Update on the metabolic effects of steroidal contraceptives.

Modern oral contraceptive pills are safe and show minimal metabolic effects that have little clinical significance to smoking and reproductive age (even up to menopause). Multiphasic and 30 to 35 micrograms EE fixed combination pills are preferable to higher dose EE pills. Triphasic pills with norgestrel or norethindrone, monophasic norethindrone pills, and combination pills with the newer progestins are all probably metabolically comparable. The levonorgestrel implant is convenient, reversible, and effective and eliminates estrogenic metabolic effects. Metabolic benefits of the pill may include less acne, better preservation of bone mass, and less blood loss. Women who smoke should be encouraged to stop. Women with risk factors for atherosclerosis such as smoking, lipid abnormalities, diabetes, or hypertension should avoid combination pills. Women with a history of pregnancy, steroid-related thrombophlebitis, or thromboembolic disease should not use estrogen-containing pills.