Jensen J T, Speroff L
Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, USA.
Obstet Gynecol Clin North Am. 2000 Dec;27(4):705-21. doi: 10.1016/s0889-8545(05)70169-8.
A sizeable literature corroborates the multiple health benefits of oral contraceptive use. The first estrogen/progestin combination pills were marketed to treat a variety of menstrual disorders. Although currently used oral contraceptives no longer carry FDA-approved labeling for these indications, they remain important therapeutic options for a variety of gynecologic conditions. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID. Although older, higher-dose pills reduced the incidence of ovarian cysts, low-dose pills suppress follicular activity less consistently. Nevertheless, cycle-related symptoms, including functional cysts, dysmenorrhea, chronic pelvic pain, and ovulation pain (mittelschmerz), generally improve. Women with polycystic ovary syndrome note improvement in bleeding patterns and a reduction in acne and hirsutism. Symptoms from endometriosis also improve with oral contraceptive therapy. Current data suggest that oral contraceptive therapy increases bone density and that past use decreases fracture risk. Oral contraceptives also improve acne, a major health concern of young women. Oral contraceptives provide lasting reduction in the risk of two serious gynecologic malignancies--ovarian and endometrial cancer. The data with respect to ovarian cancer are compelling enough to recommend the use of oral contraceptives to women at high risk by virtue of family history, positive carrier status of the BRCA mutations, or nulliparity, even if contraception is not required. Health care providers must counsel women regarding these benefits to counteract deeply held public attitudes and misconceptions regarding oral contraceptive use. Messages should focus on topics of interest to particular groups of women. The fact that oral contraceptives increase bone mineral density and reduce ovarian cancer is of great interest to women in their forties and helps influence use and compliance in this group. In contrast, the beneficial effects of oral contraceptives on acne resonates with younger women. Getting the good news out about the benefits of oral contraceptives will enable more women to take advantage of their positive health effects.
大量文献证实了口服避孕药对健康的多种益处。首批雌激素/孕激素复方避孕药上市是用于治疗各种月经紊乱。尽管目前使用的口服避孕药不再具有FDA批准的这些适应症标签，但它们仍是多种妇科疾病的重要治疗选择。公认的妇科益处包括痛经、月经过多、缺铁性贫血、异位妊娠和盆腔炎发病率降低。虽然早期的高剂量避孕药降低了卵巢囊肿的发生率，但低剂量避孕药对卵泡活动的抑制作用不太稳定。然而，与月经周期相关的症状，包括功能性囊肿、痛经、慢性盆腔疼痛和排卵痛（经间痛）通常会改善。多囊卵巢综合征女性的出血模式有所改善，痤疮和多毛症减少。口服避孕药治疗也能改善子宫内膜异位症的症状。目前的数据表明，口服避孕药治疗可增加骨密度，过去使用过则可降低骨折风险。口服避孕药还能改善痤疮，这是年轻女性主要的健康问题。口服避孕药能持续降低两种严重妇科恶性肿瘤——卵巢癌和子宫内膜癌的风险。关于卵巢癌的数据非常有说服力，足以建议因家族病史、BRCA突变携带者阳性状态或未生育而处于高风险的女性使用口服避孕药，即使她们不需要避孕。医疗保健提供者必须就这些益处向女性提供咨询，以消除公众对口服避孕药使用的根深蒂固的态度和误解。信息应聚焦于特定女性群体感兴趣的话题。口服避孕药能增加骨矿物质密度并降低卵巢癌风险这一事实，对四十多岁的女性极具吸引力，并有助于影响该群体的使用和依从性。相比之下，口服避孕药对痤疮的有益作用对年轻女性更有吸引力。宣传口服避孕药的益处将使更多女性能够利用其对健康的积极影响。
