Peck, R., & Norris, C. W. (2012). Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate. The Linacre Quarterly, 79(1), 41-56. https://doi.org/10.1179/002436312803571447
Peck R, Norris CW. Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate. Linacre Q. 2012;79(1):41-56. doi:10.1179/002436312803571447
Peck, R., and C. W. Norris. "Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate." The Linacre Quarterly, vol. 79, no. 1, 2012, pp. 41-56.
Oral contraceptives raise clot and cancer risk, two physicians argue
A narrative review by two physicians argues that oral contraceptives raise the risk of blood clots, breast cancer and cervical cancer. The authors gathered studies reporting harm and left out research backing the pills. Their summary covers clots, stroke, heart attack and two cancers.
Key Findings
The authors report a three to five times higher clot risk, called venous thromboembolism (VTE), associated with oral contraceptive use.
In a Danish comparison with levonorgestrel pills at the same estrogen dose, the rate ratio for clots was 1.82 with desogestrel, 1.86 with gestodene and 1.64 with drospirenone.
A meta-analysis of fifty-four epidemiological studies (53,297 women with breast cancer, 100,239 controls) found a relative risk of 1.24 in current users and 1.95 for use before age twenty.
A meta-analysis of thirty-four case-control studies found an odds ratio of 1.19 for premenopausal breast cancer, 1.44 with use before a first full-term pregnancy, and 1.52 beyond four years of use.
In more developed countries, a 2007 Lancet reanalysis estimated that ten years of use from around age twenty to thirty raises invasive cervical cancer incidence by age fifty from 3.8/1,000 to 4.5/1,000.
Interpretation
The paper is a narrative review and position statement. The authors chose to cover research on harm and skipped research on benefits, other side effects and liver tumors. The studies they cite are case-control studies, cohorts and meta-analyses, so the figures describe association. The authors themselves write that the breast cancer question needs randomized controlled trials. They also note that estrogen doses have fallen since the 1960s and that clot risk differs by progestin type.
RRM Context
Oral contraceptives are suppressive medications. They suppress ovulation, which the authors call a normal body process. Restorative Reproductive Medicine reads the ovulatory cycle as a vital sign and looks for the underlying cause of cycle symptoms. Suppression hides symptoms very well while disease can progress.
Our editorial summary of this paper, not the article's abstract.
Abstract
Pregnancy is not a disease. But more fundamentally, neither is human fertility. They are normal physiologic processes of the sexually mature person. By classifying pregnancy and fertility as disease states, certain entities are able to position contraception as "the cure." Currently, these same organizations want to include oral contraceptive counseling and medications in the new national health-care plan under a preventive care mandate. But it is the physician's role to counsel patients on preventive care measures. We understand that these evidenced-based screenings help to change risky behaviors and catch disease in its earliest stages, thereby reducing patients' overall morbidity and mortality. However, we believe that patients incur substantial health risks when choosing oral contraceptives (OCPs). This paper reviews the major risks of OCPs. The authors presume that the prevailing widespread acceptance and promotion of OCPs indicates general agreement within the medical community that OCPs are good for the patient (or at least not significantly harmful). Therefore, this paper concentrates on the studies which show increased harm and risk to the patient choosing to use OCPs. We have concentrated our efforts on three major areas: increased rates of cardiovascular disease, breast cancer, and human papillomavirus (HPV) or cervical cancer. If fertility and pregnancy are not disease states, and are, in fact, normal conditions associated with healthy individuals, OCPs fail the most important test of preventive medicine: they increase risk of disease instead of decreasing it. Patients should not be misled or confused into believing that what they are taking is "good for them" and is of the same beneficial effect as other preventive measures.
Peck R et al., 2016·Linacre Q·Free full text on PubMed Central
Recent studies have identified that levonorgestrel administered orally in emergency contraception (LNG-EC) is only efficacious when taken before ovulation. However, the drug does not consistently prevent follicular rupture or impair sperm function. The present systematic review is performed to analyze and more precisely define the extent to which pre-fertilization mechanisms of action may explain the drug's efficacy in pregnancy avoidance. We also examine the available evidence to determine if pre-ovulatory drug administration may be associated with post-fertilization effects. The mechanism of action of LNG-EC is reviewed. The drug has no ability to alter sperm function at doses used in vivo and has limited ability to suppress ovulation. Our analysis estimates that the drug's ovulatory inhibition potential could prevent less than 15 percent of potential conceptions, thus making a pre-fertilization mechanism of action significantly less likely than previously thought. Luteal effects (such as decreased progesterone, altered glycodelin levels, and shortened luteal phase) present in the literature may suggest a pre-ovulatory induced post-fertilization drug effect. Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA). The drug was originally thought to work by preventing fertilization. Recent research has cast doubt on this. Our review of the research suggests that it could act in a pre-fertilization capacity, and we estimate that it could prevent ovulation in only 15 percent or less of cases. The drug has no ability to alter sperm function and limited ability to suppress ovulation. Further, data suggest that when administered pre-ovulation, it may have a post-fertilization MOA.
