Birth Control Options for Women - Oral Contraception

Different progestins may affect risk for one or more of these complications. For example, the newer-generation progestins desogestrel (e.g., Desogen, Ortho-Cept) and gestodene (Minesse) may pose a higher risk for blood clots than those containing levonorgestrel. However, some evidence suggests that they pose a lower risk for heart attacks.

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Breast Cancer. Studies have been conflicting about whether estrogen in oral contraception increases the chances for breast cancer, and if it does, which women are at risk. Some research supported a higher risk in women with a family history of breast cancer and who also used OCs before 1975, which contained high-dose estrogens and progestins. A reassuring 2002 study supported an earlier major study, with both finding no evidence that current OC use increases the risk for breast cancer. It also reported no higher risk in women who had taken OCs for 15 years of more or had taken them at young ages. Some issues remain unresolved. For example, the risk for women currently taking OCs around menopause (ages 45 to 64) is still unclear. OCs users with a family history of breast cancer or who carry the BRCA1 genetic mutation (although possibly not those with the BRCA2) may be at higher risk. Such women are at higher risk for breast cancer in any case.

Cervical Cancer. A number of studies, including a major analysis, has reported a strong association between cervical cancer and long-term use of oral contraception (OC). The risk is highest (up to four times the risk of nonusers) in women infected with human papillomavirus (HPV) who have taken OCs for ten years or more. (Women who are not infected with HPV have no significantly higher risk.) The reasons for this risk from OC use are not entirely clear. Some experts have suggested that the hormones in OCs might facilitate entry of the HPV virus into the genetic material of cervical cells. Certainly, women who use OCs are less likely to use a diaphragm, condoms, or other methods that offer some protection against sexually transmitted diseases, including HPV.

Click the icon to see an image of cervical cancer.

Other Complications. Other complications have been associated with the use of oral contraceptives:

Taking oral contraceptives containing certain progestins (desogestrel in one study) also increased the risk for periodontal disease. Other progestins do not pose a risk for gum disease.
There has been some debate over whether the progestin-only pill increases the risk for permanent type 2 diabetes in women who develop a temporary form of diabetes during pregnancy (called gestational diabetes). In any case, the low-dose combination pill does not to pose such a risk. Women with a history of gestational diabetes should discuss this controversy with their physician.
Some evidence suggests that oral contraceptives may reduce lung capacity during exercise. In fact, there have been a few reports of exacerbation of asthma with OCs, but this is an uncommon effect.
The pill can affect the liver and, in rare cases, has been associated with liver tumors, gallstones, or jaundice. Women with a history of liver disease, such as hepatitis, should consider other contraceptive options.

Interactions with Other Medications. Oral contraceptives can interact with a number of other medications and herbs.

Interactions Between Oral Contraceptives and Other Medications
Examples of Medications That Reduce Effectiveness of OCs	Examples of Medications That May Increase Potency of OCs	Medications That Have Other Interactions
Certain antibiotics (penicillin tetracycline, rifampin), antifungal medications (e.g., griseofulvin), certain antiseizure medications (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and topiramate), possibly orlistat (a diet drug) and St. John's Wort.	Vitamin C, acetaminophen (Tylenol and others).	Corticosteroids, theophylline (e.g., Theo-Dur), certain drugs used for rheumatoid arthritis, including some immunosuppressants (such as cyclosporine, methotrexate, and others), morphine, certain anti-anxiety and antidepressant agents, loop diuretics, digoxin, warfarin, proton pump inhibitors (e.g., omeprazole).

Other Methods for Administering Combination Hormones

New methods of administering the combination of progestin and estrogen are now available. Failure rates with perfect use (0.1% to 0.6%) are similar to those with combined oral contraceptives. The recommendations and side effects are the same as those for OCs. None of these methods protect against sexually transmitted diseases.

Skin Patches. Ortho Evra is the first skin patch approved for preventing pregnancy. It contains a progestin (norelgestromin) and very low-dose estrogen (20 micrograms). Women should apply it on the lower abdomen, buttocks, or upper body (but not on the breasts). Each patch is worn continuously for a week and reapplied on the same day of each week. After three weekly patches, the fourth week is patch-free, which allows menstruation. (The patch remains effective for nine days, so being slightly late in changing it should not increase the risk for pregnancy.) It is as effective as oral contraceptives and compliance appears to be better--90% in one study. Problems may include more severe menstrual cramps and breast pain than with oral OCs. The skin patch may also be less effective in women who weigh more than 198 pounds. And in about 5% of women, the skin patch does not stick.

Vaginal Ring. A two-inch flexible ring (NuvaRing) is available that contains both estrogen and progestin and is inserted into the vagina. Women can insert the ring by themselves once a month and take it out at the end of the third week to allow menstruation. It appears to be very effective and to cause less irregular bleeding than OCs. Some women find it uncomfortable and a few have reported vaginal irritation and discharge, but such problems rarely cause a woman to discontinue use.

Injections. Lunelle is a once-monthly contraceptive injection that contains a combination of progestin (medroxyprogesterone acetate) and estrogen. It is administered by the health care provider every month. Unlike with progestin-only injections, a woman will have regular menstrual cycles. She may, however, experience a change in bleeding patterns after the Lunelle injections, including bleeding that lasts more than a week. Pregnancy is possible within two to four months after stopping the injections. (Note: There was a recall of this product in 2002 because of manufacturing problems that resulted in lower potency. As of this report, the manufacturer has not announced when production will resume.)