Is Your Birth Control Pill Driving You Bananas?

A collective howl is going up amongst women over at medications.com over the birth control pill, Yasmin. These women are complaining of depression, anxiety, loss of sex drive, headaches, and dizziness, and most of them didn't feel like they were adequately informed about these potential side effects. In fact, Yasmin is the most bitched about drug on medications.com, with over 4,000 women logging in to report problems with it. It looks like Yasmin needs to join the blogroll of medications that if they don't kill you they will drive you crazy.

How can this be? Birth control pills (or oral contraceptive pills, or OCPs) are combinations of sex hormones related to estrogen and progesterone. Normally these sex hormones cycle throughout the month. In addition to controlling reproduction they also have effects on the brain, which is why they can cause anxiety and depression. Taking the pill effectively blunts the normal variation in hormones; it also eliminates ovulation, which also affects sexuality. In fact, one study showed that strippers who were ovulating made $15 more per hour than strippers who were not ovulating, and that strippers on the pill made significantly less than other strippers.

OK, you say, I can live with a little moodiness. But is my pill going to kill me? OCPs can increase blood clotting, which can lead to heart attacks or strokes. But for non-smoking women age 15-30, there is no increase in death rate for a comparable form of contraception, the IUD. Because of the health risks of pregnancy, the death rate amongst women from age 15-34 who are on the pill is actually lower than for women who do not use any form of birth control.

For smokers there is an increased risk with OCPs that gets worse with age. For instance, the risk of death is 1 in 200,000 per year in non-smoking women under the age of 35. However risk increases with age and smoking to 1 in 700 per year for smokers over age 35.

The risk of cancer with OCPs overall isn't great. Some cancers, like cervical cancer, increase after ten years of use, the overall risk from breast cancer is not increased. OCPs reduce the risks of ovarian and uterine (endometrial) cancers. OCPs reduce the risk of anemia, pelvic inflammatory disease, and osteoporosis.

Women who take the pill have identical fertility rates after going off the pill compared to women who never took the pill.

Use an OCP with low doses of estradiol (<50 µg). Taking an OCP is safe for women who don't smoke. For women who are smokers over age 35, or have other reasons not to take the regular pill (e.g. history of blood clots), consider the Minipill or another all progesterone pill, or one of the alternatives to the pill, like an IUD.

J. Douglas Bremner, MD, is author of 'Before You Take That Pill: Why the Drug Industry May be Bad for Your Health.'