Combined_Oral_Contraceptive_Pill_Advantages_Disadvantages_Flashcards
What are the advantages of the combined oral contraceptive pill?
Highly effective (failure rate < 1 per 100 woman years), doesn’t interfere with sex, contraceptive effects reversible upon stopping, usually makes periods regular, lighter and less painful, reduced risk of ovarian, endometrial, and colorectal cancer, may protect against pelvic inflammatory disease, may reduce ovarian cysts, benign breast disease, acne vulgaris.
What are the disadvantages of the combined oral contraceptive pill?
People may forget to take it, offers no protection against sexually transmitted infections, increased risk of venous thromboembolic disease, increased risk of breast and cervical cancer, increased risk of stroke and ischaemic heart disease (especially in smokers), temporary side-effects such as headache, nausea, breast tenderness may be seen.
Does the combined oral contraceptive pill cause weight gain?
Whilst some users report weight gain, a Cochrane review did not support a causal relationship.
summarise cocp: advantages+disadvantages
Combined oral contraceptive pill: advantages/disadvantages
Advantages of combined oral contraceptive pill
highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial - this effect may last for several decades after cessation
reduced risk of colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts, benign breast disease, acne vulgaris
Disadvantages of combined oral contraceptive pill
people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen
Whilst some users report weight gain whilst taking the combined oral contraceptive pill a Cochrane review did not support a causal relationship.
A woman who is taking the combined oral contraceptive pill comes to see you in clinic. She is worried about the risk of cancer from taking the pill after hearing something on the news. You sit down with her and talk about evidence-based medicine. The combined oral contraceptive pill is thought to reduce the risk of which of the following types of cancer?
Breast
Ovarian
Liver
Lung
Cervical
Ovarian
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
Studies have shown that the combined oral contraceptive pill (COCP) causes a slight risk in breast cancer. However, the evidence suggests that after 10 years of stopping the pill, a woman would remain at her background risk.
The COCP is also thought to increase the risk of cervical cancer. However, this may be because women who are taking the pill are less likely to be using barrier contraception and more likely to pick up HPV which is a risk factor for cervical cancer.
The combined oral contraceptive pill is also associated with an increased risk of benign and malignant tumours.
Evidence has shown there is no increase in the risk of lung cancer in women who take the oral contraceptive pill, compared to women who don’t.
The oral contraceptive pill has been shown to reduce the risk of ovarian cancer, endometrial cancer and bowel cancer.
A 24-year-old woman presents to the clinic for family planning. She requests a form of contraception that will not interfere with sexual intercourse and is reversible upon stopping.
She currently experiences heavy, painful, and irregular periods, but is otherwise fit and well. It is suggested she starts the combined oral contraceptive pill (COCP) as there are no contraindications and it might help her symptoms.
What additional health benefits might this medication provide?
Decreased risk of breast cancer
Decreased risk of cervical cancer
Decreased risk of endometrial cancer
Decreased risk of sexually transmitted infections
Decreased risk of stroke and ischaemic heart disease
Decreased risk of endometrial cancer
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
The combined oral contraceptive pill (COCP) is a highly effective form of birth control made up of both oestrogen and progestogen. As naturally occurring oestrogen and progesterone levels are known to affect the occurrence of certain cancers, research has confirmed the use of the COCP can increase and decreased specific cancer risks. Studies have confirmed the use of the COCP is associated with a decreased risk of endometrial cancer which is thought to be due to the COCP suppressing endometrial cell proliferation.
Research has shown that breast cancer risk is increased with prolonged COCP use. It has been proposed that breast cancer expresses receptors for oestrogen and/or progesterone hormones and therefore additional, synthetic versions of these female hormones may stimulate the development and growth of breast cancer.
Similar to breast cancer, research has shown an increased risk of cervical cancer associated with the use of the COCP, not a decrease. It has been proposed that the use of the COCP may change the susceptibility of the cervical cells to persistent human papillomavirus infections which is the cause of nearly all cases of cervical cancer.
As the COCP is not a barrier form of contraception it has no effect/does not reduce the risk of sexually transmitted infections alone.
The use of oestrogen containing contraception has been associated with an increased risk of both strokes and ischaemic heart disease, with patients on pills with higher doses of oestrogen having a relatively higher risk than those on contraception with a lower dose. This increase is greatest in patients with additional risk factors such as smoking and diabetes. The mechanism for this increased risk is unclear but is believed to be due to increased blood pressure and/or increased hypercoagulation.
Which one of the following is less common in women who take the combined oral contraceptive pill?
Stroke
Endometrial cancer
Pulmonary embolism
Cervical cancer
Ischaemic heart disease
Endometrial cancer
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
The correct answer is Endometrial cancer. The combined oral contraceptive pill has been found to significantly reduce the risk of endometrial cancer. This protection increases with the duration of use and continues for many years after stopping the pill. The mechanism behind this protective effect is thought to be due to the progestogen component of the pill which opposes oestrogen’s proliferative effect on the endometrium, thus reducing hyperplasia and subsequent malignant transformation.
Stroke, on the other hand, is not less common in women who take combined oral contraceptives. In fact, these pills can slightly increase the risk of stroke, particularly ischemic stroke. This increased risk is primarily seen in women with additional risk factors such as hypertension, smoking, obesity or older age.
Similarly, Pulmonary embolism is also more common in women taking combined oral contraceptives. The hormones in these pills can increase the coagulability of blood leading to a higher risk of venous thromboembolism including pulmonary embolism.
The relationship between combined oral contraceptive use and Cervical cancer is complex. While some studies suggest an increased risk with long-term use (over 5 years), others have found no significant association when adjusted for human papillomavirus (HPV) infection status - a key cause of cervical cancer. Therefore, it cannot be said definitively that cervical cancer is less common in women who take combined oral contraceptives.
Lastly, Ischaemic heart disease is not less common among users of combined oral contraceptives either. Similar to stroke, these pills can slightly increase the risk of ischemic heart disease, especially in the presence of other cardiovascular risk factors like smoking or high blood pressure.
Which one of the following is not a recognised adverse effect of the combined oral contraceptive pill?
Increased risk of ovarian cancer
Increased risk of deep vein thrombosis
Increased risk of breast cancer
Increased risk of ischaemic heart disease
Increased risk of cervical cancer
Increased risk of ovarian cancer
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
The correct answer is Increased risk of ovarian cancer. In fact, the use of combined oral contraceptive pill (COCP) has been associated with a reduced risk of ovarian cancer. The protective effect seems to increase with the duration of use and persists for many years after discontinuation.
The option Increased risk of deep vein thrombosis is incorrect as COCP indeed increases the risk of venous thromboembolism including deep vein thrombosis. This is due to increased liver synthesis of procoagulant factors and decreased anticoagulant factors induced by oestrogen component.
The option Increased risk of breast cancer is also incorrect. Studies have shown a small increase in relative risk of breast cancer among current and recent users of COCP. However, this appears to return to baseline approximately 10 years after discontinuation.
Increased risk of ischaemic heart disease is an incorrect answer as well. The COCP can lead to an increased risk of ischaemic heart disease, especially in women who smoke or are over 35 years old. It’s thought that this may be due to the effects on lipid metabolism and coagulation.
Lastly, Increased risk of cervical cancer is also not the correct answer because there’s evidence suggesting a slightly increased risk of cervical cancer in long-term users (>5years) of COCP, although it remains controversial whether this association is causal or related to sexual behaviour patterns.
