Thursday, April 3, 2008
Cervical changes:
The thickness and strength of the cervical lining varies with the ebb and flow of reproductive hormones; and OCs can lead to an increase in the area of thin, vulnerable cervical tissue susceptible to sexually transmitted diseases (STDs). Most doctors recommend you use condoms for STD prevention while taking the Pill to prevent pregnancy, especially if you have more than one sexual partner and if you are less than 25 years old.
Liver and gallbladder complications:
OCs can cause jaundice—a liver condition that makes the skin and eyes look yellow—but only 1 in 10,000 Pill users experience Pillrelated jaundice. OCs can also cause another rare liver condition known as hepatocellular adenoma. The risk of developing this condition is about 3 or 4 per 100,000 Pill users. Liver cancer is another rare complication. Gallbladder disease, which is fairly common among users—and nonusers—of the Pill, is not life threatening but could require surgery.
Increased Blood Sugar Levels
Estrogen and progestin not only can affect blood clotting and blood lipids, they can also raise blood sugar levels. Most experts believe these changes are so minimal, they have no clinical significance. For women with diabetes, however, the situation isn't so straightforward. Some doctors believe that diabetic women with no other risk factors can use OCs with minimal trouble, but others believe prescribing OCs to diabetics exposes them to unnecessary risks
High Blood Pressure:
Although in itself not a life threatening condition, Pillrelated high blood pressure—experienced by up to 5 percent of women taking highdose pills—can lead to heart disease and stroke. If your blood pressure is over 140/90, you should stop taking OCs until it is under control. All women using the Pill should have their blood pressure checked once a year; for women with a history of blood pressure problems, a check once every six months is probably in order.
Heart and blood vessel disorders:
Although concerns about cancer are usually foremost in the minds of women using OCs, the Pill's effects on blood chemistry are actually a greater cause for worry. Both the hormones in combined OCs are responsible for these problems, but in different ways.
The progestin component of OCs can alter the level of lipids (such as cholesterol) in the blood. Although estrogen works against this effect by increasing beneficial highdensity lipoproteins (HDL) and lowering harmful lowdensity lipoproteins (LDL), progestin opposes the estrogen and does the opposite. Because high levels of LDL and depressed levels of HDL can cause fatty plaque to build up in the arteries, progestins have been implicated as a risk factor for coronary heart disease.
The estrogen component has been linked to a different problem: an increase in abnormal blood clotting, which can block circulation. A blood clot can appear in any blood vessel, but it is especially serious if it occurs in the brain, heart, or lungs.
Clots or blockages to blood flow can lead to serious and sometimes fatal complications that are usually associated with the following risk factors:
Family history of heart attack or diabetes
Previous heart or blood vessel disease
Smoking
High blood pressure
Overweight
Inactivity (either from too little exercise or from being immobilized)
If you have any of these risk factors, you should ask your physician whether the benefits from taking the Pill outweigh the possible dangers. Doctors and private clinics usually make this decision on a case-by-case basis. Public clinics may have stricter rules against giving OCs to women with certain risk factors.
Here is a description of the symptoms you might experience if you are suffering from a blood clot or blockage, and the technical name your doctor might use to describe it. If you think you have one of these problems, seek medical attention as soon as possible.
Headache, impairment of the intellect, visual problems, weakness or numbness— Cerebral infarction (stroke)
Chest pain, difficulty breathing, left arm and shoulder pain, weakness— Myocardial infarction (heart attack)
Calf pain or swelling, heat or redness in the thigh, heat or tenderness in the lower leg, pain— Thrombophlebitis
Chest pain, cough, shortness of breath— Pulmonary embolism
Abdominal pain, vomiting, weakness— Mesenteric vein thrombosis
Headache, loss of vision— Retinal vein thrombosis
Cramps, lower abdominal pain— Pelvic vein thrombosis
The progestin component of OCs can alter the level of lipids (such as cholesterol) in the blood. Although estrogen works against this effect by increasing beneficial highdensity lipoproteins (HDL) and lowering harmful lowdensity lipoproteins (LDL), progestin opposes the estrogen and does the opposite. Because high levels of LDL and depressed levels of HDL can cause fatty plaque to build up in the arteries, progestins have been implicated as a risk factor for coronary heart disease.
The estrogen component has been linked to a different problem: an increase in abnormal blood clotting, which can block circulation. A blood clot can appear in any blood vessel, but it is especially serious if it occurs in the brain, heart, or lungs.
