After a brief review of the pharmacology of commercially available oral contraceptives, the author compares the Pearl index of various contraceptive methods to evaluate the baseline advantages of contraception vs. pregnancy. The role of the steroid hormones in vascular disease is reviewed from the viewpoint of the hemostatic system, the regulation of blood pressure, glucose tolerance and the lipid and lipoprotein systems. At the dosages presently used no harmful side effects have been substantiated. Hormonal contraceptives also appear to offer positive health effects against monthly blood loss, dysmenorrhea, ascending infections, functional ovarian cysts, extrauterine pregnancies, benign mammary tumors, ovarian carcinoma and endometrial carcinomas. Hormonal contraceptives should be prescribed only after examination to rule out well known contraindications such as pregnancy, preexisting thrombosis and embolisms (including retinal thromboses), tendency toward myocardial infarct, tendency toward strokes, blood pressure above 140/90 mm Hg (untreated), acute diabetes mellitus with vascular changes heavy smoking above age 35, potential estrogen-dependent tumors (mammary carcinoma and hepatocellular adenoma), acute and progressive chronic hepatopathy, familial or congenital disorders of bilirubin metabolism (for example, Dubin-Johnson syndrome and rotor syndrome), and longterm immobilization.