Contraception has become a contentious political issue this year, with the debate bringing the topic into the spotlight and onto the lips of politicians and pundits. But physicians prescribe hormonal contraception, most commonly administered as birth control pills, for many reasons other than just pregnancy prevention.
“The most common of these alternative uses is for control of heavy menstrual bleeding,” says Dr. Octavio Chirino, chairman of obstetrics and gynecology at Mercy Hospital St. Louis. “They also are used for cycle control, such as changing the timing or length of a period, or eliminating periods for the patient’s needs. Such needs might be related to work or social issues or in treating pelvic endometriosis.” Chirino adds that the medicine also has been used to suppress ovulation and thus cyst formation, particularly in women with known polycystic ovarian syndrome.
Oral contraceptives also can help reduce androgen (male hormone) production in the body, which makes them useful for acne reduction in some women, although they are not commonly used as a first-line medication for this purpose. Women entering peri-menopause also may find that using a hormonal contraceptive eases hormonal imbalances.
Technically, hormonal contraceptives are not indicated for all of these uses. “Some of the uses of hormonal contraception are not strictly ‘on label’ because the expense of getting FDA approval for each particular indication discourages pharmaceutical companies from seeking it,” Chirino explains. “However, hormonal contraceptives for these other uses are very well recognized and accepted as being safe and effective. This is very common with many medicines that, when in use, are found to be very useful or effective for indications other than those for which they received approval.”
Hormonal contraceptives are available as transdermal patches, injections, intrauterine devices, implants and vaginal inserts, in addition to the oral form. “When choosing a hormonal birth control for additional benefits other than contraception alone, the route of delivery of the hormones can affect how they will work and how they will affect the menstrual cycle, as well as potential side effects,” explains Dr. David Weinstein, chief of obstetrics and gynecology at Missouri Baptist Medical Center. “These issues should be discussed with your physician or health care provider so that the best option can be prescribed.”
The most common misperception when it comes to hormonal contraceptive use has to do with the medication’s safety, says Dr. Carlton Pearse, chief of obstetrics and gynecology at St. Luke’s Hospital. “Birth control pills have been around since the ’60s, and they have a very long track record of safety, effectiveness and reversibility,” he says. “The pills we use now are safer than pills in the past because the dosage of estrogen has been lowered. They’ve perfected the pill, increased the safety and decreased the side effects—it’s a remarkably effective and safe combination of pills when used in the right people.” Concerns about increased risk of breast cancer have not been proven, he adds. In fact, both ovarian and uterine cancer risk decreases with hormonal contraception use.