OBJECTIVES: To estimate the overall balance of harms and benefits from the potential use of oral contraceptives (OCs) for the primary prevention of ovarian cancer DATA SOURCES: We searched PubMed(R) Embase(R) the Cochrane Database of Systematic Reviews and ClinicalTrials.gov for English-language studies published from January 1990 to June 2012 that evaluated the potential benefits (reduction in ovarian colorectal and endometrial cancers) and harms (increase in breast and cervical cancer and vascular complications) of OC use. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion; the investigators abstracted data and they performed quality ratings applicability ratings and evidence grading. Random-effects models were used to compute summary estimates of effects. A simulation model was used to estimate the effects of OC use on the overall balance of benefits and harms. RESULTS: We reviewed 55 studies relevant to ovarian cancer outcomes 66 relevant to other cancers and 50 relevant to vascular events. Ovarian cancer incidence was significantly reduced in OC users (OR [odds ratio] 0.73; 95% CI [confidence interval] 0.66 to 0.81) with greater reductions seen with longer duration of use. Breast cancer incidence was slightly but significantly increased in OC users (OR 1.08; 95% CI 1.00 to 1.17) with a significant reduction in risk as time since last use increased. The risk of cervical cancer was significantly increased in women with persistent human papillomavirus infection who used OCs but heterogeneity prevented a formal meta-analysis. Incidences of both colorectal cancer (OR 0.86; 95% CI 0.79 to 0.95) and endometrial cancer (OR 0.57; 95% CI 0.43 to 0.76) were significantly reduced by OC use. The risk of vascular events was increased in current OC users compared with nonusers although the increase in myocardial infarction was not statistically significant. The overall strength of evidence for ovarian cancer prevention was moderate to low primarily because of the lack of randomized trials and inconsistent reporting of important characteristics of use such as duration. The simulation model predicted that the combined increase in risk of breast and cervical cancers and vascular events was likely to be equivalent to or greater than the decreased risk in ovarian cancer although the harm/benefit ratio was much more favorable when protection against endometrial and colorectal cancers was added resulting in net gains in life expectancy of approximately 1 month. CONCLUSIONS: There is insufficient evidence to recommend for or against the use of OCs solely for the primary prevention of ovarian cancer. Although the net effects of the current patterns of OC use likely result in increased life expectancy when other noncontraceptive benefits are included the harm/benefit ratio for ovarian cancer prevention alone is uncertain particularly when the potential quality-of-life impact of breast cancer and vascular events are considered.

Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer

Study selection Randomised controlled trials that evaluated non-surgical interventions for non-pregnant women with irregular or abnormal cyclic uterine bleeding for three months or more were eligible for inclusion. Studies of women with polycystic ovarian syndrome were included with studies of irregular bleeding as long as the patient baseline and outcome data included information regarding cycle regularity. Studies of women with abnormal uterine bleeding caused by coagulation defects, systemic disease, structural abnormalities, cancer, medication side-effects or infertility (with a primary treatment goal of conception) were excluded. Outcomes of interest included bleeding profile, quality of life, pain, sexual function and patient satisfaction with treatment outcomes. For evidence of harms, observational studies with at least 1,600 participants/records were included.

Primary care management of abnormal uterine bleeding

Use of Medications in Arab Countries

Since the development of combined oral contraceptives over 50 years ago, significant innovations have occurred in the domain of the progestin. Evolving knowledge of progestin mechanism of action and physiology has allowed for development of novel progestins with limited steroid receptor cross-reactivity, decreased side effect profiles, and pharmacokinetics optimized for modern delivery systems. This review summarizes current knowledge of progestin physiology, modern delivery systems, and developments of progestin agonists and antagonists for contraception.

Progestins for Contraception : Modern Delivery Systems and Novel Formulations

Considerable advances have been made in the field of combined oral contraceptives since their introduction 50 years ago. This ongoing evolution has been focused on reducing the estrogen dose and synthesizing new progestogens. A recently launched combination of ethinylestradiol 20 µg and drospirenone 3 mg demonstrates the advantages of a lower estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drug's significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. In addition to the drug's contraceptive efficacy, its effects on the skin and other classic noncontraceptive benefits, the ethinylestradiol 20 µg and drospirenone 3 mg combination has demonstrated highly satisfactory results in women with premenstrual dysphoric syndrome.

https://journals.sagepub.com/doi/pdf/10.2217/WHE.10.84

Drospirenone/ethinylestradiol: a review on efficacy and noncontraceptive benefits.

Bleeding pattern tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe the Middle East and Canada.

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Bleeding pattern tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe the Middle East and Canada.