Health benefits of combined oral contraceptives – a narrative review

Abstract

Purpose

This review presents an update of the non-contraceptive health benefits of the combined oral contraceptive pill.

Methods

We conducted a literature search for (review) articles that discussed the health benefits of combined oral contraceptives (COCs), in the period from 1980 to 2023.

Results

We identified 21 subjective and/or objective health benefits of COCs related to (i) the reproductive tract, (ii) non-gynaecological benign disorders and (iii) malignancies. Reproductive tract benefits are related to menstrual bleeding(including anaemia and toxic shock syndrome), dysmenorrhoea, migraine, premenstrual syndrome (PMS), ovarian cysts, Polycystic Ovary Syndrome (PCOS), androgen related symptoms, ectopic pregnancy, hypoestrogenism, endometriosis and adenomyosis, uterine fibroids and pelvic inflammatory disease (PID). Non-gynaecological benefits are related to benign breast disease, osteoporosis, rheumatoid arthritis, multiple sclerosis, asthma and porphyria. Health benefits of COCs related to cancer are lower risks of endometrial cancer, ovarian cancer and colorectal cancer.

Conclusions

The use of combined oral contraceptives is accompanied with a range of health benefits, to be balanced against its side-effects and risks. Several health benefits of COCs are a reason for non-contraceptive COC prescription.

摘要

目的

本综述介绍了口服避孕药的非避孕健康益处的最新进展。

方法

我们对1980年至2023年期间讨论复方口服避孕药(COCs)的健康益处的文章进行了文献检索。

结果

我们确定了21种COC的主观和/或客观健康益处, 涉及(i)生殖道, (ii)非妇科良性疾病和(iii)恶性肿瘤。生殖道受益与月经出血(包括贫血和中毒性休克综合征)、痛经、偏头痛、经前综合征(PMS)、卵巢囊肿、多囊卵巢综合征(PCOS)、雄激素相关症状、异位妊娠、低雌激素、子宫内膜异位症和子宫腺肌症、子宫肌瘤和盆腔炎(PID)有关。非妇科益处与良性乳腺疾病、骨质疏松症、类风湿性关节炎、多发性硬化症、哮喘和门静脉症有关。COCs与抗肿瘤相关的健康益处包括降低子宫内膜癌、卵巢癌和结直肠癌的风险。

结论

复方口服避孕药的应用有一系列的健康益处, 需要平衡其副作用和风险。COC的几个健康益处是COC用于非避孕处方的原因。

缩写

HB: 健康益处；BMD: 骨密度；CBC: 慢性囊性乳房疾病；COC: 复方口服避孕药；COC_S: 复方口服避孕药；COCP: 联合口服避孕药片；DRSP: 屈螺酮；EDSS: 扩展残疾状态量表；EE: 炔雌醇；E2: 雌二醇；E4: 雌四醇；FA: 纤维腺瘤；GnRH: 促性腺激素释放激素；HMB: 月经大出血；HRT: 激素替代治疗；IDA: 缺铁性贫血；IUD: 宫内节育器；LMIC: 低等和中等收入国家；LNG: 左炔诺孕酮；MoA: 行为模式；MS: 多发性硬化；PCOS: 多囊卵巢综合征；PID: 盆腔炎；PMS: 经前综合征；P-only: 仅含孕激素的避孕药；RA: 类风湿性关节炎；TSS: 中毒性休克综合征；VTE: 静脉血栓栓塞症

Keywords:

• Combined oral contraception (COC)
• combined oral contraceptives (COCs)
• combined oral contraceptive pill (COCP)
• reproductive tract disorders
• ovarian and endocrine symptoms
• non-gynaecological disorders
• endometrial
• ovarian and colorectal cancer

Acknowledgements

Amanda Prowse (at Terminal 4 Communications, Hilversum, The Netherlands) is acknowledged for her contribution to the preparation of the manuscript.

Author’s roles

HJTCB and FAMvG developed the concept and design of the review. HJTCB, FAMvG, MGFG and JFME collected and interpreted the data, and prepared the manuscript. All authors were responsible for critical revision of the manuscript, further interpretation of the data, and the concluding remarks. All authors gave final approval of the version to be submitted. HJTCB, FAMvG, KG-D and HK-K are experienced physicians and gynaecologists with long term experience in prescribing the pill and counselling women using COCs.

Data availability

The data underlying this article are available in the article and in its online supplementary material.

Disclosure statement

HJTCB is President of Pantarhei Bioscience, the company that developed estetrol as oestrogen component for oral combined contraceptive (COC), but this is outside the scope of the present review. In addition, Pantarhei studied the effects of comedication of a COC and dehydroepiandrosterone (androgen-restored contraception). The other authors have nothing to disclose.

Additional information

Funding

The authors thank Gedeon Richter Benelux for their unrestricted grant to support the writing process of the current review.