Benefits of Oral Contraceptives Apart from Preventing Pregnancy

While the first thing that comes to mind about birth control pills, or oral contraceptives, is probably that they keep you from becoming pregnant, contraception is not the only benefit of these agents.

In our recent discussions of endocrine system and oral contraceptives, known commonly as birth control pills, we learned that oral contraceptives have been found to lower the risk of developing certain types of cancers. These include cancers that are not easily detected early or that tend to be more deadly compared with cancers whose increased occurrence has been associated with oral contraceptives. Thus, whereas the pill has been associated with increased occurrence of breast cancer and cervical cancer, these associations do not translate into an elevated occurrence of cancer deaths. This may have to do with the fact that many breast cancers are detected fairly early when they can be treated effectively. The same is true of cervical cancer, which is detected by way of Pap smear, and testing performed on the samples that a Pap smear produces. As for oral contraceptives lowering the risk of developing cancer, here we are talking about several types of cancer. One such cancer is ovarian cancer, for which there is not yet even a screening test, so it is often diagnosed a late stage and thus has high mortality.

Along with ovarian cancer, oral contraceptive use also is associated with a lower risk of cancer of the colon and rectum. Such cancers can have a range of outcomes, from detected early and fully cured to deadly, and lower risk of endometrial cancer, which also has varying outcomes, depending on when it is discovered. Scientists also have uncovered evidence suggesting that oral contraceptives may lower your risk of certain female reproductive cancers, particularly when the oral contraceptives are taken after pregnancy.

Very few women go on oral contraceptives purely for the sake of preventing colon cancer, endometrial cancer, and ovarian cancer. Moreover, women who are at particular risk for ovarian cancer are those with what doctors and geneticists call BRCA mutations. These are common particularly among Ashkenazi Jews and since they are also associated with breast cancer, whose occurrence is higher in association with birth control pills, most doctors would be uncomfortable prescribing oral contraceptives to women with such mutations. This is rather a dilemma, however, since, as bad as breast cancer is for a woman and her family, on average ovarian cancer is more deadly.

Much more than to prevent cancer, oral contraceptives are given for other reasons. In particular, these agents work well as an off-label treatment for acne and to treat a condition called hirsutism, which is characterized by the growth of body hair that is excessive, or thicker than normal, or located on parts of the body where you don’t want it, such as on the face, abdomen, arms, or chest. The combination of acne and hirsutism occur in a condition called polycystic ovarian syndrome (PCOS). This is a condition involving abnormalities of the ovaries, resulting from a combination of problems with hormones, metabolic factors, genes, and the environment. The problems include an improper ratio between the pituitary hormones that act on the ovaries, called LH and FSH. Levels of LH are too high and the schedule of how LH is released in pulses from the pituitary is abnormal. Meanwhile, the levels of FSH are decreased and cysts form within the ovaries. Along with promoting acne and hirsutism, this situation also makes ovulation difficult. Consequently, women with PCOS tend to ovulate less frequently than other women and tend to have fewer periods, which is to say that the time between periods is often longer than one month. This is called oligomenorrhea and it is associated with reduced fertility. However, oral contraceptives, especially those with particular formulations, compensate for the hormonal process, leading to a reduction in the number of cysts and normalization of the ovaries. After stopping oral contraceptives in order to get pregnant, women with PCOS often have trouble getting pregnant and may need fertility treatment.

Oral contraceptives also are given, off-label, to treat excessive uterine bleeding and irregular uterine bleeding and a condition called endometriosis. In endometriosis, endometrial tissue (the tissue that lines the inside of the uterus) grows outside the uterus and throughout the pelvic and abdominal cavities.

Due to such off-the-shelf benefits of oral contraceptives, there are many cases of women taking oral contraceptives who are not sexually active, or who are in same-sex relationships with other women.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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