Power Of The Pill
New low-dose pills not only tackle contraception, they also ward off a host of ailments, such as endometrial and ovarian cancers as well as pelvic inflammatory disease. Also, they can minimize irregular bleeding, cramping and pre-menstrual syndrome.
Twenty-eight tiny pills surround a dial in a round, Barbie-doll pink plastic case. As recognizable as a Nike swoosh, it’s an international icon for contraception.
But what few people realize, according to doctors who research oral contraceptives, is that these tablets — so minuscule you barely need to swallow — also provide a wide array of health benefits to women. They can minimize cramps and heavy bleeding. They can prevent ectopic pregnancy and pelvic inflammatory disease.
Best of all, the new low-dose birth control pill can even protect women against endometrial and ovarian cancer. “It’s one of the best-kept secrets in America,” says Dr. David Grimes, an ob-gyn at Family Health International in Research Triangle Park, N.C. “Ninety percent of American women don’t know this.”
Women who take the pill for 10 to 12 years, he says, reduce their risk of ovarian cancer by 80 percent. The effect lasts for 15 years after they quit.
“It’s like a non-participating life insurance policy,” Grimes says. “I wish my malpractice insurance worked that way.”
Today more than 10 million women in the United States take the pill, making it the most popular nonsurgical form of birth control in the country. It has changed dramatically since it was first introduced in 1960. Back then, oral contraceptives contained up to 150 micrograms of estrogen, compared to 20 to 35 micrograms today.
The most commonly prescribed birth control pill now on the market combines synthetic estrogen and progestin. It stops ovulation, thickens the cervical mucus, which makes it more difficult for sperm to enter the uterus, and thins the lining of the uterus, which reduces the chance that a fertilized egg can be implanted.
When used correctly, oral contraceptives are 99 percent effective against pregnancy. Women at risk for sexually transmitted disease, however, must combine them with condoms.
By regulating a woman’s daily dose of estrogen and progestin, the pill can minimize irregular bleeding, cramping and pre-menstrual syndrome.
“Women on the pill are so regular they can predict like a Swiss train the time the period will start and stop,” Grimes says. Similarly, the pill may help alleviate symptoms of perimenopause and menopause, such as insomnia, mood swings and body temperature shifts.
Low-dose oral contraceptives can also be used to eliminate monthly bleeding altogether — an option embraced by business women traveling to Europe, honeymooners and some gynecologists.
“I don’t like to menstruate,” says Dr. Leslie Miller, assistant professor of obstetrics and gynecology at the University of Washington at Haborview Medical Center. “I have two children, 6 and 4. The last time I had a period was three years ago.”
While other doctors prefer to postpone menstruation for no longer than three months, Miller is convinced there’s no reason for her to have a period at all.
“When you have a menses on the pill, it’s an artificial one,” Miller says. “It’s not because you have to bleed or you have something built up inside that you have to get rid of.”
In fact, the artificial hormones in the birth control pill prevent the lining of the uterus from building up as it naturally would, Miller says.
Most pills are packaged in courses that contain 21 days of hormones, followed by seven days of inert ingredients which allow women to menstruate. Miller simply takes each 21-day course back to back. Her prescription is so low in estrogen that it contains only 20 micrograms.
Miller points out that historically women menstruated much less than they do today. They usually didn’t start their cycle until they were 16, then they married early, gave birth to numerous babies, breastfed for years and died young. They may have not had more than 50 menstrual cycles in a lifetime, compared to more than 400 today.
Miller warns women not to attempt menstrual reduction without their doctor’s supervision. Other physicians may disagree with Miller’s approach.
There’s wider agreement, however, that taking oral contraceptives provides women with a long list of health benefits. They include the following:
Endometriosis: Patches of endometrial tissue cling to the uterus, ovaries or fallopian tubes, causing a condition which may be painful and even lead to infertility.
Birth control pills, by eliminating ovulation and creating lighter periods, can help suppress the growth of this tissue. “You can shrink those little individual implants,” says Dr. Anita Nelson, associate professor of obstetrics and gynecology at the University of California at Los Angeles.
