Recommendations from the findings by the RCGP oral contraception study on the mortality risks of oral contraceptive users.

It has been shown [in the research results published in the Lancet on 8 October] in the RCGP study population that oral contraceptive users compared with non-users have an increased risk of 1 per 5000 per year of dying from cardiovascular disease. This risk is concentrated, however, in women over the age of 35 years, especially if they smoke cigarettes and have used oral contraceptives continuously for five years or more. This relationship to duration of use requires confirmation. These observations in the study will permit clinicians to identify women at special risk more accurately than before. There is no evidence to suggest that the risk for most women under the age of 35 years is great enough to warrant any change in clinical practice unless the well-known additional risk factors of cardiovascular disease are present. The division of the data at age 35 is arbitrary and it would be prudent to assume that there is a gradually increasing risk at an earlier age. These are the considerations on which we have based our recommendations. Recommendations WOMEN UNDER 30 YEARS OF AGE We have no evidence to justify recommending any change of practice. It would be wise to emphasise the general advantage of stopping smoking. Because we have to assume a gradually increasing risk up to 35 years of age, we suggest that some women over 30 years ought to reconsider their use of oral contraceptives. We believe that women in this age group who have used oral contraceptives continuously for more than five years and who are cigarette smokers should come into this category. If they would stop smoking it would probably be reasonable for them to continue the pill. If not, it might be wiser for them to change to another method. Because of the obvious confidentiality of this issue, we have not been able to consult our respective Councils. These recommendations therefore represent the personal opinions of the above named. WOMEN OVER 35 YEARS There may well be circumstances where women over the age of 35 years would accept the additional risks involved and would wish to continue oral contraceptives. However, in general it would be wise for all oral contraceptive users over 35 years of age to reconsider their method of contraception. Older women who smoke and/or have used oral contraceptives continuously for more than five years may well have extra risks which they and their …