Is the oral contraceptive (OC) pill a good long-term option?

From the Guidelines

The oral contraceptive pill can be a good long-term option for many women, depending on individual health factors and preferences, as it offers benefits such as reduced menstrual pain, lighter periods, improved acne, and decreased risk of ovarian and endometrial cancers, with an effectiveness rate of about 93% with typical use, improving to 99% with perfect use 1. When considering the use of oral contraceptives as a long-term option, it is essential to evaluate individual health factors and preferences. Most combined oral contraceptives contain ethinyl estradiol (20-35 mcg) plus a progestin, while progestin-only pills contain just one hormone. These pills can be safely used for many years or even decades by healthy non-smoking women under 35, with no mandatory "breaks" needed. Some of the key benefits of oral contraceptives include:

• Reduced menstrual pain
• Lighter periods
• Improved acne
• Decreased risk of ovarian and endometrial cancers However, they don't protect against STIs and may have side effects like nausea, breakthrough bleeding, or mood changes. Some women should avoid combined pills due to risk factors like smoking after age 35, history of blood clots, certain cancers, or uncontrolled high blood pressure, as stated in the U.S. Medical Eligibility Criteria for Contraceptive Use 1. Regular check-ups with a healthcare provider are crucial to monitor for any issues and ensure the pill remains appropriate as your health needs change over time, considering the risks associated with continuing contraception, such as acute cardiovascular events or breast cancer, especially for women over 45 years old 1.

From the FDA Drug Label

The effect of long-term use of the oral contraceptives with lower formulations of both estrogens and progestogens remains to be determined There are two studies which have shown persistence of risk of vascular disease for ever-users of oral contraceptives In a study in the United States, the risk of developing myocardial infarction after discontinuing oral contraceptives persists for at least 9 years for women 40–49 years who had used oral contraceptives for five or more years, but this increased risk was not demonstrated in other age groups. The Committee concluded that although cardiovascular disease risks may be increased with oral contraceptive use after age 40 in healthy non-smoking women (even with the newer low-dose formulations), there are also greater potential health risks associated with pregnancy in older women and with the alternative surgical and medical procedures which may be necessary if such women do not have access to effective and acceptable means of contraception.

The oral contraceptive (OC) pill may not be a good long-term option for all women, particularly those over 40 years old or with underlying risk factors, due to the potential increased risk of cardiovascular disease and vascular disease. The risk of myocardial infarction and thromboembolic disease may persist for several years after discontinuing oral contraceptives. However, the benefits of low-dose oral contraceptive use by healthy non-smoking women over 40 may outweigh the possible risks 2, 2, 2. Key considerations for long-term use include:

• Age: Women over 40 years old may be at increased risk of cardiovascular disease
• Smoking status: Smokers may be at increased risk of cardiovascular disease and thromboembolic disease
• Underlying risk factors: Women with hypertension, hyperlipidemias, obesity, and diabetes may be at increased risk of cardiovascular disease
• Dose and formulation: Lower-dose formulations with minimal androgenic activity may be preferred to minimize exposure to estrogen and progestogen.

From the Research

Long-Term Use of Oral Contraceptives

The oral contraceptive (OC) pill can be a good long-term option for many women, depending on their individual health status and risk factors.

• Studies have shown that OCs are a reliable and convenient method of birth control, with a low risk of cardiovascular disease and stroke in women without other risk factors 3.
• However, the risk of thromboembolic disease is related to the estrogen dose, and women who smoke are at higher risk 3, 4.
• Progestin-only pills are a safer option regarding thrombotic and vascular complications, and are recommended for women with a history of hypertension or thrombosis 4.
• OCs have been shown to protect against endometrial and ovarian cancer, and the risk of breast cancer is only minimally increased among current OC users 3, 5.

Age Considerations

• Women over 35 can safely use OCs, especially in the absence of other risk factors 3, 6.
• The risk of thromboembolism increases with age, and the lowest available dose of ethinyl-estradiol should be prescribed for women over 40 6.
• Progestogen-only pills are a good option for perimenopausal women, but may have an unpredictable bleeding pattern 6.

Individualization of OCs

• The choice of OC should be individualized based on a woman's medical history, risk factors, and personal preferences 5, 7.
• Low-dose pills with minimal doses of progesterones and estrogens can provide good control of the menstrual cycle and reduce side effects 7.
• The type of progesterone used can affect the risk of side effects, and drospirenone has antiandrogenic and antimineralcorticoid activity that can help prevent water retention and weight gain 7.