Pelvic inflammatory disease: Rates of this disease, which can also lead to infertility, can be cut in half by the birth control pill. Infections such as gonorrhea and chlamydia may remain in the vagina and never reach the uterus, apparently because the pill thickens the mucus in the cervix and reduces bleeding, Nelson says.
Ectopic pregnancy: A fertilized egg can develop outside the uterus, usually in a fallopian tube. The condition can be dangerous, even life-threatening. By stopping ovulation, the pill reduces the risk of ectopic pregnancy by 90 percent, Grimes says.
Iron-deficiency anemia: Heavy monthly bleeding can lead to a low red blood cell count. By reducing blood flow, the pill also prevents anemia.
Osteoporosis: The longer a woman takes the pill, the more dense with calcium her bones will be, Grimes says. Researchers speculate that her bones may be less likely to deteriorate later through osteoporosis.
Oral contraceptives also appear to reduce acne and ovarian cysts, and reduce the rate of benign breast disease by half.
But it’s important to keep in mind that not every woman can take the pill. Women who are pregnant, have breast or uterine cancer, liver failure, high blood pressure or history of a blood clotting disorder should not take it. Neither should any woman who is over 35 and smokes.
Low-dose birth control pills carry fewer risks than their predecessors. While the earlier high-dose pills increased a woman’s risk of heart attack, according to a study published in the American Heart Association journal Circulation, the newer low-dose pills do not.
A major study in 1996 analyzed 54 previous studies on the pill and breast cancer. It found that, while taking the pill and for up to 10 years after quitting, women have a slightly higher risk of being diagnosed with breast cancer. Ten years after stopping the pill, a woman’s risk for breast cancer was no higher than normal.
“The important message to get across to people is that low-dose contraceptives are very, very safe,” says Dr. Leon Speroff, professor of obstetrics and gynecology at Oregon Health Sciences University in Portland.
In Speroff’s view, the biggest problem connected with the pill is compliance. Too often, women forget to take their daily pill, or start taking it too late in their cycle.
One pharmaceutical company hid a microchip in their packages and recorded women’s pill-taking habits. The company found, Speroff says, that women missed pills three times more than they reported.
“We have a huge rate of unwanted pregnancies and abortions because women don’t take the pill,” Speroff says.
Dr. Christiane Northrup, a Maine ob-gyn who is the author of the best-selling book, “Women’s Bodies, Women’s Wisdom” (Bantam, $17.95), does not share her colleagues’ enthusiasm for the birth control pill.
She sees their approach as emblematic of a culture which persists in viewing menstruation as a curse rather than a gift.
“Even at low-dose you become more in tune with the pharmaceutical companies than with the moon,” she says. “Once you begin to understand that the menstrual cycle is part of your inner wisdom and once you understand that your fertility is not a disease, you can begin to work consciously with both of them.”
Northrup prescribes birth control pills to women whose lives prevent them from making changes in their diets and relationships. She believes such changes can improve many menstrual problems.
She finds menstruation “a wonderful introspective time,” and has never taken the pill herself. She wouldn’t dream of embracing Miller’s menstrual reduction regime.
“I don’t want to live in a world where I have to stop it or lie about it or manipulate my body into not having it,” she says.
Even women initially sold on the pill may stop taking it - for a variety of reasons. Physicians who advocate its use find that frustrating.
One of the most common reasons is nuisance bleeding, which usually diminishes after the first three months. Another is weight gain.
But experts disagree about the impact of the pill on a woman’s weight. Dr. Susan Cox, associate professor of obstetrics and gynecology at the University of Texas, says women will gain five to six pounds initially, but level off after three months. “It’s not a lot, but for some women, it’s a disaster,” Cox says.
Speroff does not believe the pill causes women to add any pounds at all. “Weight gain is caused by eating too much and exercising too little,” he says.
On the fundamental issue, however, both agree: Women who are properly screened by their doctors shouldn’t be concerned about taking these artificial hormones.
“No, not at all,” Cox says. “The benefits extraordinarily and by great lengths outweigh the risks.”