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Ann Intern Med. 1994 May 15;120(10):821-6.

Oral contraceptive use and mortality during 12 years of follow-up: the Nurses' Health Study.

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  • 1Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

OBJECTIVE:

To examine prospectively the risk for mortality among women who had ever used oral contraceptives compared with those who had never used oral contraceptives.

DESIGN:

Prospective cohort study.

SETTING:

Nurses' Health Study.

PARTICIPANTS:

166,755 women aged 30 to 55 years in 1976, followed through 1988 (1.3 million person-years of follow-up).

RESULTS:

On the basis of 2879 deaths, we found no overall difference in mortality among women who had ever used oral contraceptives compared with women who had never used oral contraceptives; the relative risk for ever-users, adjusted for age, body mass index, and cigarette smoking was 0.93 (95% CI, 0.85 to 1.01). We observed no trend in risk for total mortality with increasing duration of past use of oral contraceptives. After adjusting for age, body mass index, and cigarette smoking, women who had used oral contraceptives for 10 or more years had a relative risk of 1.06 (CI, 0.83 to 1.35).

CONCLUSION:

Use of oral contraceptives is safe; no evidence from this study indicates that long durations of oral contraceptive use adversely affect long-term risk for mortality.

PIP:

Clinical researchers prospectively followed 166,755 female nurses, 30-55 years old, between 1976 and June 1, 1988, to compare the mortality risk of women who had ever used oral contraceptives (OCs) with those who had never used OCs. Most of the women did not use OCs after 1976, indicating that, if they had used OCs, they were likely to be the high-dose OCs. During the 20 years, 2879 women had died. The causes of death included cancer (1456), cardiovascular conditions (568), suicide (114), other traumatic causes (151), and other causes (590). The age-adjusted relative risk of total mortality for women who had ever used OCs was 0.99. When the researchers also controlled for body mass index and cigarette smoking, the relative risk for ever users was 0.93. Whey they controlled for all of the above and follow-up interval, parity, age at menarche, age at 1st birth, and menopause, they observed that ever use had an increased relative risk of breast cancer mortality (1.09) and a reduced risk for mortality from ovarian and endometrial cancer (0.34 and 0.81, respectively). The reduced risk for ovarian cancer continued after cessation of use (relative risk = 0.79). The apparent increased risk for breast cancer was mostly limited to current users (relative risk = 1.63). When the researchers controlled for age, body mass index, and cigarette smoking, they noted that women who had used OCs for at least 10 years had a somewhat increased relative risk of mortality (1.06). An elevated cardiovascular mortality risk (1.54) among these women was largely offset by the reduced cancer mortality risk (0.84). There was no overall trend in risk with increasing duration of past use of OCs for total mortality or mortality related to cardiovascular disease or cancer. The research indicates that OC use is safe.

Comment in

  • ACP J Club. 1994 Sep-Oct;121 Suppl 2:54-5.
PMID:
8154642
[PubMed - indexed for MEDLINE]
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