Clots or blockages to blood flow can lead to serious and sometimes fatal complications that are usually associated with the following risk factors:
Family history of heart attack or diabetes
Previous heart or blood vessel disease
Smoking
High blood pressure
Overweight
Inactivity (either from too little exercise or from being immobilized)
If you have any of these risk factors, you should ask your physician whether the benefits from taking the Pill outweigh the possible dangers. Doctors and private clinics usually make this decision on a case-by-case basis. Public clinics may have stricter rules against giving OCs to women with certain risk factors.
Here is a description of the symptoms you might experience if you are suffering from a blood clot or blockage, and the technical name your doctor might use to describe it. If you think you have one of these problems, seek medical attention as soon as possible.
Headache, impairment of the intellect, visual problems, weakness or numbness— Cerebral infarction (stroke)
Chest pain, difficulty breathing, left arm and shoulder pain, weakness— Myocardial infarction (heart attack)
Calf pain or swelling, heat or redness in the thigh, heat or tenderness in the lower leg, pain— Thrombophlebitis
Chest pain, cough, shortness of breath— Pulmonary embolism
Abdominal pain, vomiting, weakness— Mesenteric vein thrombosis
Headache, loss of vision— Retinal vein thrombosis
Cramps, lower abdominal pain— Pelvic vein thrombosis
SEE YOUR DOCTOR IF...
Here is an easytoremember acronym to help you determine whether to consult your doctor about what could be pillrelated complications. Seek help if you experience jaundice, a breast lump, or any of the following warning signals:
A Abdominal pain (severe)
C Chest pain (severe), cough, shortness of breath
H Headache (severe), dizziness, weakness, or numbness
E Eye problems (vision loss or blurring), speech problems
S Severe leg pain (calf or thigh)
Source: Contraceptive Technology. Irvington Publishers Inc., New York, NY, 1994.
OC use has been implicated in a rare form of liver cancer known as hepatocellular carcinoma. However, since so few people ever develop this cancer, it has been difficult for researchers to determine with accuracy whether OCs were actually the cause. The largest study to include data about hepatocellular carcinoma found no association with OC use. In addition, death rates from liver cancer in the United States haven't changed since the introduction of OCs to the marketplace in the 1960s.
Despite a suggestion that OC use might lead to skin cancer, followup studies indicate no difference in the risk for Pill users versus nonusers. There is also no proven relationship between OCs and kidney cancer, colon cancer, gallbladder cancer, or pituitary tumors.
A Abdominal pain (severe)
C Chest pain (severe), cough, shortness of breath
H Headache (severe), dizziness, weakness, or numbness
E Eye problems (vision loss or blurring), speech problems
S Severe leg pain (calf or thigh)
Source: Contraceptive Technology. Irvington Publishers Inc., New York, NY, 1994.
OC use has been implicated in a rare form of liver cancer known as hepatocellular carcinoma. However, since so few people ever develop this cancer, it has been difficult for researchers to determine with accuracy whether OCs were actually the cause. The largest study to include data about hepatocellular carcinoma found no association with OC use. In addition, death rates from liver cancer in the United States haven't changed since the introduction of OCs to the marketplace in the 1960s.
Despite a suggestion that OC use might lead to skin cancer, followup studies indicate no difference in the risk for Pill users versus nonusers. There is also no proven relationship between OCs and kidney cancer, colon cancer, gallbladder cancer, or pituitary tumors.
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.)
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.)
How Effective Is the Pill?
Given all the ways the Pill discourages fertilization it's hard to believe that anyone can get pregnant while using it. And in fact, the Pill does have an effectiveness rate of over 99 percent when used correctly, (taking an active tablet every day during the 21day cycle). However, because women do forget to take a pill now and then, actual effectiveness in realworld use is about 97 percent.
ARE YOU A GOOD CANDIDATE FOR OCS?
You and your doctor should discuss the pros and cons of birth control pills. In general, pills might not be right for you if you:
Are pregnant
Are over 35 and a heavy smoker (more than 15 cigarettes a day)
Are over 50 years of age
Begin getting migraine headaches after you start using the Pill
Are about to have major surgery which would immobilize you
Are breastfeeding
Have had a child in the last two weeks
Additionally, OCs might not be right for you if you have or have had in the past:
Problems with blood clots (thrombophlebitis or cerbrovascular accidents)
Heart disease
Cancer of the breast or reproductive tract
Liver problems or cancer
Kidney disease
High blood pressure
Diabetes
Active gallbladder disease
Congenital hyperbilirubinemia (Gilbert's disease)
Conditions which would make it difficult to take a pill every day (mental retardation, psychiatric illness, substance abuse)
That may sound pretty good, but remember that it does fall short of total certainty. For example, even assuming the Pill is 99.5 percent effective, 84,000 of the 16.8 million women currently using OCs will have an unintended pregnancy, even if they take their pills correctly every day! If you are concerned about accidental pregnancy while using OCs, you should use a backup method—like a condom or spermicide—each time you have sex. In addition to allaying your fears about getting pregnant, a latex condom, unlike the Pill, will help protect you from the viral types of sexually transmitted disease.
