Journal of Contraception Reproductive Health Care - The European ...

The 8th Congress of The European Society of Contraception Abstracts of Invited Speakers
IS-13
Health benefits – breast and bone
A. Glasier
Family Planning and Well Woman Services, Dean Terrace Clinic, Edinburgh, UK
The evidence for non-contraceptive benefits of hormonal contraception on breast and bone relates only to the combined oral
contraceptive pill (COC). Most reviews on the topic state that the pill is associated with a reduced risk of benign breast disease
(BBD) and that it is ‘good for bone’.
The data on BBD are scanty, somewhat old and, of course, observational. It seems counter-intuitive that COC use should be
associated with an increased risk of breast cancer while at the same time preventing benign disease. The beneficial effects, if any,
may be limited.
There are more data on the effect of COC on bone and they are more recent. However studies on the effects of contraception
on bone mineral density are not easy to do since there are many confounding variables.
The quality of the research is very variable, but the better studies tend towards demonstrating no significant effect on the pill on
bone mineral density. The limited amount of observational data is even more difficult to interpret but it is hard to conclude that
use of the pill is associated with a reduced risk of osteoporotic fracture.
The benefits of combined hormonal contraception on breast and bone may well have been overstated.
IS-14
Non-contraceptive effects – dysfunctional uterine bleeding
I. Milsom
Department of Obstetrics & Gynecology, Sahlgrenska Academy at Göteborg University, Sweden
Menstrual disorders such as menorraghia and dysmenorrhea have been reported to seriously affect approximately 2.5 million
women annually in the USA and cost US industry 8% of the total wage bill. Dysmenorrhea is probably the commonest form of
menstrual disorder with a reported prevalence of 50–90% among young women. In Sweden 15% of young women have been
reported to suffer from dysmenorrhea which causes absenteeism from school or work every month. Approximately 10% of fertile
women suffer from menorraghia, defined as a menstrual blood loss of 480 ml. Excessive blood loss may lead to iron deficiency
anaemia and ultimately necssitate hysterectomy.
The use of different contraceptive techniques has been shown to influence menstrual blood loss and the occurrence of dysmenorrhea.
Some contraceptive methods have been reported to decrease the occurrence of menorraghia while other methods have
been reported to increase the prevalence of dysmenorrhea and menorraghia
Combined oral contraceptives (COC) are generally accepted to provide effective pain relief for 70–80% of women with primary
dysmenorrhea. This opinion has however been contested in a recent Cochrane review. COC’s have also been reported to
reduce menstrual blood loss by approximately 50%. On the other hand copper (Cu) intrauterine devices (IUD) have been
reported to increase menstrual blood loss by approximately 50% and dysmenorrhea has been reported to be more common
among users of a Cu-IUD.
Thus the choice of contraceptive method can influence the occurrence of these conditions and in some cases contraceptive
methods can be used as an effective treatment for dysfunctional uterine bleeding. The scientific evidence behind the influence of
contraceptive methods on dysfunctional uterine bleeding will be described.
18 The European Journal of Contraception and Reproductive Health Care