Birth Control Options for Women - Oral Contraception

Advantages of Oral Contraceptives

Oral contraceptives are the choice of between one-quarter and one-third of American women who use birth control, making them the most popular reversible contraceptives in the US. OCs are among the most effective contraceptives; failure rates are very low and are usually due to noncompliance. Some studies have suggested that women who are overweight may have a higher risk for failure. The risk for these women is also still very low, however.

OCs also have the following advantages:

More sexual freedom. OCs do not interfere with intercourse, and in fact, many women report that sex is more pleasurable because they no longer have to worry about pregnancy.
Reduce menorrhagia (heavy bleeding) and, therefore, reduce the risk for anemia.
Reduction in dysmenorrhea (severe pain). High-dose OCs have been especially helpful, but they carry risks. Specific newer low-dose OCs that contain certain progestins, such as Yasmin (with drospirenone) and Mircette (with desogestrel), may reduce menstrual pain.
Possible reduction in premenstrual syndrome with specific OCs, notably Yasmin. This OC may reduce premenstrual depression, water retention, and appetite to a greater degree that other OCs. Some OCs, however, are associated with worse emotional changes. Monophasic OCs may have a more beneficial effect on mood than triphasic OCs. To confuse matters, OCs with high progestin/low estrogen levels may produce worse moods in women without premenstrual syndrome but may be helpful for women with PMS.
Reduction in endometriosis.

Endometriosis is the condition in which the tissue that normally lines the uterus (endometrium) grows on other areas of the body causing pain and irregular bleeding.

Reduction of ovarian cancer. OCs may reduce the risk of ovarian cancer by 30% to 50% (even in women with genetic risk factors). Progestin appears to be the protective factor by suppressing ovulation. Protection occurs after five years of use and persists for 10 to 20 years after stopping. (One study indicated that taking birth control pills for only three to six months may confer long-term protection.) Some experts believe that women at particular risk for ovarian cancer might consider oral contraceptives with the highest progestin dose.
Reduction of endometrial (uterine) cancer. According to some studies, older OCs reduced the risk for endometrial cancer by half. More studies are needed on newer formulations, which have lower doses of estrogen, but it is generally believed that they, too, are protective.
Possible protection against colon cancer. Duration of use does not seem to be associated with decreased risk, but protection appears stronger for women who have used oral contraceptives more recently.
Acne improvement with low-dose OCs. (Some low-dose OCs, such as Ortho Tri-Cyclen, have been specifically approved for acne reduction, although most low-dose OCs reduce testosterone levels and so many may help reduce acne. Yasmin, for example, has properties that block male hormones, which are associated with acne. In one study, Yasmin use produced a 63.5% response.)
Possible protection against bone loss with low-dose OCs in some cases. The effect of OCs on bone density is unclear and may depend on the specific formulas that make up an OC. An important Canadian study that followed a group of young women found that OCs resulted in lower bone density and higher risk for fractures, possibly because taking OCs at younger ages interferes with achieving peak bone mass. Some evidence suggests, however, that OCs may protect against bone loss in women during the perimenopausal period. In addition, specific progestins (such as norethindrone or norgestimate) may be bone protective. More research is needed.