Happy Birthday to “The Pill”—5-2010
© Richard Grossman MD, 2010
It was fifty years ago that the Food and Drug Administration approved “the pill”. What a half-century it has been!
The birth control pill made it possible for couples to have sex without concern about pregnancy. True, before hormonal contraceptives there were other contraceptives—but the condom, diaphragm and spermicide took away much of the spontaneity of sex. One of the advantages of the pill is that it separates contraception from intercourse.
Shortly before getting married in 1966 my wife visited a doctor to get on birth control pills. I remember that she brought home a bottle of tablets. Packaging has changed since then with the package helping the woman to remember to take her pill. There is even a pill pack with a reminder alarm!
The amount of hormone in each tablet has also changed; it has decreased immensely. The estrogen in today’s low dose pill is one seventh that of the first pill. If you have wondered why pills are different colors for different days, it is because many of today’s oral contraceptives vary the dosage during the month to get good cycle control with a very low level of hormones.
One formulation is not optimal for all women. Although all of today’s combined pills contain the same estrogen, the dosage varies between 20 and 50 micrograms. They also have different progestins (hormones similar to the other major hormone the ovary produces, progesterone). Some are excellent in controlling menstruation, others excel at helping with acne and others are best in alleviating PMS.
Initially every woman took active hormone pills for three weeks then stopped (or took placebos) for a week, then went back on the active pills again. That pattern has changed. Some pill formulations are designed so that the woman only menstruates every three months, and one prevents any bleeding at all. Suppressing periods is especially helpful for women who have problems such as heavy bleeding or bad cramps. We now recommend against a “vacation” from hormonal contraception—this only increases the risk of pregnancy.
“The pill” is one of several ways a woman can take hormones. In China the hormones are available as little dots on rice paper. We have patches that women wear; the hormones are delivered through the skin. There is also a plastic vaginal ring that slowly emits the hormones.
Of the two hormones, the progestin is the one most responsible for controlling fertility; the estrogen is added for cycle control. Unfortunately, the estrogen also increases the chances of blood clots, stroke and heart attack, especially in older women and those who smoke.
Progestin-only contraception without estrogen is available in “the minipill”, in a shot that is effective for 3 months, as an implant that goes under the skin of a woman’s arm, and in an IUD. All of these methods have the advantage of safety, but they often cause erratic bleeding.
We prescribe “the minipill” for women who are breastfeeding and for older women and those who are at risk of blood clots. This pill carries a very low risk of blood clots, but has a higher pregnancy rate and many users have irregular bleeding. It is important to take it at the same time every day, preferably at night.
Emergency contraception is a high dose of progestin that can prevent pregnancy when taken after unprotected intercourse. Although it can cause nausea, it has no serious risks and is up to 90 percent effective.
Birth control pills are safe for almost all women despite the slightly increased risk of blood clots. There are many beneficial side effects, including less bleeding and pain with periods, more predictable periods, and fewer ovarian and breast cysts. They also decrease the risk of developing several types of cancer. Overall, studies show that women who use “the pill” live longer than women who are “pill-free”.
“The pill” caused a revolution. This was the first widely available family planning method, and allowed women to have a sexual relationship without fear of pregnancy. It also has been a large part of programs that have slowed the growth of the human population. Historically, our growth was controlled by high mortality rates, especially by the deaths of children. It is much better to prevent undesired pregnancies than to rely on high mortality rates.
We just spent Mother’s Day with our son Dave, who was conceived after we had been married several years. Gail, my wife, took “the pill” and it was a blessing that we could wait before starting our family.
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