Hormonal Contraception: More Bad News

I'm on vacation but cannot resist posting this info. I advise my patients to go nonhormonal with contraception - condoms, rhythm method, IUD, or Fem Cap. Here's more data to add to the mounting pile of adverse effects associated with hormonal contraception! SG

Hormonal Contraception and Cervical Cancer Risk

Risk for cervical cancer increased in current users of hormonal contraception but declined after use stopped.

Cervical cancer risk is increased in current and recent users of hormonal contraception, but the effect’s duration has not been delineated. To quantitate this risk more precisely, investigators pooled data on 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 studies. Analyses were stratified by potential confounders (e.g., study site, time since last use, and type of contraceptive [oral or injectable; combined oral estrogen-progestogen or progestogen only]).

The risk for cervical cancer was higher in current users of combined oral contraceptives than in never users (relative risk, 1.9 with more than 5 years’ use). After cessation of use, the risk declined, equaling that of never users in 10 years. The increase in risk did not vary substantially with human papillomavirus status, although confidence intervals were wide because of limited numbers. Data were insufficient for fully comparable analyses of progestogen-only and injectable contraceptives.
Comment: Although this careful analysis confirms an increase in risk for cervical cancer among women using hormonal contraception, the finding should not dissuade clinicians from providing such contraception. The increased risk could reflect biologic interaction or confounding by sexual behavior: Women who use hormonal contraception are less likely to use barrier methods and so are more likely to be exposed to HPV, some types of which are documented cervical carcinogens. However, among women with oncogenic HPV infection, use of hormonal contraception has not been shown to affect the natural history of HPV-induced dysplasia (Journal Watch Women’s Health Feb 7 2006). Furthermore, hormonal contraception decreases parity, thereby reducing other causes of morbidity and mortality — especially in the developing world. Women choosing hormonal contraception can also be reassured that cytologic screening as well as HPV vaccination and testing are effective methods for preventing cervical cancer.

— Anna Wald, MD, MPH
Published in Journal Watch Women's Health December 20, 2007