ARE YOU A GOOD CANDIDATE FOR OCS?
You and your doctor should discuss the pros and cons of birth control pills. In general, pills might not be right for you if you:
Are pregnant
Are over 35 and a heavy smoker (more than 15 cigarettes a day)
Are over 50 years of age
Begin getting migraine headaches after you start using the Pill
Are about to have major surgery which would immobilize you
Are breastfeeding
Have had a child in the last two weeks
Additionally, OCs might not be right for you if you have or have had in the past:
Problems with blood clots (thrombophlebitis or cerbrovascular accidents)
Heart disease
Cancer of the breast or reproductive tract
Liver problems or cancer
Kidney disease
High blood pressure
Diabetes
Active gallbladder disease
Congenital hyperbilirubinemia (Gilbert's disease)
Conditions which would make it difficult to take a pill every day (mental retardation, psychiatric illness, substance abuse)
That may sound pretty good, but remember that it does fall short of total certainty. For example, even assuming the Pill is 99.5 percent effective, 84,000 of the 16.8 million women currently using OCs will have an unintended pregnancy, even if they take their pills correctly every day! If you are concerned about accidental pregnancy while using OCs, you should use a backup method—like a condom or spermicide—each time you have sex. In addition to allaying your fears about getting pregnant, a latex condom, unlike the Pill, will help protect you from the viral types of sexually transmitted disease.
Your OC Options
Birth control pills come in packs of either 21 “active” pills (containing hormones), or packs of 28 pills, 21 of which are active and seven of which are inactive placebos. The placebo pills are simply a way of staying in the habit of taking a daily pill, even while having your period.
Either package, 21 days or 28 days, can be “monophasic” or “triphasic.” Monophasic pills provide the same dosage level of hormones all through the active cycle, whereas triphasic pills give different dosage levels during each week of active pills. Triphasics were designed to more closely follow a woman's natural hormonal pattern. However, most experts say the fluctuations don't really matter and may even cause extra problems, such as increased “breakthrough” bleeding (sporadic menstruation) while on the Pill, or an increase in Pill-related headaches.
Birth control pills are either called “combined” OCs or “progestinonly” OCs. Combined pills are a combination of the hormones estrogen and progesterone. Progestinonly pills, also called minipills, lack the estrogen component. Since women shouldn't use estrogencontaining products when they are breastfeeding, minipills are often prescribed for women who want protection from pregnancy six weeks after they give birth. Minipills also have lower doses of progestin than combination forms, making them a good choice for women worried about metabolic effects of the hormones (but a bad choice for women who want highly effective birth control). They also require a woman to take them on a rigidly regular schedule.
Either package, 21 days or 28 days, can be “monophasic” or “triphasic.” Monophasic pills provide the same dosage level of hormones all through the active cycle, whereas triphasic pills give different dosage levels during each week of active pills. Triphasics were designed to more closely follow a woman's natural hormonal pattern. However, most experts say the fluctuations don't really matter and may even cause extra problems, such as increased “breakthrough” bleeding (sporadic menstruation) while on the Pill, or an increase in Pill-related headaches.
Birth control pills are either called “combined” OCs or “progestinonly” OCs. Combined pills are a combination of the hormones estrogen and progesterone. Progestinonly pills, also called minipills, lack the estrogen component. Since women shouldn't use estrogencontaining products when they are breastfeeding, minipills are often prescribed for women who want protection from pregnancy six weeks after they give birth. Minipills also have lower doses of progestin than combination forms, making them a good choice for women worried about metabolic effects of the hormones (but a bad choice for women who want highly effective birth control). They also require a woman to take them on a rigidly regular schedule.
THE PILL: PROS AND CONS
To help you decide whether oral contraception is for you, here's a brief overview of its pluses and minuses:
Advantages:
Highly effective
Does not interrupt sex
Safe for most women
Protects against ovarian and endometrial cancer
Decreases menstrual cramps and pain
Reduces menstrual blood flow, thereby reducing anemia
Is easily reversible
Is easy to use and discontinue
Has been well researched
Disadvantages:
Offers no protection from sexually transmitted diseases
Can be expensive
Produces rare but dangerous complications
May cause mood changes
May give rise to nuisance side effects such as headaches, weight gain, and breakthrough bleeding
Must be taken every day
Taking OCs for many years poses no increased risk of infertility, as was believed by 45 percent of the respondents. Experts say women don't need to take a break from the Pill, even after using it for long periods of time.
