OCs--Update on Usage, Safety, and Side Effects
At this time, oral contraceptives (OCs) are the most popular reversible method of contraception in the world. Marketing statistics gathered from at least 31 countries show that about 325 million cycles of OCs were sold in 1977. This quantity of pills would supply 25 million women for a 1-year period; about 21 million of these women are in developed countries with 4 million in developing nations. Sales are increasing rapidly in Asia and Latin America, while they are leveling off or declining somewhat in Western Europe and the U.S. National family planning programs in developing countries provide OCs on a free or subsidized basis to about 9 million women (excluding the People's Republic of China). It is estimated that about 54 million women throughout the world were using OCs in 1977. Regarding OC safety, data from 3 major cohort studies in Britain and the U.S. provide new information on the relationships between OC use and circulatory system disease. A study of 46,000 British women by the Royal College of General Practitioners found that: 1) OC users experienced higher death rates from circulatory system disease than women who had never used OCs; 2) OC users faced a greater range of circulatory diseases than was originally suspected, including arterial and venous disorders; 3) women who used OCs for 5 years or longer faced a 10-fold greater risk of death from circulatory disease than women who never used the OC; and 4) these risks do not apply to all women equally -- women over age 35 and women who smoke face the greatest risks. WHO researchers have found that improving death rate trends for women aged 35-44 were associated with trends of increasing OC usage. No definitive new data are available regarding OC use and cancer. Investigations of other possible side effects have revealed no substantial new risks associated with OC use. Virtually all the data on serious side effects of OCs come from developed countries. The risks of using OCs are outweighed in the developing countries by the greater risks of pregnancy and childbirth.