In the Royal College of General Practitioners study of oral contraception in the UK, by 1981 there had been 13 cases of newly occurring otosclerosis in each of the groups of oral contraceptive users (101 985 woman-years) and controls (146 534 woman-years) this showed a non-significant relative risk of 1.29. Although, by analogy with pregnancy, it may be prudent to suppose that oral contraceptives could exacerbate pre-existing otosclerosis, the data do not support the view that the condition is associated with their use.
Combined oral contraceptives are generally considered not to have a detrimental effect on bone mineral density but study results have been inconsistent and any clinical significance unclear. However, overall, combined oral contraceptives appear not to affect bone mineral density or biochemical markers of bone turnover. Reviews of studies in different age groups have found that bone mineral density in healthy premenopausal women does not appear to be significantly affected.
Before hormonal contraceptives are given, the woman should undergo an appropriate medical examination and her medical history should be carefully evaluated. Regular examination is recommended during use.
All methods of contraception effectively reduce the risk of ectopic pregnancy overall by reducing the rate of pregnancy. However, when contraception fails the proportion of pregnancies that are ectopic is higher for users of oral and in-tra-uterine progestogen-only contraceptives and levonorgestrel implants than in the general population. There is no increase in the proportion of ectopic pregnancies for methods that inhibit ovulation more reliably, such as combined oral contraceptives and medroxyprogesterone acetate depot injection.