ABSTRACT
In selected healthy migraine-free, non-smokers, with modern pills and careful monitoring, the many gynaecological and other benefits of COCs are now felt to outweigh the small, though increasing, cardiovascular (and breast cancer) risk of a modern pill up to age 51, which is the mean age of the menopause. Depending on her choice, an appropriate COC (most commonly a 20 µg product such as Mercilon or Femodette, see p. 36) may thus be preferable (WHO 2) to hormone replacement therapy (HRT) up to the age of 51, for women who need contraception as well as a supplement to diminished ovarian function. Smokers above the age of 35 are a different matter. Pending more data, if they request a hormonal contraceptive they should use a progestogen-only method – an IUD or IUS might be even better (or perhaps the partner should have a vasectomy?).
