Screening before and during the use of oral contraceptives and hormone replacement therapy

Abstract

Most users of oral contraceptives (OC), and many users of hormone replacement therapy (HRT) are apparently healthy, using a preparation for preventative purposes. It is understandable, therefore, that many clinicians feel that they should screen women using these preparations for hidden disease. Sometimes this has resulted in women being subjected to a variety of procedures. This medicalization of the provision of care can inhibit women from availing themselves of these services. All screening programmes must have evidence that: early detection will affect the natural history of the disease; the performance characteristics of the test must be known; the test should be cost-effective, acceptable to users and providers, should influence clinical decisions, and treatment should exist for abnormal results. The tests time to time suggested before and during the use of OC and HRT do not fulfill these needs. Whether any of the contraindications for OC use are present can be determined simply by taking a history and performing a physical examination including measurement of blood pressure. The same policy applies to the women who will start HRT. If facilities are available for screening mammography this test should be performed prior to starting HRT as the oestrogen can promote the growth of an existing subclinical breast cancer. It is not cost effective to perform an endometrial biopsy in women without abnormal genital bleeding prior to starting HRT. Routine measurement of bone density is also not cost effective or necessary since no current available agent reduces the risk of fractures in women with osteoporosis more than HRT.