Human Reproduction, Vol. 15, No. 2, 485-492,
February 2000
© 2000 European Society of Human Reproduction and Embryology
Screening before and during the use of oral contraceptives and hormone replacement therapy
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.
Key words: hormone replacement therapy/oral contraceptives/screening
To whom correspondence should be addressed: Professor P G Crosignani, Clinica Ostetrica e Ginecologica II, Facolta de Medicina e Chirurgia, University Degli Studi di Milano, Via Commenda, 12-20122 Milano, Italy
* A meeting was organized by ESHRE (Capri, August 27–28, 1998) with financial support from Schering S.p.A. to discuss the above subjects. The speakers included J.Collins (Hamilton), E.Diczfalusy (Rönninge), T.Farley (WHO), P.Hannaford (Aberdeen), S.Skouby (Copenhagen), J.C.Stevenson (London) and U.Winkler (Essen). D.R.Mishell (Los Angeles) was not able to participate but contributed to the manuscript. The discussants included P.G.Crosignani (Milano), L.A.J.Heinemann (Berlin), C.La Vecchia (Milano), M.Meschia (Milano), T.Norpoth (Berlin), G.Rosano (Roma) and M.Whitehead (London). This report was prepared by P.G.Crosignani and B.L.Rubin.