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The Pill Turns 50: Taking Stock

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This year marks the 50th anniversary of the birth control pill, a development that ushered in the sexual revolution of the 1960s and gave women unprecedented freedom to explore their sexuality without having to worry about pregnancy. Because of its convenience, the pill remains the most popular method of birth control in the United States. It also fits well with society's view of the female body as something that requires outside control.

Though there are other reliable methods of contraception, birth control pills have been "pushed" by the medical profession as the optimal method of contraception for the last half century. Other methods, for example diaphragms, condoms and fertility awareness, have been actively downplayed even though, when used properly, they are nearly as effective as the pill. These other methods require more education about the body and more active participation than the pill. They are not geared to the average busy doctor's schedule.

Many physicians also feel that women will not use barrier methods of contraception, such as diaphragms, condoms, or fertility awareness because they have seen too many "failures." This is true of some women but not all women. The data show that in the women who are ideal users--who use the method correctly every time--barrier methods and even "fertility awareness" (natural family planning) can be 95 to 98 percent effective. [1]

Optimal use of contraception other than the pill (or an IUD) also requires women to interact consciously with their fertility--and, ideally, to engage their sexual partners in this awareness as well. The reality is that many women still don't have conscious dominion over their fertility, don't appreciate their fertility cycles and aren't in partnerships that respect these cycles either. The pill (and now the patch) is, therefore, an ideal solution for many. We can use it to manipulate our menstrual cycles, avoiding periods altogether or on weekends. In short, it fits our cultural ideal.

The pill is the most-studied medication in history. Unfortunately, because it's made from synthetic non-bioidentical hormones, it has more side effects than it should! Though we have the science and technology to make safer oral contraceptives (OCs) from bioidentical hormones, there is no profit in doing so--and therefore no support for it. None are currently available.

Is the Pill Right for You?

In order to choose the right birth control method for you, you need to decide honestly where you are in your own life--and how much responsibility you are willing to assume over your fertility. Some women don't even want to think about getting to know their times of ovulation and checking their cervical mucus, let alone inserting a diaphragm before each intercourse. That's fine--they often do well on the pill or another "automatic" method. Other women prefer barrier methods, such as diaphragms and I encourage these methods, too--but only in those women who are committed to using them consciously.

When I was practicing, I worked repeatedly with women who had three or four abortions from failure to use so-called unnatural contraceptives; the pill would have been a better choice for these women, given their sexual behavior. But they refused to put anything "unnatural" in their bodies. I counseled that there is nothing natural about abortion when a woman fails to use her "natural" method of birth control conscientiously.

These women, though conscious about food and the environment, often suffer from the mind/body split we've all inherited. They believe that part of being a desirable woman is to be available sexually, without asking their partners to share in the responsibility. This is a shame, particularly given that there are so many ways to express oneself sexually without the risk of unintended pregnancy. I recommend that all women make every effort to put their own sexual and fertility needs first in every relationship. Doing so takes courage and support.

Pill and Sexual Dysfunction

Ironically, research shows that oral contraceptives might actually contribute to long-term sexual dysfunction in some women. The January 2006 issue of The Journal of Sexual Medicine reports that the pill lowers levels of testosterone, even after the women have stopped taking oral contraceptives. Such problems occur because pill users have elevated levels of a protein called sex hormone binding globulin (SHBG) that binds testosterone, rendering it unavailable for use by the body.

Low values of "unbound" testosterone potentially lead to side effects such as decreased desire, arousal and lubrication and increased sexual pain. Although some research showed that such problems persisted even after the pill was discontinued, long-term studies are still needed to determine if the problems are permanent. [2] Of all the side effects, what concerns me the most is the potential adverse long-term effect on libido.

