One of our lovely readers had some questions under the popular contraception post. I have decided to post it for the benefit of those who missed the comment and response.
Please read Dr. Adeola’s response to the questions.
Thank you for your questions Joyce.
Deciding which contraception is good for one on the background of the perceived risks associated with its use can be daunting .
What particular contraceptive to avoid would usually be based on the individual’s health history and whether or not the benefit outweighs the risk and this benefit versus risk ratio is generally applied in the practice of medicine to determine whether or not a treatment modality is worth the while .
Answer to your first question: 1. Hormonal contraceptives may impact on our natural hormone balance for example, women have reported nausea/breast pain/tenderness, mood changes, menstrual changes, reversible ovarian cysts and weight gain amongst others with the use of the oral contraceptive pills and contraceptive implants.
The reasons for these are not entirely causal but evidence suggest these symptoms /side effects have been attributed to contraceptive use. There are situations where contraceptive effects is deemed complimentary eg around the peri menopause where the woman doesn’t feel as much of the disturbing symptoms of the peri menopause because of the ameliorating effects of the oral contraceptive in use.
Answer to your second question: 2. Contraceptive use and cancer risk has always been a hot topic .
Every woman has a baseline cancer risk attributable to other factors whether or not we use contraception.
The use of some types of contraception may further increase the risk slightly but for most people it’s not too much of a risk to outweigh the benefits of contraception therefore it’s beneficial for that woman to use the contraception in question. However for some women, the use of certain contraception becomes an unacceptable risk ( or contraindication to contraceptive use ) where the risks far outweigh the benefit and as such a particular method is deemed unsafe for a particular lady based on her health profile and it should never be recommended or prescribed for her.
This risk as far as cancer is concerned is usually based on previous or current history of cancer , family history of cancer, current risk of cancer based on the persons current habits / lifestyle / certain medications etc amongst other considerations: this is not exhaustive and it is decided based on individual consultations.
I have tried to summarise below the cancer risks associated with contraceptive use :
Progesterone only contraceptive e.g mini pills, implants
There is a possible increased risk of breast cancer with the use of POPs. However, this risk is very small compared with the overall risk of developing breast cancer, and 10 years after stopping the POP, the risk of developing breast cancer is the same as for women who have never used hormonal contraceptives.
Combined oral contraceptive pills (COC)
There is a possible small increased risk of breast cancer which returns to normal within 10 years after stopping the COC.
There is a small increased risk of cervical cancer which is related to duration of use.There is a small increased risk after 5 years and a two-fold increase after 10 years. The risk returns to normal 10 years after stopping the COC.Advise women to attend routine cervical cytology screening. *There has been some debatable evidence lately that the use of the COC might be protective against ovarian cancer but evidence for this has not been generally substantiated.
Intrauterine contraceptives: e.g. mirena and IUCD
These are long-acting reversible contraceptives which have a licensed duration of use of 3–10 years, depending on the device chosen.
Mirena ( the one that has a hormone embedded in it that it releases slowly locally into the womb and doesn’t go elsewhere ): there is no evidence that it increases cancer risk , it actually
protects against overgrowth of the lining of the womb (so somewhat protective against womb cancer)
IUCD : this has no hormones and has no reported bearing with cancer.. All of the methods discussed above have their other side effects and more details can be found in the link included in my previous post on contraception choices but they are generally safe and that explains why it’s available for women in their reproductive life and most women use these from teenage years up to late forties/early fifties. I would like to think that if the adverse risks are unacceptably high it shouldn’t be recommended for such a widespread use in medicine.
There are screening methods eg mammograms for breast cancer, cervical screening for cervical cancer , screening bloods and ultrasound to pick some changes /abnormalities in the ovaries but any woman whether on contraception or not that notice changes in their breasts, abnormal vaginal discharge , bleeding during or after sex, unexplained vaginal bleeding, inter-menstrual bleeding, unexplained bloating , unintentional weight loss or any other symptoms that concerns them should see their doctor as a matter of urgency.
So Joyce, I am hopeful that you will be able to have an informed discussion with your two daughters on this topic as a guide to help them seek the appropriate contraception for them.
*( NICE CKS: National institute of clinical excellence clinical knowledge summaries)