Current controversies and future direction of oral contraception

Despite their general use for more than 30 years there is ongoing controversy within the medical community and the lay press about the safety of oral contraceptive pills (OCPs). Cervical cancer and breast cancer continue to dominate as controversial issues. Presently, many experts agree that OCPs may accelerate the growth of early breast cancer in certain subgroups of younger women, e.g. with initiation at an early age, before the first pregnancy, when used long term. They do not agree on the profile of the woman at risk, whether this risk continues with older women, and whether the risk is of such significance for certain women that they should not take OCPs. Resolution of issues about risks of dysplasia and invasive cervical cancer will be difficult because of the many variables contributing to causation. It is more of a problem in areas of the world where routine Papanicolaou smears are not available. Controversy continues as to which of the new progestins, norgestimate, desogestrel, or gestodene offers the greatest advantages to OCP users. This is particularly true in the case of gestodene. Only further research will elucidate such questions. There is significant disagreement as to the root causes of high user failure rates with OCPs and how to remedy these. Some experts believe that making OCPs available off prescription and without direct medical supervision is the way to proceed, although other strongly disagree, citing the need to require regular Papanicolaou smears and check-ups to rule out sexually transmitted diseases.(ABSTRACT TRUNCATED AT 250 WORDS)