Health Risks and Benefits

All women who are on the pill (or the patch) should know about the following effects of the pill, too, in order to be fully informed:

• Oral contraceptives have been a boon for many women, though they may contribute to suboptimal nutrition and an increased incidence of yeast infection in many (the pill has been associated with lowered serum levels of B vitamins and other metabolic changes). [3]

• OCs are associated with a slightly increased risk for cervical adenocarcinoma [4], elevated triglyceride levels [5] and systemic lupus erythematosus (SLE). [6] Although the announcement didn't get much press in the U.S., the World Health Organization has classified birth control pills with combined estrogen and progestin (as well as combined-hormone HRT) as carcinogenic. (The latest such designation came after the cancer research agency of the World Health Organization convened a group of 21 scientists from eight countries in France in June 2005. Reviewing the scientific literature on the pill and cancer, the group pointed to evidence for an increase in cervical cancer, breast cancer and liver cancer in making its decision, while also stressing that convincing evidence existed for a protective effect against endometrial and ovarian cancers.) [7] Yet other authorities don't think the slightly increased relative risk for breast cancer is significant. [8]

• In my experience, the pill is also associated with mood swings, weight gain and decreased sex drive in many women.

• The birth control patch Ortho Evra and the ring (NuvaRing) are also made from synthetic hormones and have roughly the same effect as the pill, though a slightly higher risk of blood clots.

Going off the pill makes many women feel much better, although not all symptoms always subside.

Health benefits of the pill include lowered risk of ovarian cancer, endometrial cancer, acne and pelvic inflammatory disease. In general, the pill's benefits outweigh its risks for the vast majority of women because the health risks from unintended pregnancies far outweigh any risk from the pill.

Women who are on the pill should take a good multivitamin-mineral supplement containing B-complex. The majority of women who have serious health problems with the pill are smokers. Smokers should not use the pill after the age of 35.

Here's the bottom line: We have the scientific know-how to design safe and effective hormonal contraception using bioidentical hormones, which would most likely eliminate the downside of using the pill. I doubt that we will see these developed for years to come. So in the meantime, if the pill works well for you and you feel good on it, then by all means, celebrate its 50th anniversary with joy!

If, on the other hand, you are on the pill to "regulate your periods" or for some other reason, please understand that the pill does very little to "cure" any underlying hormonal imbalance. It simply puts the ovaries "on hold" artificially until such time as a woman stops taking them.

Taking the pill is an individual decision. It's neither a panacea nor a curse. In the final analysis, it has certainly done far more good than harm!

Copyright Christiane Northrup, Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited.

This information is not intended to treat, diagnose, cure, or prevent any disease.
All material in this article is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise, or other health program.

References:

[1] R. Hatcher et al., Contraceptive Technology (New York: Irvington Publishers, 1991).
[2] C. Panzer et al., "Impact of Oral Contraceptives on Sex Hormone Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction," Journal of Sexual Medicine, vol. 3, no. 1 (January 2006), pp. 104-13.
[3] M. K. Horwitt et al., "Relationship Between Levels of Blood Lipids, Vitamins C, A, E, Serum Copper, and Urinary Excretion of Tryptophan Metabolites in Women Taking Oral Contraceptive Therapy," American Journal of Clinical Nutrition, vol. 28 (1975), pp. 403-12; K. Amatayakul, "Vitamin Metabolism and the Effects of Multivitamin Supplementation in Oral Contraceptive Users," Contraception, vol. 30, no. 2 (1984), pp. 179-96; and J. L. Webb, "Nutritional Effects of Oral Contraceptive Use," Journal of Reproductive Health, vol. 25, no. 4 (1980), p. 151.
[4] A. M. Kaunitz, "Oral Contraceptives," in Thomas G. Stovall and Frank W. Ling, eds., Gynecology for the Primary Care Physician (Philadelphia: Current Medicine, 1999).
[5] I. F. Godsland et al., "The Effects of Different Formulations of Oral Contraceptive Agents on Lipid and Carbohydrate Metabolism," New England Journal of Medicine, vol. 323, no. 20 (Nov. 15, 1990), pp. 1375-81.
[6] M. Bernier, Y. Mikaeloff, M. Hudson, and S. Suissa, "Combined Oral Contraceptive Use and the Risk of Systemic Lupus Erythematosus," Arthritis Care & Research, vol. 61, no. 4 (April 15, 2009), pp. 476-81.
[7] V. Cogliano et al., "Carcinogenicity of Combined Oestrogen-Progestagen Contraceptives and Menopausal Treatment," Lancet Oncology, vol. 6, no. 8 (August 2005), pp. 552-53.
[8] Collaborative Group on Hormonal Factors in Breast Cancer, "Breast Cancer and Hormonal Contraceptives: Further Results," Contraception, vol. 54, no. 3 suppl. (Sept. 1996), pp. 1S-106S.

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