Oral contraceptives. The benefits and the cardiovascular risks.

For healthy women under 25 years of age, the benefits of oral contraceptive (OC) use far outweigh the risks. Because the agents protect against such life-threatening conditions as ovarian and endometrial cancer, pelvic inflammatory disease, and ectopic pregnancy, the number of deaths they prevent is larger than the number they cause. For nonsmokers up to age 40, OCs may offer more benefits than other available fertility-control methods, although for smokers 35 years of age or older, the risks of OC use outweigh the benefits. When risk factors for cardiovascular disease are taken into account in selecting OC users and when an appropriate agent is chosen, the likelihood of a cardiovascular accident is greatly reduced. The formulations containing low-dose estrogen and low-dose, low-potency progestins appear to be safest, as they have fewer adverse effects on serum lipids and lipoproteins.