Contraception Family Planning Medical Reproductive Health

Happy Birthday to “The Pill”

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.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at:

Action Contraception Durango Herald Family Planning Medical Population Public Health Reproductive Health Women's Issues

No on Amendment 48

The article below may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at:


No on Amendment 48

© Richard Grossman MD, 2008



“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof….” First Amendment to the Constitution of the United States


            “I am sorry, Mrs. Folk. There is nothing I can do.” I am in my office, holding ultrasound pictures. The Folks are sitting in front of me, looking dumbfounded. Two of their three children are present; the oldest is at school.

            “These pictures show a tubal pregnancy. It is very early, but we can still see the fetal heartbeat. It is clearly outside of your uterus.” Mrs. Folk is crying now.

             “In the past we used to treat ectopic pregnancies with surgery, or even just medicine. That is not possible now. Your chances of dying from this pregnancy are about fifty-fifty.”

            Approximately one pregnancy in 200 is in the wrong place. Although a woman’s uterus is wonderfully adapted to nourishing a developing fetus, her tubes are not. When a pregnancy grows in the tube, it tears the fragile tissue, causing pain and internal bleeding. Women still die of tubal pregnancies.

            Is the above scenario some sort of science fiction, set in some remote hard-hearted future? No, not if proposed Amendment 48 passes this November election. This scenario could happen right here in Colorado next year.

            Clearly 48 was drafted to stop all abortions in Colorado (even after rape or incest). It is short—and extremely deceptive. Nicknamed the “Personhood Amendment”, 48 reads: “As used in sections 3, 6, and 25 of article II of the State Constitution, the terms ’person’ or ‘persons’ shall include any human being from the moment of fertilization.”

            Section 25 of the Colorado Constitution states: “Due process of law. No person shall be deprived of life, liberty or property, without due process of law.” If a developing fetus (or even a newly fertilized egg) is defined as a person, then anyone who interrupts a pregnancy, no matter if it is potentially lethal to the mother, could be punished. The woman herself would be an accomplice. This would mean that anyone, including a physician who does surgery to save a woman’s life because of a tubal pregnancy, would be subject to the same penalties as a first degree murderer. Would the police have to investigate women who have miscarriages, too?

            The proposed amendment is so extreme that, if 48 were to pass, it would create legal havoc in our state. It would take years and millions of dollars to work out the legal implications.

            This amendment would not only prevent abortion, but it might also prevent many forms of contraception. Antiabortion people claim that hormonal birth control and IUDs cause abortions. Their evidence for this is weak, and is at odds with the majority of medical experts including the American College of Obstetricians and Gynecologists—my professional organization.

            The sad fact is that the amendment would probably increase the number of abortions! Making abortion illegal doesn’t stop women from trying to interrupt pregnancies—it makes them use desperate means. For instance, when abortion became legal in Norway, the abortion rate didn’t increase. Women did get better care, however. Remember that the best way to prevent abortions is with access to good contraception.

            Moreover, proposed Amendment 48 would prevent couples from taking advantage of many infertility treatments. In vitro fertilization would be banned because of the risk of losing an embryo—defined as a person.

            The people who wrote this proposed amendment (and the 131,245 people who signed petitions to put it on the ballot in November) appear to be honest, God-fearing Coloradoans. Their website lists physicians who support the amendment, but very, very few live in Colorado! In fact, they are outsiders testing the waters in our state to see how they can control women’s reproductive lives. Because of their efforts to impose their strict religious beliefs on everyone, they are the closest thing we have in the USA to the Taliban.

            This proposed amendment would punish parents and physicians who believe that all children should be planned and loved. It has been centuries since people were punished so severely for trying to help women control their fertility. There is strong evidence that the motivation to seek out and kill “witches” in Colonial times was to eradicate women who held the secrets of contraception. This was one way men could retaliate against women who knew more than they did.

            Don’t let religious zealots control women’s lives in Colorado. Vote “NO” to proposed Amendment 48. Go to for more information.


Published October, 2008