Advantages and disadvantages of combined hormonal contraception

Advantages and disadvantages of combined hormonal contraception are listed in Advantages and disadvantages of combined hormonal contraception. Also consider other factors affecting choice of contraceptive method.

Table 1. Advantages and disadvantages of combined hormonal contraception
[NB1]
Advantages
very effective (93% with typical use; 99.5% with perfect use) allows the individual to control contraception (starting, stopping and taking breaks) and to manipulate the menstrual cycle with a tailored regimen (eg to avoid unnecessary withdrawal bleeding) suitable for Quick Start [NB2] improves: acne heavy menstrual bleeding dysmenorrhoea symptoms of endometriosis polycystic ovarian syndrome (PCOS) premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) perimenopausal symptoms reduces the risk of endometrial, ovarian and bowel cancer, functional ovarian cysts and benign ovarian tumours no adverse effect on bone mineral density, so can be used first line in adolescents and perimenopausal individuals possibly reduces the risk of bacterial vaginosis all pills containing norethisterone and most pills containing levonorgestrel are available on the PBS
Disadvantages
high user involvement (must be taken every day); continuation rate 55% at 1 year potential short delay of return to fertility after stopping (does not appear to be affected by the length of use) vaginal ring expires 4 months after dispensing vaginal ring and many pills are not available on the PBS drug interactions increased risk of venous thromboembolism increased risk of ischaemic stroke and myocardial infarction [NB3] small increase in the risk of cervical and breast cancer; encourage cervical screening and HPV vaccination, and take a history for breast cancer risk factors (see also Contraception and cancer risks) may increase blood pressure; take baseline blood pressure and recheck every 12 months small increase in the risk of inflammatory bowel disease unscheduled bleeding can occur can cause melasma for vaginal ring: vaginal discharge, discomfort for the user or partner and ring expulsion other adverse effects [NB4]: headache nausea breast tenderness bloating mood changes [NB5] reduced libido weight gain
Note: PBS = Pharmaceutical Benefit Scheme NB1: See also Comparison of combined oral contraceptives and the contraceptive vaginal ring (Comparison of combined oral contraceptives and the contraceptive vaginal ring). NB2: Combined oral contraceptives containing cyproterone should not be used for Quick Start unless pregnancy can be reasonably excluded, because there is a theoretical risk of feminisation of a male fetus. For general advice on excluding pregnancy, see Starting intrauterine contraception. NB3: Absolute risks of ischaemic stroke and myocardial infarction with use of combined hormonal contraception are extremely low and appear to depend on the dose of ethinylestradiol. NB4: These adverse effects have been reported by users of combined hormonal contraception, but evidence is insufficient to prove a causal effect. NB5: An association between first prescription of an antidepressant and contraceptive use has been seen, but a causal link is not proven.