Kahlenborn C et al., 2015·Linacre Q·Free full text on PubMed Central
There has been much debate regarding levonorgestrel emergency contraception's (LNG-EC's) method of action since 1999 when the Food and Drug Administration first approved its use. Proponents of LNG-EC have argued that they have moral certitude that LNG-EC works via a non-abortifacient mechanism of action, and claim that all the major scientific and medical data consistently support this hypothesis. However, newer medical data serve to undermine the consistency of the non-abortifacient hypothesis and instead support the hypothesis that preovulatory administration of LNG-EC has significant potential to work via abortion. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room protocols. In the future, technology such as the use of early pregnancy factor may have the potential to quantify how frequently preovulatory LNG-EC works via abortion. Lay How Plan B (levonorgestrel emergency contraception) works has been vigorously debated ever since the Food and Drug Administration approved it in 1999. Many doctors and researchers claim that it has either no-or at most-an extremely small chance of working via abortion. However, the latest scientific and medical evidence now demonstrates that levonorgestrel emergency contraception theoretically works via abortion quite often. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room rape protocols.
Since the introduction of hormonal contraceptives in the 1960s, there have been a variety of both health benefits and safety concerns attributed to their use. In most instances, the noncontraceptive benefits of oral contraceptives (OCs) outweigh the potential cardiovascular risks. In fact, the probability of a patient experiencing a cardiovascular event while taking a low-dose OC is very low. However, smoking, hypertension, obesity, and diabetes are risk factors that must be taken into account when prescribing OCs. The neoplastic effects of hormonal contraceptives have been extensively studied, and recent meta-analyses indicate that there is a reduction in the risk of endometrial and ovarian cancer, a possible small increase in the risk for breast and cervical cancer, and an increased risk of liver cancer. Finally, many women will experience noncontraceptive health benefits with OCs that expand far beyond pregnancy prevention. Some of these benefits include reduction in menstrual-related symptoms, fewer ectopic pregnancies, a possible increase in bone density, and possible protection against pelvic inflammatory disease.
Hunter DJ et al., 2010·Cancer Epidemiol Biomarkers Prev·Free full text on PubMed Central
Previous studies convincingly showed an increase in risk of breast cancer associated with current or recent use of oral contraceptives from the 1960s to 1980s. The relation of contemporary oral contraceptive formulations to breast cancer risk is less clear. We assessed lifetime oral contraceptive use and the specific formulations used among 116,608 female nurses ages 25 to 42 years at enrollment in 1989, and subsequently updated this information every 2 years. We related this information to risk of breast cancer up to June 1, 2001. During 1,246,967 person-years of follow-up, 1,344 cases of invasive breast cancer were diagnosed. Past use of any oral contraceptive was not related to breast cancer risk [multivariate relative risk (RR), 1.12; 95% confidence interval 0.95-1.33]. Current use of any oral contraceptive was related to a marginally significant higher risk (multivariate RR, 1.33; 95% CI, 1.03-1.73). One specific formulation substantially accounted for the excess risk: the RR for current use of triphasic preparations with levonorgestrel as the progestin was 3.05 (95% CI, 2.00-4.66; P < 0.0001). Current use of oral contraceptives carries an excess risk of breast cancer. Levonorgestrel used in triphasic preparations may account for much of this elevation in risk. Different oral contraceptive formulations might convey different risks of breast cancer; ongoing monitoring of these associations is necessary as oral contraceptive formulations change.
Zhu H et al., 2012·Eur J Contracept Reprod Health Care
It has been suggested that taking oral contraceptives (OCs) may increase breast cancer incidence. However, data in this regard are inconsistent. We performed this meta-analysis to estimate the association between OC use and breast cancer risk. Prospective cohort studies on OC use and breast cancer risk were identified by searching databases from the period 1960 to 2012. Results from individual studies were synthetically combined using STATA 11 software. A total of 13 prospective cohort studies were included in our meta-analysis, involving 11,722 cases and 859,894 participants. The combined relative risk (RR) of breast cancer for evercompared with never-OC users was 1.08 (95% confidence interval [CI]: 0.99-1.17). Dose-response analysis based on five eligible studies showed that every ten-years' increment of OC use was associated with a significant 14% (95% CI: 1.05-1.23) rise in breast cancer risk. Little evidence of publication bias was found. This meta-analysis provides evidence of a non-significant increase in breast cancer risk associated with ever OC use, but the risk for long-term OC users is significantly greater. However, the latter finding is based on only a limited number of studies.
Segarra I et al., 2023·Front Med (Lausanne)·Free full text on PubMed Central
Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.
Therapeutics › Hormonal Agents › Estrogen Preparations · Contraception › Oral Contraceptives › Cancer Risk · Ethics and Policy › Policy and Regulation › Access and Coverage Policy
Rebecca Peck, Charles W Norris
Becky Peck, R Peck, Charlie Norris, Chuck Norris, C Norris
PMID 30082959 30082959 DOI 10.1179/002436312803571447 10.1179/002436312803571447 Peck et al. 2012, Peck 2012
Cite this article
Peck, R., & Norris, C. W. (2012). Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate. The Linacre Quarterly, 79(1), 41-56. https://doi.org/10.1179/002436312803571447
Peck R, Norris CW. Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate. Linacre Q. 2012;79(1):41-56. doi:10.1179/002436312803571447
Peck, R., and C. W. Norris. "Significant Risks of Oral Contraceptives (OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate." The Linacre Quarterly, vol. 79, no. 1, 2012, pp. 41-56.
