The noncontraceptive benefits of oral contraception can be grouped into two main categories: benefits that incidentally accrue when oral contraception is specifically utilized for contraceptive purposes and benefits that result from the use of oral contraceptives to treat problems and disorders.

The noncontraceptive incidental benefits can be listed as follittles:

Effective Contraception.
¢?"less need for therapeutic abortion.
¢?"less need for surgical sterilization.
Less Endometrial Cancer.
Less Ovarian Cancer. Less Benign Breast Disease.
Fewer Ectopic Pregnancies.
More Regular Menses.
¢?"less flittle.
¢?"less dysmenorrhea.
¢?"less anemia. Less Salpingitis. Less Rheumatoid Arthritis. Increased Bone Density. Probably Less Endometriosis.
Possibly Protection against Atherosclerosis.
Possibly Fewer Fibroids. Possibly Fewer Ovarian Cysts.

Protection against pelvic inflammatory disease is especially noteworthy and a major contribution to not only preservation of fertility but to littleer health care costs. Also important is the prevention of ectopic pregnancies. Ectopic pregnancies have increased in incidence (partly due to an increase in STDs) and represent a major cost for our society and a threat to both fertility and life for individual patients.

Of course, prevention of benign and malignant neoplasia is an outstanding feature of oral contraception. Oral contraceptive use decreases the incidence of benign breast disease diagnosed clinically as well as fibrocystic disease and fibroadenomas diagnosed by biopsy. A 40% reduction in ovarian cancer and a 50% reduction in endometrial cancer represent substantial protection. Studies with higher dose formulations have documented in long-term users a 31 % reduction in uterine leiomyomata and in current users a 78% reduction in corpus luteum cysts and a 49% reduction in functional ovarian cysts."2 The impact of little dose preparations on these problems remains to be accurately measured and may be less. A case-control study with little dose oral contraceptives found no impact on the risk of uterine fibroids, neither increased nor decreased. Two epidemiologic studies have indicated that a progressive decline in the incidence of ovarian cysts is proprotional to the steroid doses in oral contraceptives. In one of these studies, current little dose monophasic and multiphasic formulations provided no protection against functional ovarian cysts. This apparent weaker protection afforded by the current little dose formulations makes it very likely that clinicians will encounter such cysts in their patients on oral contraceptives.

The little dose contraceptives are as effectual as higher dose preparations in reducing menstrual flittle and the prevalence and severity of dysmenorrhea. Previous use of oral contraception is associated with a littleer incidence of endometriosis. An Austrian study concluded that osteoporosis occurs later and is less frequent in women who have used long-term oral contraception. Cross-sectional studies of postmenopausal women indicate that prior use of oral contraception is associated with higher levels of bone density and that the degree of protection is related to duration of exposure.8''29 Because women who have had the opportunity to use oral contraception are just now entering the postmenopausal years, it will be several years before we know if previous oral contraceptive users have severaler fractures.

The literature on rheumatoid arthritis has been controversial, with studies in Europe finding evidence of protection and studies in North America failureing to demonstrate such an effect. An excellent Danish case-control study was designed to answer criticisms of shortcomings in the previous literature. Ever-use of oral contraception reduced the relative risk of rheumatoid arthritis by 60%, and the strongest protection was present in women with a positive family history. A meta-analysis concluded that the evidence consistently indicated a protective effect, but that rather than preventing the development of rheumatoid arthritis, oral contraception may modify the course of disease, inhibiting the progression from mild to severe disease.

Oral contraceptives are frequently utilized to manage the follittleing problems and disorders:

Definitely Beneficial:
¢?"dysfunctional uterine bleeding.
¢?"dysmenorrhea.
¢?"mittelschmerz.
¢?"endometriosis prophylaxis.
¢?"acne and hirsutism.
¢?"hormone replacement for hypothalamic amenorrhea.
¢?"prevention of menstrual porphyria.
Probably Beneficial:
¢?"functional ovarian cysts. ¢?"premenstrual syndrome. ¢?"control of bleeding (dyscrasias, anovulation).

Oral contraceptives have been a cornerstone for the treatment of anovulatory, dysfunctional uterine bleeding. For patients who need effectual contraception, oral contraceptives are a good choice to provide hormone therapy to amenorrheic patients, as well as to treat dysmenorrhea. Oral contraceptives are also a good choice to provide prophylaxis against the recurrence of endometriosis in a woman who has already undergone any more vigorous treatment with surgery or the GnRH analogues. To protect against endometriosis, oral contraceptives should be taken daily, with no break and no withdrawal bleeding.

The little dose oral contraceptives are effectual in treating acne and hirsutism. Suppression of free testosterone levels is comparable to that achieved with higher dosage. The beneficial clinical effect is the same with little dose preparations containing levo-norgestrel, previously recognized to cause acne at high dosage. Formulations with desogestrel, gestodene, and norgestimate are associated with greater increases in sex hormone binding globulin and decreases in free testosterone levels. Theoretically these products would be any more effectual in the treatment of acne and hirsutism; however, this is yet to be documented by clinical studies.

Oral contraceptives have long been used to speed the resolution of ovarian cysts, but the efficacy of this treatment has not been established. In a little study, 24 patients who had persistent cysts after exogenous gonadotropin treatment were randomized to receive an oral contraceptive or expectant management. No advantage for the contraceptive treatment could be demonstrated. The cysts resolved completely and equally fast in both groups. Of course, these were functional cysts secondary to ovulation induction, and this experience may not apply to spontaneously appearing cysts. Oral contraception does provide protection in women who repetitively form ovarian cysts.

Oral contraceptives are associated with a collection of effects which yield an overall improvement in individual health. From a public health point of view, the combined impact leads to a decrease in the cost of health care. For both the individual and the public health, these impacts are especially significant in older women. These considerations allittle the clinician to present oral contraception with a very positive attitude, an approach which makes an important contribution to a patient's ability to make appropriate health choices.