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A practise bulletin issued by the American College of Obstetricians and Gynecologists (ACOG) and published in the January 2010 issue of the medical journal Obstetrics & Gynecology aims to remind women and medical practitioners that benefits of the pill and other forms of hormonal contraception extend beyond the primary purpose of pregnancy prevention.

During their reproductive years, more than 80% of women in the United States use some form of hormonal contraception, such as oral contraceptive (OC) pills, patches, single-rod progestin such as Implanon and other implants, injections (such as Depo-Provera), vaginal rings (such as Nuvaring), and the intrauterine device (such as Mirena). In addition to preventing unplanned pregnancies, hormonal contraceptives are used off-label to effectively treat menstrual disorders including dysmenorrhoea (painful periods) and menorrhagia (heavy periods).

Up to 90% of young women report painful periods, which is one of the leading causes of school and work absenteeism among women. If left untreated, menorrhagia (heavy periods) can cause anaemia. Approximately three quarters of women with dysmenorrhoea (painful periods) respond favourably to combined oral contraceptive pill treatment, and the vaginal ring may be equally effective.

Heavy and/or painful periods

The most cost-effective treatment strategy for menorrhagia may be combined pill use for 1 year, followed by use of a levonorgestrel intrauterine device (Mirena). The levonorgestrel intrauterine system appears to be better than cyclical progestogen tablets (such as Norethisterone) for the treatment of heavy bleeding. Cyclic combined Pill decrease menstrual blood loss by 40% to 50%, or even more, for extended-cycle (84-day) preparations. However, extended-cycle preparations may cause higher rates of spotting.

The Pill and PMT

Some evidence suggests that the combination of ethinyl estradiol ( an estrogen)plus drospirenone (a progestogen) may reduce symptoms of premenstrual dysphoric disorder (commonly known as PMT). Yasmin is the best known Pill brand with this combination.

The Pill and reduced risk of cancer

Use of combined contYasmin may help with PMTraceptives containing both estrogen and progesterone is associated with a lower risk for the development of endometrial cancer (50% reduction in risk vs never-use), ovarian cancer (27% decrease in risk), and colorectal cancers. Studies to date suggest that longer duration of OC use is linked to a decreased risk for the development of endometrial and ovarian cancer for up to 20 years after discontinuing use. Current or recent use of oral contraception also may protect against colorectal cancer in the short term (18% decrease in risk).

The Pill and symptoms of Polycystic Ovaries

In addition, combined contraceptives block androgen production and may therefore reduce hirsutism and acne. Contraceptives containing drospirenone or cyproterone acetate may be most effective for treatment of hirsutism, but all combined contraceptives appear to be similarly effective against acne.

Cautions for the Pill

Hormonal contraceptives may also be of theoretic or actual benefit in preventing menstrual migraines, treating pelvic pain caused by endometriosis, and treating bleeding from uterine fibroids. Extended-cycle or continuous hormonal contraception may reduce the frequency of menstrual migraine, but combined OCs have been associated with possible increased stroke risk in women with migraine who are 35 years or older, who smoke, or who have focal neurologic signs. Combined OCs should therefore be avoided in these women.

"Combined oral contraceptives are effective in normalizing irregular periods, reducing symptoms of premenstrual dysphoric disorder (PMT), improving acne, and allowing women to avoid having their period at inconvenient times, such as during a business trip, vacation, or honeymoon," Dr. Reid said. "Although there is little data on the newer forms of hormonal contraception in terms of their off-label benefits, experts suggest that they may be as effective as the more studied ones in treating the same conditions."

Specific recommendations, based on good, consistent scientific evidence (level A), are as follows:

Specific recommendations based on limited or inconsistent scientific evidence (level B), are as follows:

A performance measure proposed by the ACOG is the percentage of women wishing to preserve reproductive potential who are using hormonal contraception to treat symptoms of menorrhagia (heavy periods) and/or dysmenorrhoea (painful periods) , provided they have no contraindications to use of hormonal contraception. Contraindications for combined pill use will include a personal or strong family history of thrombosis.

Why the Pill may be better for your health than you realise

By Dr Joe Kabyemela, MD