Since their approval by the Food and Drug Administration in 1960, OCs or oral contraceptive pills (also known as "birth control pills") have played a key role in preventing unwanted pregnancy. Indeed, OCs are the most widely used form of reversible contraception used in the United States today. Traditionally, women taking oral contraceptives have cited both ease of use and effectiveness as the leading contributors in their decision to use this over other forms of contraception. What women (and physicians in many cases) have failed to realize is that there are also numerous non-contraceptive benefits which have been ascribed to use of oral contraceptive pills.

With it’s widespread use (over 70 million women worldwide), the oral contraceptive pill is one of the most widely studied medications ever prescribed. Thorough evaluation of the data that has been collected brings forth two general conclusions. First, relatively small health risks are associated with current pill formulations, particularly for those who are healthy and do not smoke. And second, the health benefits of OCs clearly outweigh the risks. Although the avoidance of unwanted pregnancy is an obvious and important health benefit of OCs, the focus of this article is the less recognized non-contraceptive health benefits that one may accrue through the use of OCs. Among these benefits are well-documented protection against endometrial (uterine) and ovarian cancer, benign breast disease, salpingitis (infections of the fallopian tubes), ectopic or tubal pregnancies, painful menstruation, and anemia due to iron deficiency. Growing evidence also suggests a protective effect against osteoporosis, and there is at least some evidence to suggest protection from colorectal cancer, uterine fibroid tumors, toxic shock syndrome, and rheumatoid arthritis as well.

Ovarian cancer causes nearly 15,000 deaths a year in the United States - more deaths than any other cancer of the female reproductive system - but has virtually no early warning signs or method of early detection. The risk of developing ovarian cancer is reduced by approximately 40% in anyone who has ever used an oral contraceptive pill. A protective effect has been observed with as little as 3-6 months use, with further declines in risk accompanying longer periods of use. It is also important to note that this protective effect seems to persist for 15 years after the last OC use since there is an increased incidence of this disease in older women.

Although ovarian cancer is responsible for more deaths than any other gynecologic cancers, endometrial cancer represents the most common gynecologic cancer affecting over 34,000 women in the United States each year. The risk of developing endometrial cancer is reduced by approximately 50% in anyone who has used an OC for 12 months or longer. As with ovarian cancer the protective effect increases with longer use and persists for up to 15 years after discontinuing use of OCs. Again this lasting effect is important since most endometrial cancers occur in women over 50 years of age.

A reduced incidence of benign breast lumps - including both fibrocystic lumps and fibroadenomas - is among the most consistently demonstrated benefits of OC use. Such benign breast disease often results in cyclic pain in the breasts and may necessitate repeated cyst aspiration or biopsy to ensure that a cancer is not missed.

Salpingitis and pelvic inflammatory disease (PID) are generally the result of sexually transmitted infections which ascend from the cervix and vagina through the uterus and fallopian tubes and into the pelvis. The protective effect of OCs is felt to be a result of changes in the cervical mucous which make it less penetrable by bacteria. Protection is most notable in women using OCs for at least 1 year, in whom the risk was reduced by 70%. Along with a 50% reduction in the number of hospitalizations for the treatment of the infection itself, there is also a reduction in long-term sequelae to pelvic infections including infertility and increased risk of ectopic pregnancy because of tubal damage.

By inhibiting ovulation, OCs protect against ectopic pregnancy. The incidence of ectopic pregnancy has risen dramatically over the past 25 years presumably due to the spread of sexually transmitted infections like Chlamydia and Gonorrhea. When an ectopic pregnancy occurs, the result is often a reduction in fertility through loss or permanent damage to the affected fallopian tube. In more severe cases, rupture of an ectopic pregnancy may lead to internal hemorrhage and death. Use of OCs reduces the incidence of ectopic pregnancy by 90%.

Dysmenorrhea (painful menstruation) is generally improved through the use of OCs This effect may particularly benefit teenage patients, among whom dysmenorrhea is a very common complaint. Approximately 60% of adolescents report dysmenorrhea, and of those, 14% missed school as a result.

Most women who have taken an OC will attest that the menstrual flow is generally lighter when they are on the pill than when they are not. This decreased menstrual blood loss reduces the risk of developing iron-deficiency anemia. Obviously, this is a much more important effect in women who have prolonged or extremely heavy periods from the start.

Osteoporosis refers to a decrease in bone density which commonly affects postmenopausal women and commonly leads to fractures of the hip and spine. As women who have had the opportunity to use OCs are just now entering the postmenopausal years, it will be several years before this question is answered. However, at east two early studies have shown that prior use of OCs is associated with greater bone density in postmenopausal women and that the degree of protection against osteoporosis is related to the degree of exposure to OCs.

One recent study found a 40% reduction in risk of cancers of the lower gastrointestinal tract among women who had ever used OCs, and a 50% reduction in women who had used OCs for 2 or more years. Although several studies have found similar protection with OC use, others have not. Further research is needed.

Uterine fibroids are common benign tumors of the uterine wall which can be associated with symptoms of pelvic pressure or irregular or heavy menstruation. A large English study found a 30% reduced risk of uterine fibroids in OC users. Unfortunately, a large Italian study found no effect.

Several studies performed in the 1980s reported an overall 50% reduction in toxic shock syndrome on OC users. However, two more recent studies failed to demonstrate such an effect of OCs.

Two studies performed before 1982, showed a 40-50% reduction in risk of developing rheumatoid arthritis in OC users. Since then, 12 studies have yielded conflicting results.

Are OCs the wonder drugs of the 1990s? Perhaps. Perhaps not, but neither should they be feared because of undue media emphasis on adverse effects of the pill. Clearly the benefits described above far outweigh any possible increase in risk of breast cancer (the most recent media concern) that might be seen in OC users. In fact, studies to date have shown no overall increased risk of breast cancer for women taking OCs up to age 55 and no increased risk for women on OCs with a family history of breast cancer or a history of benign breast disease.

Oral contraceptives are associated with a collection of effects which lead to an overall improvement in individual health. To date, they have rarely been prescribed for their non-contraceptive benefits alone, but it is not difficult to imagine a broader spectrum of usage in the next decade.

Walter J. Hodges Jr., M.D., F.A.C.O.G.