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[Oral contraceptives in perspective--benefit-risk evaluation].

The 30-year history of oral contraceptives (OCs) is replete with concern and controversy which has resulted in reduced use and increased frequency of abortion especially among young women. Yet in Sweden OCs are the most accepted contraceptives among them even though condom use has increased because of the fear of sexually transmitted diseases. About 50-70% of sexually active young women use OCs. Even low-dose OCs that contain less than 50 mcg of ethinyl estradiol have side effects e.g. mood changes and weight gain. Deep venous thrombosis is rare amounting to 1 case/10000 per year. The use of low-dose OCs leads to a fourfold increase of venous thrombosis according to a WHO report which is as high as shown in earlier studies. A new finding is that compared to levonorgestrel-containing pills there is a double risk of venous thrombosis among women using OCs containing desogestrel gestodene or norgestimate. On the other hand recent studies also show that these gestagens lower the risk of heart attack. Testing resistance against activated protein C (APC) has been suggested as a way to preclude the risk for deep venous thrombosis when using OCs. Among those women who have deep venous thrombosis 25-40% can be attributed to APC resistance; however most women who have APC resistance do not get thrombosis. There are some arguments against screening for APC resistance because of the all too low predictive value of determining such APC resistance for venous thrombosis. The debate about screening should be decided by consensus among coagulation experts epidemiologists and gynecologists with active clinical experience regarding the advice to be given to young women with APC resistance taking into consideration the individuals health status desire for pregnancy and possible other risk factors for thrombosis.