A recent press release from the American College of Obstetricians and Gynecologists announces that Hormonal Contraceptives Offer Benefits Beyond Pregnancy Prevention. This is in the same vein as similar articles published over the years about “non-contraceptive benefits of the pill” – a laundry list of the many benefits women may obtain by using hormonal contraception. It’s not clear how they should be used by practicing obgyn’s. One use is certainly as additional talking points to convince women who are cautious or reluctant to replace their body’s own menstrual physiology with a pharmaceutical product.

I haven’t been able to read the full document (for some reason my university access seems to only find the first page of the full document), but it appears that, like previous reviews I have read, it is a biased list, including benefits but not risks. Perhaps what is most in common is the sense that a spontaneous menstrual cycle is somehow suspect, that fluctuations over time are unnatural, and that pharmaceutical control is a good solution.

I can understand why the pharmaceutical industry might want to publish a long list of off-label uses (although they would be quickly stopped by the US’s FDA and regulatory bodies in other countries). But it is a curious thing to find a professional group extolling the many off-label benefits of a class of pharmaceutical drugs. Do cardiologists publish practice bulletins about the non-cardiovascular benefits of statins?

There are other perspectives about how one might treat painful periods or heavy menstrual flow. The published Cochrane Reviews (well-respected summaries of published studies) about cramps suggest that the evidence for non-steroidal anti-inflammatories (NSAIDS, such as ibuprofen) is more solid and clear than that for combined oral contraceptives, and that, to date, no studies have compared them head-to-head. Moreover, NSAIDs also have been shown to reduce menstrual flow.

The press release notes the protective effects against endometrial, ovarian and colorectal cancer, but fails to note the increased risk of sexually transmitted infections. Being on the pill is the most important risk factor for not using condoms.

And when absent or long periods occur, inducing regular and predictable flow will reduce the risk of endometrial cancer, but otherwise primarily serves to mask the underlying issue. In that case, going on the pill can be like hitting snooze on your smoke alarm.


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