THE COMBINED ORAL-CONTRACEPTIVE - RISKS AND ADVERSE-EFFECTS IN PERSPECTIVE

The risks and adverse effects of the low dose, new generation progesto gen combined oral contraceptives (COCs) are much lower than original s tudies involving pills containing 50 mu g estrogen. The main effects a re those on the cardiovascular system, lipid and glucose metabolism an d cancer. Any effect of the COC on myocardial infarction is probably m inimal if the woman has no other risk factors especially smoking. The third generation progestogen, low dose COCs have very little effect on lipid or glucose metabolism. There may be a slight increase in breast cancer if COCs are used under the age of 25 years and for more than 4 to 8 years, and in the risk of cervical cancer. It is too early to es timate long term cancer effects of the newer COCs. Adverse effects suc h as nausea and breast tenderness can be managed by changing the estro gen dose or the type of progestogen. Overall, the clinical benefits of the COC probably outweigh the risks and adverse effects.