Thursday, April 3, 2008

The Benefits and Risks

OCs are among the most thoroughly studied drugs in the world. The vast body of data collected on them indicates that although they do have certain side effects, few women are likely to experience them. Moreover, most of the information on side effects was collected from studies of higher dose pills than those generally in use today. And research done in the Pill's early years involved women who had not been screened to see if they were good candidates. Today, women with a personal or family history of heart disease or other illnesses linked to the Pill are usually steered towards another method of birth control. If you are healthy, you don't smoke more than 15 cigarettes a day, and no one in your family has suffered from cancer, a heart attack, or very high cholesterol, you may never experience any of the more serious side effects.

The Pill can produce both “nuisance” side effects and more serious health problems. Included among the more serious potential effects are increased risk of cervical and liver cancer (and possibly breast cancer—studies so far are inconclusive), heart and blood vessel disorders (clots and high cholesterol), high blood pressure, increased blood sugar levels, complications with the liver and gallbladder, cervical changes (increasing your risk for sexually transmitted diseases), eye problems, and delays in fertility once pills are discontinued. Some women at risk for these complications can continue taking OCs if they use them cautiously. Your doctor should be able to help you determine whether or not you should avoid the Pill.

Cancer: Women who have used OCs sometime in their lives are less likely to develop cancer by age 55 than women who have never taken the Pill. Oral contraceptives really do protect against certain kinds of cancer. If you use OCs for at least a year, your risk of developing endometrial cancer diminishes by 50 percent and it drops even more after three years of Pill use. The protection lasts up to 15 years after you stop using OCs.

Ovarian cancer, the most lethal of all female reproductive tract cancers, is also 40 percent less likely to develop in a woman who has used OCs. Even if you use OCs for as little as three months, you get some protection, but to get the full effect you need to take them for 5 to 10 years. If you use them for 10 years, your risk is reduced by 80 percent. The protection lasts for at least 10 to 15 years after discontinuation.

Endometrial and ovarian cancer are not the most common female cancers. Still, an estimated 2,000 cases of endometrial cancer and 1,700 cases of ovarian cancer were averted by Pill use in the 1980s.

OCs do not protect women from cervical cancer. In fact, the opposite may be true. Women who take the Pill for over a year appear to run an increased risk of developing this disease, the risk doubles when the medication is taken for 10 years. However, the most important risk factors for cervical cancer are not OCs, but rather the number of sexual partners a woman has had and how old she was when she first had sex. Exposure to human papillomavirus (HPV) and smoking also increase a woman's risk, while the use of barrier contraceptives, such as a diaphragm, condoms or spermicides protects against cervical cancer. It is difficult to determine the impact of these factors in women with cervical cancer who also used OCs, so research results have not been definitive. One study conducted by the Centers for Disease Control and Prevention (CDC) showed that women who used OCs didn't get cervical cancer more often than non­users. Instead, the higher rate of cancer diagnosed among these women was simply due to more careful screening, including more frequent Pap smears.

One woman in 9 will develop breast cancer during her lifetime, so it's not surprising that breast cancer is the main concern of anyone considering use of OCs. Unfortunately, despite a large body of scientific evidence showing no association between the two, a few studies have seemed to uncover an increased risk of breast cancer among those using OCs. Researchers aren't sure if these studies are important or if they are merely aberrations. It will probably take a decade or more before they reach a definitive conclusion. Many experts do agree that OC use is not associated with breast cancer after age 45. Some younger women, however, may be at higher risk. Several studies have shown that women who use OCs early in life, use them for longer than four years, and/or don't have a full term pregnancy early in life have a slightly increased risk for breast cancer. (However, other research concludes the opposite.)

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