HORMONAL METHODS OF CONTRACEPTION: ORAL CONTRACEPTIVES
Oral contraceptive pills were first marketed in the United States in 1960. Their convenience quickly made them the most widely used reversible method of fertility control.
Most oral contraceptives work through the combined effects of synthetic estrogen and progesterone. Because the levels of estrogen in the pill are higher than those produced by the body, the pituitary gland is never signaled to produce follicle-stimulating hormone (FSH), without which ova will not develop in the ovaries. Progesterone in the pill prevents proper growth of the uterine lining and thickens the cervical mucus, forming a barrier against sperm.
Pills are meant to be taken in a cycle. At the end of each three-week cycle, the user discontinues the drug or takes a placebo pill for one week. The resultant drop in hormones causes the uterine lining to disintegrate, and the user will have a menstrual period, usually within one to three days. The same cycle is repeated every 28 days. Menstrual flow is generally lighter than it is for women who don’t use the pill because the hormones in the pill prevent thick endometrial buildup.
Today’s pill is different from the one introduced more than four decades ago. The original pill contained large amounts of estrogen, which caused certain risks for the user, whereas the current pill contains the minimal amount of estrogen necessary to prevent pregnancy.
Because the chemicals in oral contraceptives change the way the body metabolizes certain nutrients, all women using the pill should check with their prescribing practitioners regarding dietary supplements. The nutrients of concern include vitamin С and the B-complex vitamins -B2, B6, and B12. A nutritious diet that includes whole grains, fresh fruits and vegetables, lean meats, fish and poultry, and nonfat dairy products is advised.
Oral contraceptives can interact negatively with other drugs. For example, some antibiotics diminish the pill’s effectiveness and may require an adjustment in dosage to maintain the desired effectiveness. Women in doubt should check with their prescribing practitioners, their pharmacists, or other knowledgeable health professionals.
Return of fertility may be delayed after discontinuing the pill, but the pill is not known to cause infertility. Women who had irregular menstrual cycles before going on the pill are more likely to have problems conceiving, regardless of pill use.
Use of the pill is convenient and does not interfere with lovemaking. It may lessen menstrual difficulties, such as cramps and premenstrual syndrome (PMS). Women using oral contraceptives have lower risks for developing endometrial and ovarian cancers. They are also less likely than nonusers to develop fibrocystic breast disease. In addition, pill users have lower incidences of ectopic pregnancies, ovarian cysts, pelvic inflammatory disease, and iron deficiency anemia. But possible serious health problems associated with the pill include the tendency for pill users’ blood to form clots and an increased risk for high blood pressure in a few women. Clotting can lead to strokes or heart attacks. The risk is low for most healthy women under 35 who do not smoke; it increases with age and especially with cigarette smoking.
Outside these risk factors and certain side effects associated with the pill, its greatest disadvantage is that it must be taken every day. If a woman misses taking one pill, she is advised to use an alternative form of contraception for the remainder of that cycle, while another disadvantage is that the pill does not protect against sexually transmitted infections (STIs). The cost of the pill may also be a problem for some women. Finally, some teenagers report that the requirement to have a complete gynecological examination in order to get a prescription for the pill is a huge obstacle. Educating young women about what goes on in a gynecological exam would certainly help ease their anxiety.
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