Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1989 Dec 16;299(6714):1487–1491. doi: 10.1136/bmj.299.6714.1487

Mortality among oral contraceptive users: 20 year follow up of women in a cohort study.

M P Vessey 1, L Villard-Mackintosh 1, K McPherson 1, D Yeates 1
PMCID: PMC1838344  PMID: 2514858

Abstract

OBJECTIVE--To see whether the use of oral contraceptives influences mortality. DESIGN--Non-randomised cohort study of 17,032 women followed up on an annual basis for an average of nearly 16 years. SETTING--17 Family planning clinics in England and Scotland. SUBJECTS--Women recruited during 1968-74. At the time of recruitment each woman was aged 25-39, married, a white British subject, willing to participate, and either a current user of oral contraceptives or a current user of a diaphragm or intrauterine device (without previous exposure to the pill). MAIN OUTCOME MEASURES--Overall mortality and cause specific mortality. RESULTS--238 Deaths occurred during the follow up period. The main analyses concerned women entering the study while using either oral contraceptives or a diaphragm or intrauterine device. The overall relative risk of death in the oral contraceptive users was 0.9 (95% confidence interval 0.7 to 1.2). Though the numbers of deaths were small in most individual disease categories, the trends observed were generally consistent with findings in other reports. Thus the relative risk of death in the oral contraceptive users was 4.9 (95% confidence interval 0.7 to 230) for cancer of the cervix, 3.3 (95% confidence interval 0.9 to 17.9) for ischaemic heart disease, and 0.4 (95% confidence interval 0.1 to 1.2) for ovarian cancer. There was a linear trend in the death rates from cervical cancer and ovarian cancer (in opposite directions) with total duration of oral contraceptive use. Death rates from breast cancer (relative risk 0.9; 95% confidence interval 0.5 to 1.4) and suicide and probable suicide (relative risk 1.1; 95% confidence interval 0.3 to 3.6) were much the same in the two contraceptive groups. In 1981 the relative risk of death in oral contraceptive users from circulatory diseases as a group was reported to be 4.2 (95% confidence interval 2.3 to 7.7) in the Royal College of General Practitioners oral contraception study. The corresponding relative risk in this study was only 1.5 (95% confidence interval 0.7 to 3.0). CONCLUSIONS--These findings contain no significant evidence of any overall effect of oral contraceptive use on mortality. None the less, only small numbers of deaths occurred during the study period and a significant adverse (or beneficial) overall effect might emerge in the future. Interestingly, the mortality from circulatory disease associated with oral contraceptive use was substantially less than that found in the Royal College of General Practitioners study.

Full text

PDF
1489

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Croft P., Hannaford P. C. Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners' oral contraception study. BMJ. 1989 Jan 21;298(6667):165–168. doi: 10.1136/bmj.298.6667.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Forman D., Vincent T. J., Doll R. Cancer of the liver and the use of oral contraceptives. Br Med J (Clin Res Ed) 1986 May 24;292(6532):1357–1361. doi: 10.1136/bmj.292.6532.1357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Goldzieher J. W. Oral contraceptive hazards--1981. Fertil Steril. 1981 Mar;35(3):275–276. doi: 10.1016/s0015-0282(16)45370-7. [DOI] [PubMed] [Google Scholar]
  4. Kay C. R. The Royal College of General Practitioners' Oral Contraception Study: some recent observations. Clin Obstet Gynaecol. 1984 Dec;11(3):759–786. [PubMed] [Google Scholar]
  5. McPherson K., Vessey M. P., Neil A., Doll R., Jones L., Roberts M. Early oral contraceptive use and breast cancer: results of another case-control study. Br J Cancer. 1987 Nov;56(5):653–660. doi: 10.1038/bjc.1987.261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Pancreatic extracts. Lancet. 1977 Jul 9;2(8028):73–74. [PubMed] [Google Scholar]
  7. Rooks J. B., Ory H. W., Ishak K. G., Strauss L. T., Greenspan J. R., Hill A. P., Tyler C. W., Jr Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA. 1979 Aug 17;242(7):644–648. [PubMed] [Google Scholar]
  8. Slone D., Shapiro S., Kaufman D. W., Rosenberg L., Miettinen O. S., Stolley P. D. Risk of myocardial infarction in relation to current and discontinued use of oral contraceptives. N Engl J Med. 1981 Aug 20;305(8):420–424. doi: 10.1056/NEJM198108203050802. [DOI] [PubMed] [Google Scholar]
  9. Stampfer M. J., Willett W. C., Colditz G. A., Speizer F. E., Hennekens C. H. A prospective study of past use of oral contraceptive agents and risk of cardiovascular diseases. N Engl J Med. 1988 Nov 17;319(20):1313–1317. doi: 10.1056/NEJM198811173192004. [DOI] [PubMed] [Google Scholar]
  10. Vessey M. P., Lawless M., McPherson K., Yeates D. Neoplasia of the cervix uteri and contraception: a possible adverse effect of the pill. Lancet. 1983 Oct 22;2(8356):930–934. doi: 10.1016/s0140-6736(83)90451-8. [DOI] [PubMed] [Google Scholar]
  11. Vessey M. P., Lawless M., Yeates D. Oral contraceptives and stroke: findings in a large prospective study. Br Med J (Clin Res Ed) 1984 Sep 1;289(6444):530–531. doi: 10.1136/bmj.289.6444.530-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Vessey M. P., McPherson K., Lawless M., Yeates D. Oral contraception and serious psychiatric illness: absence of an association. Br J Psychiatry. 1985 Jan;146:45–49. doi: 10.1192/bjp.146.1.45. [DOI] [PubMed] [Google Scholar]
  13. Vessey M. P., McPherson K., Villard-Mackintosh L., Yeates D. Oral contraceptives and breast cancer: latest findings in a large cohort study. Br J Cancer. 1989 Apr;59(4):613–617. doi: 10.1038/bjc.1989.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Vessey M. P., McPherson K., Yeates D. Mortality in oral contraceptive users. Lancet. 1981 Mar 7;1(8219):549–550. doi: 10.1016/s0140-6736(81)92875-0. [DOI] [PubMed] [Google Scholar]
  15. Vessey M., Mant D., Smith A., Yeates D. Oral contraceptives and venous thromboembolism: findings in a large prospective study. Br Med J (Clin Res Ed) 1986 Feb 22;292(6519):526–526. doi: 10.1136/bmj.292.6519.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Vessey M., Metcalfe A., Wells C., McPherson K., Westhoff C., Yeates D. Ovarian neoplasms, functional ovarian cysts, and oral contraceptives. Br Med J (Clin Res Ed) 1987 Jun 13;294(6586):1518–1520. doi: 10.1136/bmj.294.6586.1518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wiseman R. A., MacRae K. D. Oral contraceptives and the decline in mortality from circulatory disease. Fertil Steril. 1981 Mar;35(3):277–283. doi: 10.1016/s0015-0282(16)45371-9. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES