Data regarding the effects of oral contraceptive use on women's risk of melanoma have been difficult to resolve. We undertook a pooled analysis of all case -control studies of melanoma in women completed as of July 1994 for which electronic data were available on oral contraceptive use along with other melanoma risk factors such as hair colour, sun sensitivity, family history of melanoma and sun exposure. Using the original data from each investigation (a total of 2391 cases and 3199 controls), we combined the study-specific odds ratios and standard errors to obtain a pooled estimate that incorporates inter-study heterogeneity. Overall, we observed no excess risk associated with oral contraceptive use for 1 year or longer compared to never use or use for less than 1 year (pooled odds ratio (pOR)=0.86; 95% CI=0.74 -1.01), and there was no evidence of heterogeneity between studies. We found no relation between melanoma incidence and duration of oral contraceptive use, age began, year of use, years since first use or last use, or specifically current oral contraceptive use. In aggregate, our findings do not suggest a major role of oral contraceptive use on women's risk of melanoma.

Key content Dysmenorrhoea can be treated successfully with combined oral contraceptives. Combined oral contraceptives have been shown to reduce and regulate menstrual bleeding. Combined oral contraceptives can treat acne in women also desiring contraception. Severe premenstrual syndrome may respond to drospirenone‐containing combined oral contraceptives. Use of combined oral contraceptives decreases the risk of endometrial and ovarian cancer. Learning objectives To explain the role of combined oral contraceptives in reducing the risk of cancer. To identify the uses of combined oral contraceptives in treating gynaecological problems such as dysmenorrhoea, abnormal uterine bleeding, premenstrual syndrome, acne, hirsutism and polycystic ovary syndrome. Ethical issues Compared with preventing pregnancy, the risk/benefit profile of combined oral contraceptives for non‐contraceptive indications may be different and women should be counseled according to their individual circumstance.

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