Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Hormonal Contraception

The term hormonal contraception refers to birth control pills, the birth control patch, the birth control vaginal ring, and the progesterone only injection. Though these hormonal preparations are designed for contraception, they are also often used to treat menstrual periods that are heavy, painful, or irregular. The use of combination hormonal contraception is a safe option for women over the age of 35 who do not smoke. Use may be continued until menopause. Perimenopausal women can benefit from the use of hormonal contraception in several ways. First, of course, is the prevention of unintended pregnancy. Less obvious are the effects that these hormonal preparation have in regulating menstrual cycles and decreasing menopausal symptoms. Therefore, women who are not in need of contraception may still benefit from hormonal contraception because it may help ease the transition to menopause. In addition, hormonal contraception reduces the risk of uterine and ovarian cancer. Hormonal contraception is not recommended for women over the age of 35 whom smoke because of the increased of risk heart attack.

Many women avoid the use of hormonal contraception because of the fear of breast cancer. Women with a positive family history of breast cancer or of fibrocystic breast changes are not necessarily at increased risk. The majority of women with a family history of breast cancer can use hormonal contraception safely. Current users of contraception have a 1.24 relative risk of developing breast cancer. Ten years after discontinuing use, however, this risk becomes identical to those who have never used contraception. Interestingly, of those women who are diagnosed with breast cancer while using contraception, the survival rates are higher.

There are many medical conditions that must be considered when prescribing hormonal contraception. For example, contraception must be used cautiously in women with a history of migraine headaches because women with migraines are at increased risk of ischemic strokes. Though some women have improvement with their symptoms with use of hormonal contraception, some when can have worsening of symptoms and associated increase risk of stroke. Women with coronary heart disease, hypertension, diabetes, or atherosclerosis may not be good candidates for hormonal contraception. The decision must be based on review of laboratory values, medical history, and assessment of risks and benefits. Women with a history of a blood clot during pregnancy or related to use of hormones are not candidates for hormonal contraception. Women however who developed a blood clot as a result of trauma and prolonged immobilization (i.e. motor vehicle accident) are unlikely at increased risk for recurrence and may be candidates for hormonal contraception.

In closing, hormonal contraception is a useful tool for the management of many hormonally related disorders that women suffer. These preparations are becoming increasingly popular for the treatment of perimenopausal symptoms, fibroids, and heavy menstrual periods. Despite other co-existing illnesses, most women can use hormonal contraception safely. As with all medications, the decision to begin to use hormonal contraception must be individualized and based on the evaluation of the risk and benefits of therapy.