The safety and long-term effects of hormonal contraception.

Introduction

Hormonal contraception is widely used for pregnancy prevention and offers various noncontraceptive health benefits. However, its safety and long-term effects have been subjects of extensive research, particularly concerning cardiovascular risks, cancer risks, and other potential adverse effects. This synthesis aims to present the key insights from multiple research papers on the safety and long-term effects of hormonal contraception.

Key Insights

Cardiovascular Risks:
- Hormonal contraceptives, especially oral contraceptives (OCs), are associated with an increased risk of cardiovascular diseases such as venous thromboembolism (VTE), ischemic stroke, and myocardial infarction (MI). These risks are influenced by factors like smoking, hypertension, and diabetes .
- The risk of cardiovascular events is generally low in younger women but increases with age and in the presence of other risk factors.
Cancer Risks:
- Hormonal contraceptives may reduce the risk of endometrial and ovarian cancer but could slightly increase the risk of breast and cervical cancer. There is also an increased risk of liver cancer .
- The association between OC use and breast cancer remains unresolved, with some studies suggesting an increased risk in younger women but a decreased risk in older, nulliparous women.
Noncontraceptive Health Benefits:
- Hormonal contraceptives can reduce menstrual-related symptoms, decrease the incidence of ectopic pregnancies, and potentially increase bone density. They may also offer protection against pelvic inflammatory disease .
- Lower-dose OCs have fewer adverse effects on lipids and glucose metabolism and may even have beneficial impacts on lipid profiles.
Psychological and Behavioral Effects:
- Women using hormonal contraceptives report higher rates of depression, reduced sexual functioning, and changes in mate preferences and sexual satisfaction .
HIV and Infectious Disease Risks:
- Hormonal contraceptives do not appear to accelerate HIV disease progression or significantly increase the risk of female-to-male HIV transmission.
- OCs do not reduce the risk of gonococcal or chlamydial infections and may enhance the spread of lower tract infections.
Adverse Effects and Management:
- Common adverse effects include weight gain, nausea, menstrual irregularities, breast tenderness, mood changes, and acne. These effects often diminish with continued use .
- Long-acting injectable contraceptives are consistently associated with weight gain, unlike other hormonal methods.
Teratogenic Risks:
- Hormonal contraceptives used prior to pregnancy do not increase the frequency of chromosomal aberrations or congenital malformations. However, certain hormones used during pregnancy may increase the risk of congenital malformations in genetically predisposed fetuses.

Conclusion

Hormonal contraceptives are generally safe and effective for pregnancy prevention, offering several noncontraceptive health benefits. However, they are associated with increased risks of certain cardiovascular diseases and cancers, particularly in older women and those with additional risk factors. Psychological and behavioral side effects, as well as potential impacts on infectious disease transmission, are also important considerations. While the benefits often outweigh the risks for many women, individual risk factors must be carefully evaluated to ensure safe and effective use.

The safety and long-term effects of hormonal contraception.

Summary

Introduction

Key Insights

Conclusion

Sources and full results

The safety of hormonal contraceptives for women living with HIV and their sexual partners.

Hormonal contraceptive methods do not appear to accelerate HIV disease progression or increase female-to-male HIV transmission risks.

Safety concerns and health benefits associated with oral contraception.

Oral contraceptives provide noncontraceptive health benefits, such as reduced menstrual symptoms, fewer ectopic pregnancies, and increased bone density, while posing potential cardiovascular risks.

Hormonal contraception.

Hormonal contraception, when used correctly, can effectively prevent pregnancy and reduce the risk of vascular disease, lipid changes, and glucose metabolism.

An overview of oral contraceptives

Hormonal contraception effectively prevents pregnancy, but may cause weight gain, nausea, and other side effects.

Hormonal contraception and risk of cardiovascular disease. An international perspective.

Oral contraceptives increase the risk of stroke and myocardial infarction, with screening users potentially reducing the additional mortality attributable to OC use.

Noncontraceptive effects of hormonal contraceptives: bone mass, sexually transmitted disease and pelvic inflammatory disease, cardiovascular disease, menstrual function, and future fertility.

Oral contraceptives may have limited positive effects on bone mass and may increase the risk of pelvic inflammatory disease, but newer formulations may reduce cardiovascular risks and may improve menstrual function.

Would male hormonal contraceptives affect cardiovascular risk?

Male hormonal contraceptives are generally safe for cardiovascular risk in younger to middle-aged men, but long-term safety and long-term use require further data.

Are hormonal contraceptives teratogenic?

Hormonal contraceptives may be potentially teratogenic, but their use prior to pregnancy does not increase the risk of congenital malformations, and their use during pregnancy should be avoided.

Managing adverse effects of hormonal contraceptives.

Adverse effects of hormonal contraceptives generally resolve within three to five months, with long-acting injectable depot medroxyprogesterone acetate consistently associated with weight gain.

Psychobehavioral Effects of Hormonal Contraceptive Use

Hormonal contraceptive use may increase depression, reduce sexual functioning, and alter mate choice, potentially impacting human evolution and future offspring.

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