than a contraceptive
prescription medication has probably been studied the most intensively?
Oral contraceptives (OCs), invented in the 1960s. They’ve been used,
at one time or another, by 80% of American women. “The Pill,” as OCs
are familiarly known, gives women control over their own fertility with
very low risk of adverse effects. The Pill cannot be surpassed for
safety and reliability (when correctly used) combined
with reversibility. That is, a woman can discontinue it and become
pregnant if she wishes. Unlike condoms, though, it does not protect
against sexually transmitted diseases. OCs come in many different
formulations and deliver much lower doses of hormones than they used to.
Some combine estrogen with progestin, while some (mini-pills) have
many women fear the Pill, which has had an undeservedly bad press. Using
the Pill is far less a threat to a woman’s health, generally speaking,
than pregnancy and childbirth. Though there were concerns that the old
high-dose Pill could increase the risk of heart disease, the new
low-dose formulations contain only a quarter of the estrogen and
one-tenth the progestin and have decreased the risks of all adverse
effects. The surprise, though, is that the health benefits of OCs go beyond
contraception, and outlast the reproductive years.
and the Pill
cancer: It’s been known for some time that the Pill can cut the
risk of ovarian cancer by half. Indeed, it’s now recommended to women
at high risk for ovarian cancer because of family history and
longer such women use the Pill, the greater their reduction in risk, up
to 60% after six years of use. And it protects low-risk women, too. This
may be because the Pill reduces the number of ovulations a woman has
over her lifetime. The Pill also reduces the risk of nonmalignant
cancer: Cancer of the uterine lining, though less likely to be fatal
than ovarian cancer, is more common. The Pill can reduce the risk of
endometrial cancer by 50%. It
protects against fibroid tumors (benign) of the uterus, and can be used
to treat endometriosis, a benign but often painful condition that can
protective effect against these cancers appears to continue long after a
woman stops taking the Pill.
cancer: Pill users as well as scientists have worried that the
estrogen in the Pill might promote breast cancer. But the news is
encouraging. Most studies have found no increased risk from using OCs,
especially with the new low-dose Pill. However, one study at the
National Cancer Institute in 1995 did find a very slight increase in
risk in women under 35 who had
used OCs for at least six months. But when checked 10 years after
discontinuation, the women’s risk had returned to normal. It’s not
certain that the Pill really caused this small increase, which may have
been more apparent than real. One possible reason for the increase:
women on OCs probably get more thorough and more regular checkups. Thus
the cancers were usually discovered at an early stage and were often
curable. A more recent British study of 46,000 women found no increased
disease and the Pill
latest evidence shows that OCs do not put healthy women at risk for
heart disease or blood clots, unless they smoke. However, a study in Circulation
last year, which looked at women in California and Washington, found
that low-dose OCs do not increase the risk of a heart attack even in
women who smoke or have another major risk factor for cardiovascular
disease, such as obesity, high blood pressure, or diabetes.
the Pill is not recommended for women over 35 who smoke.
and the Pill
on the Pill gives a woman greater control over her menstrual periods. If
her periods have been irregular, the Pill can make them predictable. If
she wants to postpone a period because of athletic activity or a
forthcoming vacation, she can skip the blank pills and start the next
month’s dose. OCs also reduce the amount of menstrual bleeding, thus
reducing iron loss, and can also relieve or prevent menstrual cramps. In
some women, OCs can help be an effective medication for PMS, preventing
or reducing premenstrual symptoms such as bloating, anxiety, depression,
mood swings and headaches.
uses, and some drawbacks
there are other benefits, too: enhanced sexual enjoyment for many women
and their partners, as well as “morning after” or emergency
contraception. The Pill may be helpful for acne, too.
all drugs, however, OCs can have side effects in some users, including
headaches, weight gain and bloating, depression, and unwanted menstrual
changes such as missed periods or breakthrough bleeding. Women with
bothersome side effects have to weigh the benefits and risks, preferably
with good advice from their physician or nurse-practitioner. There are
many kinds of OCs to choose from. If one causes side effects, another
have to be taken regularly, every day. And OCs are expensive ($20 to $30
for a month’s supply) and not always covered by health insurance. But
this is changing: some states now require coverage of OCs.
you are on the Pill, remember that it can interact with other
medications, so do remind your doctor that you take OCs when a new
medication is being prescribed. In particular, some antibiotics can
reduce the effectiveness of OCs.
safe and indeed advisable for a Pill user to continue taking it right up
through menopause. It can prevent or reduce unpleasant menopausal
symptoms such as hot flashes, sleeplessness, and mood swings. There’s
some evidence, still not definitive, that OCs help preserve bone
once your menstrual periods have stopped and pregnancy is no longer a
risk, you should stop taking the Pill and consider the pros and cons of
hormone replacement therapy (HRT).
small study suggested that there is a small increased risk of breast
cancer from taking OCs followed by HRT, but more research is needed.
Taking hormones after menopause offers its own set of benefits (protection against heart
disease, postponement or reduction of bone loss) and risks (an increase
in breast cancer risk for some women). The dose of estrogen in HRT is
only 10 to 25% as much as that in the lowdose Pill.