Methods of reversible
contraception,
oral contraceptives,
intrauterine devices, and
Norplant (systemic
progestin-only
contraceptive; Wyeth-Ayerst, Radnor, PA), can be used for women over 35 years of age.
Oral contraceptive formulations are safe and effective for healthy women up to the age of menopause.
Oral contraceptives in women who do not
smoke cigarettes do not result in a significant increased risk for
cardiovascular disease. The incidence of
breast cancer is not increased in women who have used
oral contraceptives. A slight increase was found in younger women who had been on
oral contraceptives based on a reanalysis of the
contraceptive and
steroid hormone study of the Centers for Disease Control. A reduction in the incidence of ovarian epithelial
neoplasia by 40% was found in three European case-control studies. Two
intrauterine devices are currently available on the US market: Paragard (GynoPharma, Somerville, NJ) and Progestasert (Alza Corp., Palo Alto, CA). Both of these provide highly effective
contraception. A World Health Organization prospective randomized study found that there was an increase in
pelvic inflammatory disease rates in the first 20 days after
intrauterine device insertion. The
intrauterine device itself did not increase the
pelvic inflammatory disease incidence rates. The
Norplant system exerts its
contraceptive action through
ovulation inhibition and alteration of cervical mucus. The major consumer complaint is irregular or prolonged
uterine bleeding, which can be controlled by oral
estrogen.