Oral contraceptives: where are the excess deaths?

In the 1960s and 1970s a substantial body of data was published indicating an excess death rate mainly related to a cluster of cardiovascular complications in women who were either taking or had taken oral contraceptives (OCs). The epidemiological interpretation of these data has been seriously questioned and many workers now think that the excess deaths in these women are almost entirely attributable to smoking. In addition it is clear that the death rate from myocardial infarction in women in Australia which had declined significantly in the last 12 years is quite different from that seen in women in the United Kingdom where the death rate from myocardial infarction continues to increase. The validity of basing warnings contradindications and advice to patients regarding the use of OCs on data from different populations should be reconsidered. (authors)