NON-CONTRACEPTIVE HEALTH BENEFITS
The following non-contraceptive health benefits related to the use of combination oral contraceptives are supported by epidemiological studies which largely utilized oral contraceptive formulations containing estrogen doses exceeding 0.035 mg of ethinyl estradiol or 0.05 mg mestranol.
Effects on menses:
° increased menstrual cycle regularity
° decreased blood loss and decreased incidence of iron deficiency anemia
° decreased incidence of dysmenorrhea
Effects related to inhibition of ovulation:
° decreased incidence of functional ovarian cysts
° decreased incidence of ectopic pregnancies
° decreased incidence of fibroadenomas and fibrocystic disease of the breast ° decreased incidence of acute pelvic inflammatory disease
° decreased incidence of endometrial cancer ° decreased incidence of ovarian cancer
Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral con-traceptives. In breakthrough bleeding, as in all cases of irregular bleeding from the vagina, nonfunctional causes should be borne in mind. In undiagnosed persistent or recurrent abnormal bleeding from the vagina, adequate diagnostic measures are indicated to rule out pregnancy or malignancy. If pathology has been excluded, time or a change to another formulation may solve the problem. Changing to an oral contracep-tive with a higher estrogen content, while potentially useful in minimizing menstrual irregularity, should be done only if necessary since this may increase the risk of thromboembolic disease.
Use of oral contraceptives in the event of a missed menstrual period:
1. If the patient has not adhered to the prescribed schedule, the possibility of pregnancy should be consid-ered at the time of the first missed period and oral contraceptive use should be discontinued if pregnancy is confirmed.
2. If the patient has adhered to the prescribed regimen and misses two consecutive periods, pregnancy should be ruled out.