A practical guide for prescribing birth control pills
Abrams, J.
New Jersey Medicine 91(6): 393-395
1994
ISSN/ISBN: 0885-842X PMID: 8047304 Document Number: 427658
More than 50 million US women have used oral contraceptives (OCs) in the past 25 years, and the consensus is that the benefits and advantages of OC use outweigh most of the disadvantages. Side effects have been reduced or eliminated by reduced dosage preparations, and effectiveness has been virtually 100%. Despite this widespread use, most US women are misinformed about OCs, perhaps because pediatricians, family physicians, and nurse-practitioners are insufficiently informed. The economic power of the drug manufacturers has been brought to bear on the medical profession to prescribe OCs for virtually every woman of child-bearing age. The drug industry which has been touting the safety of OCs has recently introduced new progestins which are supposed to be "lipid-neutral" and have fewer androgenic effects. Therefore, the potentially harmful effects of the old progestins were deemphasized deliberately. A cautious but advisable approach for physicians to follow in prescribing OCs has 8 points. 1) All sexually active females should be advised that barrier contraception is the best protection (except abstinence) from sexually transmitted diseases, including AIDS. 2) OCs with more than 35 mcg estrogen should be withdrawn from the market. 3) All patients should be encouraged to lead a healthy lifestyle. 4) Barrier methods should be encouraged for patients with such medical conditions as migraine headaches, prominent varicose veins, diabetes, increasing weight gain, hypertension, thyroid dysfunction, and mitral valve prolapse. 5) Switching to a preparation with the new progestins should be considered for some patients who are smokers or have abnormal lipid profiles. 6) It might be advantageous under certain circumstances for a patient to discontinue OC use for a period of time. 7) Women who no longer desire a pregnancy should be encouraged to consider surgical sterilization. 8) Nulliparous women over 30 years old should discontinue OC use to diminish their risk of breast cancer. This last point is controversial, and the editors of this publication invite the readers' comments.