Noncontraceptive benefits of oral contraceptive use: an evidence-based approach

Numerous noncontraceptive benefits of oral contraceptive (OC) use have been identified. These include a reduction in ovarian and endometrial cancers, functional ovarian cysts, pelvic inflammatory disease, benign breast disease, iron-deficiency, menstrual disorders, dysmenorrhea, bone loss, and acne. The best "evidence" is in the area of cancer prevention, maintenance of bone mineral density (BMD) and the treatment of acne vulgaris. Based on the body of evidence available today, several evidence-based clinical recommendations can be made regarding BMD. In young, reproductive-age women with a hypoestrogenic condition, there is a protective effect on BMD with OC use. In older reproductive-age women with declining ovarian function, there is also a protective effect on BMD with OC use. With long-term use of OCs (greater than 5 years) protection increases with increasing duration of use. There is a high degree of biologic plausibility for the beneficial effect of OC use on states associated with androgen excess, such as acne. Two randomized, placebo-controlled, multicenter clinical trials of a triphasic norgestimate-containing OC were published. Using evidence-based criteria, there is strong evidence that this OC effectively treats acne vulgaris. As further experimental and observational studies are completed, they should substantiate many of the other known benefits; thus, further evidence-based recommendations will be possible.