Fortythree percent of those interviewed said that women over age 35 shouldn't take OCs. However, the truth is that healthy nonsmoking women can use OCs all the way through menopause without any detriment to health.
More importantly, very few women interviewed for this poll knew that the Pill can actually protect women from certain health problems, including some types of cancer. Although it is clearly stated on the Pill package insert, less than 20 percent of women polled knew that the Pill helps reduce the incidence of ovarian and endometrial cancer, ovarian cysts, and benign cysts of the breast.
The Pill is not right for all women because, despite its beneficial effects, it is also associated with some risks. Doctors usually advise women likely to suffer from heart attacks, strokes, or blood clots—especially those who smoke—to choose some other type of contraception. Several other conditions, such as hypertension, diabetes, or sickle cell disease, also make Pilltaking risky.
The following information should help you improve your “Pill I.Q.”
Advantages:
Highly effective
Does not interrupt sex
Safe for most women
Protects against ovarian and endometrial cancer
Decreases menstrual cramps and pain
Reduces menstrual blood flow, thereby reducing anemia
Is easily reversible
Is easy to use and discontinue
Has been well researched
Disadvantages:
Offers no protection from sexually transmitted diseases
Can be expensive
Produces rare but dangerous complications
May cause mood changes
May give rise to nuisance side effects such as headaches, weight gain, and breakthrough bleeding
Must be taken every day
Taking OCs for many years poses no increased risk of infertility, as was believed by 45 percent of the respondents. Experts say women don't need to take a break from the Pill, even after using it for long periods of time.
Fortythree percent of those interviewed said that women over age 35 shouldn't take OCs. However, the truth is that healthy nonsmoking women can use OCs all the way through menopause without any detriment to health.
More importantly, very few women interviewed for this poll knew that the Pill can actually protect women from certain health problems, including some types of cancer. Although it is clearly stated on the Pill package insert, less than 20 percent of women polled knew that the Pill helps reduce the incidence of ovarian and endometrial cancer, ovarian cysts, and benign cysts of the breast.
The Pill is not right for all women because, despite its beneficial effects, it is also associated with some risks. Doctors usually advise women likely to suffer from heart attacks, strokes, or blood clots—especially those who smoke—to choose some other type of contraception. Several other conditions, such as hypertension, diabetes, or sickle cell disease, also make Pilltaking risky.
The following information should help you improve your “Pill I.Q.”
Oral Contraceptives
Birth control pills have been popular since the 1960s, and today they are relied upon by more than half of all women using a reversible method of birth control. Over the years, a tremendous amount of research has been done on their effects, but despite the large body of knowledge available, scientists are still at work investigating such things as the association between OCs and breast cancer.
Even if you think you're well informed about oral contraceptives, take this quick true/false quiz to determine your “Pill I.Q.”:
The Pill works by destroying the egg once it is released from the ovary.
Taking the Pill too long makes it difficult for most women to conceive; it may even cause them to become sterile.
A woman should take a short break from the Pill after she has used it for five years.
Women over 35 years old should not take the Pill.
Taking the Pill can lead to many types of cancer, including ovarian and endometrial cancer.
If you answered false to all these statements, you know more about the Pill than a great many people. A recent Gallup poll of over 1,000 American women aged 18 to 44 found that knowledge is sorely lacking about this widespread method of birth control. For example, onequarter of the survey's respondents believed that the Pill works by killing the egg, when in fact it inhibits egg production altogether.
Even if you think you're well informed about oral contraceptives, take this quick true/false quiz to determine your “Pill I.Q.”:
The Pill works by destroying the egg once it is released from the ovary.
Taking the Pill too long makes it difficult for most women to conceive; it may even cause them to become sterile.
A woman should take a short break from the Pill after she has used it for five years.
Women over 35 years old should not take the Pill.
Taking the Pill can lead to many types of cancer, including ovarian and endometrial cancer.
If you answered false to all these statements, you know more about the Pill than a great many people. A recent Gallup poll of over 1,000 American women aged 18 to 44 found that knowledge is sorely lacking about this widespread method of birth control. For example, onequarter of the survey's respondents believed that the Pill works by killing the egg, when in fact it inhibits egg production altogether.
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