Oral contraceptives. The current risk-benefit ratio.

When oral contraceptive (OCs) first became available, they were thought to be close to the ideal method of contraception. However, by the late 1960s, reports of cardiovascular complications were beginning to appear. The risks of four cardiovascular diseases increased: (1) hypertension, (2) venous thromboembolism, (3) stroke and (4) myocardial infarction. First, hypertension is now accepted as one of the proven side effects of OC use. It also contributes to the morbidity and/or mortality resulting from stroke, myocardial infarction, and cardiac and renal failure. Second, the risk of a previously normal woman's developing venous thromboembolism is increased by OC use, but the absolute risks vary considerably. Third, the risk of stroke is greater among OC users, and the risk persists after one discontinues OC use. Finally, there is an association between Pill use and coronary heart disease, but heart attacks occur mainly in women who have additional risk factors, such as increasing age and smoking.