Semin Reprod Med 2001; 19(4): 305-312
DOI: 10.1055/s-2001-18638
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Risks of Oral Contraceptive Pills

Helen C. Pymar, Mitchell D. Creinin
  • Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Women's Research Institute, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
29 November 2001 (online)

ABSTRACT

Oral contraceptive pills have been associated with increased risk for myocardial infarction, stroke, and venous thromboembolism. Studies have been published recently that suggest that these risks are minimal in appropriately chosen low-risk women. Stroke is a very uncommon event in childbearing women, occurring in approximately 11 per 100,000 women over 1 year. Thus, even a doubling of this risk with oral contraceptive pills would have minimal effect on attributable risk. The estimated risk of myocardial infarction associated with oral contraceptive pill use in nonsmokers is 3 per million women over 1 year. The estimated risk of venous thromboembolism attributable to oral contraceptive pills is less than 3 per 10,000 women per year. Additionally, the literature suggests that there may be an increased risk of breast cancer associated with long-term oral contraceptive pill use in women under the age of 35. However, because the incidence of breast cancer is so low in this population, the attributable risk of breast cancer from birth control pill use is small.

REFERENCES

  • 1 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study.  Lancet . 1996;  348 498-505
  • 2 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study.  Lancet . 1996;  348 505-510
  • 3 Croft P, Hannaford P. Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners' oral contraception study.  BMJ . 1989;  298 165-168
  • 4 Gerstman B, Piper J, Tornita D, Ferguson W, Stadel B, Lundin F. Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease.  Am J Epidemiol . 1991;  133 32-37
  • 5 Brinton L, Daling J, Liff J. Oral contraceptives and breast cancer risk among younger women.  J Natl Cancer Inst . 1995;  87 827-835
  • 6 Beral V. Mortality among oral contraceptive users: Royal College of General Practitioners' Oral Contraceptive Study.  Lancet . 1977;  2 727-731
  • 7 Inman W, Vessey M. Investigation of deaths from pulmonary, coronary, and cerebral thrombosis and embolism in women of child-bearing age.  BMJ . 1968;  2 193-199
  • 8 Hannaford P, Croft P, Kay C. Oral contraception and stroke: evidence from the Royal College of General Practitioners Oral Contraception Study.  Stroke . 1994;  25 935-942
  • 9 Thorogood M, Mann J, Murphy M, Vessey M. Fatal stroke and use of oral contraceptives: findings from a case-control study.  Am J Epidemiol . 1992;  136 35-45
  • 10 Petitti D, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel H. Stroke in users of low-dose oral contraceptives.  N Engl J Med . 1996;  335 8-15
  • 11 Schwartz S, Siscovick D, Longstreth W. Use of low-dose oral contraceptives and stroke in young women.  Ann Intern Med . 1997;  127 596-603
  • 12 Schwartz S, Petitti D, Siscovick D. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies.  Stroke . 1998;  29 2277-2284
  • 13 Rosenberg L, Kaufman D, Helmrich S, Miller D, Stolley P, Shapiro S. Myocardial infarction and cigarette smoking in women younger than 50 years of age.  JAMA . 1985;  253 2965-1969
  • 14 Sidney S, Petitti D, Quesenberry C, Klatsky A, Ziel H, Wolf S. Myocardial infarction in users of low-dose oral contraceptives.  Obstet Gynecol . 1996;  88 939-944
  • 15 Sidney S, Siscovick D, Petitti D. Myocardial infarction and use of low-dose oral contraceptives: a pooled analysis of 2 US studies.  Circulation . 1998;  98 1058-1063
  • 16 Dunn N, Faragher B, Thorogood M. Risk of myocardial infarction in young female smokers.  Heart . 1999;  82 581-583
  • 17 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case-control study.  Lancet . 1997;  349 1202-1209
  • 18 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Effect of different progestagens in low estrogen oral contraceptives on venous thromboembolic disease.  Lancet . 1995;  346 1582-1588
  • 19 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study.  Lancet . 1995;  346 1575-1582
  • 20 Farmer R, Lawrenson R, Thompson C, Kennedy J, Hambleton I. Population-based study of risk of venous thromboembolism associated with various oral contraceptives.  Lancet . 1997;  349 83-88
  • 21 Jick H, Jick S, Gurewich V, Myers M, Vasilakis C. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestagen components.  Lancet . 1995;  346 1589-1593
  • 22 Spitzer W, Lewis M, Heinemann L, Thorogood M, MacRae K. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study.  BMJ . 1996;  312 83-88
  • 23 Vandenbroucke J, Koster T, Briet E, Reitsma P, Bertina R, Rosendaal F. Increased risk of venous thrombosis in oral-contraceptive users who are carriers of factor V leiden mutation.  Lancet . 1994;  344 1453-1457
  • 24 Simpson E, Lawrenson R, Nightingale A, Farmer R. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database.  Br J Obstet Gynaecol . 2001;  108 56-60
  • 25 Suissa S, Blais L, Spitzer W, Cusson J, Lewis M, Heinemann L. First-time use of newer oral contraceptives and the risk of venous thromboembolism.  Contraception . 1997;  56 141-146
  • 26 Jick H, Kaye J, Vasilakis-Scaramozza C, Jick S. Risk of venous thromboembolism among users of third generation oral contraceptives compared with users of oral contraceptives with levonorgestrel before and after 1995; cohort and case-control analysis.  BMJ . 2000;  321 1190-1195
  • 27 Piccinino L, Mosher W. Trends in contraceptive use in the United States: 1982-1995.  Fam Plann Perspect . 1998;  30 4-46
  • 28 Phillips K, Glendon G, Knight J. Putting the risk of breast cancer in perspective.  N Engl J Med . 1999;  340 141-144
  • 29 Hankinson S, Colditz G, Manson J. A prospective study of oral contraceptive use and risk of breast cancer (Nurses' Health Study, United States).  Cancer Causes Control . 1997;  8 65-72
  • 30 Trapido E. A prospective cohort study of oral contraceptives and breast cancer.  J Natl Cancer Inst . 1981;  67 1011-1015
  • 31 Dupont W, Page D. Risk factors for breast cancer in women with proliferative breast disease.  N Engl J Med . 1985;  312 146-151
  • 32 Hsieh C-C, Crosson A, Walker A, Trapido E, MacMahon B. Oral contraceptive use and fibrocystic breast disease of different histologic classifications.  J Natl Cancer Inst . 1984;  72 285-290
  • 33 Pastides H, Kelsey J, LiVolsi V, Holford T, Fischer D, Goldenberg I. Oral contraceptive use and fibrocystic disease with special reference to its histopathology.  J Natl Cancer Inst . 1983;  71 5-9
  • 34 LiVolsi V, Stadel B, Kelsey J, Holford T, White C. Fibrocystic breast disease in oral-contraceptive users: a histopathological evaluation of epithelial atypia.  N Engl J Med . 1978;  299 381-385
  • 35 Fatality Analysis Reporting System. Available at: http://www-fars.nhtsa.dot.gov. Accessed October 31, 2001
  • 36 Maternal mortality: United States, 1982-1996. MMWR .  1998;  47 705-707
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