Oral contraceptives: an update

Oral contraceptives are used by large numbers of reproductive-aged women across the world. Recent data examining cardiovascular risk indicates a persistent risk for venous thromboembolism among all oral contraceptive users. This risk is enhanced by the presence of hemostatic disorders such as factor V Leiden. Whether the progestins gestodene and desogestrel also affect the risk of venous thromboembolism is controversial. Ischemic stroke is rare among users unless they smoke or have hypertension. Similarly, there appears to be no increased risk of hemorrhagic stroke among oral contraceptive users who do not have these risk factors present. Myocardial infarction is rare among oral contraceptive users. However, cigarette smoking coupled with age acts synergistically to substantially increase the risk of this disorder among oral contraceptive users. There is a small increase in risk of breast cancer among oral contraceptive users, although the risk disappears about 10 years after the last use of these preparations. Successful use of oral contraceptives appears to be significantly affected by side effects, understanding of the package insert and time of pill taking. Since serious sequelae are uncommon, improved compliance may be the most important challenge towards improving the use of oral contraceptives for the future.