Treatment of perimenopausal changes aOnly the low-dose EE/droperidol oral contraceptive has U.S. Food and Drug Administration approval for premenstrual dysphoric disorder treatment. From Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. Am J Obstet Gynecol 2004;190(Suppl):S12, with permission.
All combination OCs offer some protection from functional ovarian cysts, but this is dose related (190). Although OCs may prevent cyst formation, they are not helpful in treating large functional ovarian cysts and should not be used for this purpose (191). OCs appear to decrease the risk of developing leiomyomata (192).
All combination OCs reduce circulating androgen levels and usually improve acne. Three OCs were specifically FDA approved for acne treatment: the norgestimate/EE triphasic (TriCyclen), the norethindrone/EE multiphasic (Estrostep), and the 20 μg EE /3 mg droperidol OC.
There is some evidence that OC use is protective against colon cancer. A case-control study in Italy comparing women with colon cancer with controls found a 37% reduction in colon cancer and a 34% reduction in rectal cancer (colon cancer OR, 0.63; 95% CI, 0.45–0.87 and rectal cancer OR, 0.66; 95% CI, 0.43–1.01). Longer use produced more protection against colon cancer (193). Results of the U.S. Nurses Health Study disclosed some degree of protection. Women who used OCs for 96 months or more had a 40% lower risk of colorectal cancer (RR, 0.60; 95% CI, 1.15–2.14) (194). A large case-control study from Wisconsin found most of the benefit limited to women who were less than 14 years since discontinuing OCs (195). The mechanism of protection has not been identified.
After discontinuing OCs, return of ovulatory cycles may be delayed for a few months. Women who have amenorrhea more than 6 months after discontinuation of OCs should undergo a full evaluation because of the risk for prolactin-producing pituitary tumors.
This risk is not related to OC use but rather to the probability that the slow-growing tumor was already present and produced menstrual irregularity, prompting the patient to take OCs (196).
Sexuality In a study that recorded all episodes of female-initiated sexual behavior throughout the menstrual cycle, an increase in sexual activity at the time of ovulation was noted. This increase was not present in women who were taking OCs (197). No other study appears to have addressed female initiated sexual activity and OC use. A 2003 study from Spain studied sexual desire in a comparative cohort of women using OCs and a cohort using IUDs. Sexual desire decreased over time, but was not affected by the contraceptive method (198). OCs containing the new progestin drospirenone are reported to improve sexual functioning and feelings of well-being (199,200).