An update on the pill
Initiatives in Population 7(3): 2-15
1983
ISSN/ISBN: 0115-2181 PMID: 12339841 Document Number: 407289
The discussion traces the development of the oral contraceptive (OC) pill and presents the most recent medical findings on OC and its effects. In 1959 the 1st combined OC, Enovid, was officially approved for use in the US after clinical trials in Los Angeles and Puerto Rico. By 1975, OCs were being used in the US by more than 1/3 of married women who practiced family planning and by an even higher percentage of unmarried contraceptive users. Retail pharmacy sales of OCs have declined by 40% during the 1975-79 period. The major reason given for the decline was the side effects or fear of side effects arising from OC use. Many OCs are available today because of an increasing variety of chemical combinations and the rapid increase in product names, according to "Oral Contraceptives: A Guide for Programs and Clinics," a Pathfinder Fund handbook. The authors classified OCs into 2 general groups -- combined pills and the mini-pills. OCs used in the combined preparation each contain 2 synthetic hormones -- estrogen and progestin. The combined OC is 99% effective when taken properly. The most popular belief now is that OCs act by interfering with the normal menstrual cycle. The mini-pills, which contain small doses of synthetic progestins, have a contraceptive effect by altering the cervical mucus and by altering the lining of the womb or endometrium. Absolute, strong relative, and other relative contraindications to pill use are listed. Side effects that are possibly life threatening include blood clots in the legs, pelvis (lower abdomen), lungs, heart, or brain. Women OC users over 40 have a higher risk of heart attack than younger users, and users over 40 who smoke have the highest risk of heart attack. Benign tumors of the liver, which have been found to be more common in women who use OCs, may cause rupture of the capsule of the liver, extensive bleeding, and even death. Rare tumors of the liver, hepatocelluar adenomas, are more likely to occur in long term OC users, older women, and women using high dose pills. Side effects considered serious are gallbladder disease and hypertension. Fairly minor OC side effects are listed as are noncontraceptive benefits of OC use.