 2018b. https://cks.nice.org.uk/acne-vulgaris (accessed 11 July 2019)

Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG.. 2017; 124:(3)e73-e105 https://doi.org/10.1111/1471-0528.14260

Shabaan MM, Zakherah MS, El-Nashar SA, Sayed GH. Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial. Contraception. 2011; 83:(1)48-54 https://doi.org/10.1016/j.contraception.2010.06.011

Vessey M, Yeates D. Oral contraceptives and benign breast disease: an update of findings in a large cohort study. Contraception. 2007; 76:(6)418-424 https://doi.org/10.1016/j.contraception.2007.08.011

Wu L, Wu Q, Liu L. Oral contraceptive pills for endometriosis after conservative surgery: a systematic review and meta-analysis. Gynecol Endocrinol.. 2013; 29:(10)883-890 https://doi.org/10.3109/09513590.2013.819085

Non-contraceptive benefits of hormonal contraception

02 August 2019
Volume 1 · Issue 8

Abstract

Beyond their primary role of preventing pregnancy, hormonal contraceptives provide a number of non-contraceptive benefits including a reduction in menstrual pain and bleeding, improvement in acne and a decrease in the lifetime risk of cancer of the ovaries and endometrium. They are also widely used in the management of a number of gynaecological conditions including endometriosis, premenstrual syndrome and polycystic ovary syndrome. Although the risks may outweigh the benefits when a method is used solely for contraception, the risk-benefit profile may change when it is also used for a medical indication. Potential non-contraceptive benefits should be discussed with all women when considering the most appropriate form of contraception to suit their needs.

Beyond their primary role of preventing pregnancy, hormonal contraceptives provide a number of non-contraceptive benefits (Table 1), the most well-established of which are described in this article. Some of these benefits may be key factors affecting a woman's contraceptive choice, such as effect on menstrual bleeding; while others may be more secondary advantages, such as reduction in the lifetime risk of certain cancers.

Hormonal contraceptives also have an important role in the management of many gynaecological conditions, some of which may be outside standard product licenses, but are supported by clinical guidelines. Where a drug is used outside its product license, the prescriber should discuss the proposed treatment fully with the patient and be satisfied that there is sufficient clinical evidence to support its use. In the case of contraception, the Faculty of Sexual and Reproductive Healthcare (FSRH) produce evidence-based guidance on contraceptive prescribing in the UK, including clear indications for off-label use. The UK Medical Eligibility Criteria (UKMEC) summarises the suitability of each method for contraceptive purposes only. Although the risks may outweigh the benefits when a method is used solely for contraception, the risk-benefit profile may change when it is used for a medical indication, and expert clinical judgment should always be sought.

Register now to continue reading

Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month