09 Dec Oral Contraceptive Pill
Ask The Lady Doctor – Which contraceptive should I choose (Part IV)
Oral Contraceptive Pill (OCP)
OCP’s might be considered second only to penicillin as the most revolutionary drug ever discovered. It is a medication so ground-breaking that it eventually became known simply as “The Pill”.
Since it’s introduction in 1960, The Pill has given women a control over their fertility (and sexuality) that was unknown previously. The idea that a woman could actually plan her life out and decide if and when she wanted children was totally emancipating. During the last 50 years, many women have opted to postpone childbearing in favour of establishing a career. Hence we now see many first-time mothers at ages 30, 35 and even 40 years of age.
Efficacy
The first OCP was prescribed for regulation of periods and to married women only. It was initially feared that its use would result in sexual promiscuity. 50 years later, the OCP has become the most widely used and successful method of reversible contraception in the world. Its continued use and popularity is attributed to several factors:
· OCP’s are highly effective (when used properly, almost 100% effective)
· OCP’s are easy to use (but you must remember to take your pill daily)
· OCP’s can be discontinued easily and their effects rapidly reversed
· OCP’s tend to make menstruation less uncomfortable and flow lighter
What are the risks?
What about the risks associated with taking OCP’s? The fact is that the risks of taking the OCP are lower than the risk to life associated with pregnancy. Practically all of this risk is related to cardiovascular disease. Two groups of women who should NOT take OCP’s are:
· Those with additional health problems (hypertension, obesity, diabetes) · Those who smoke cigarettes and are over 35
The original “Pill” had more estrogen and progesterone than those currently available. Many of the untoward side effects were a result of higher hormonal concentrations in the preparations. The trick was to reduce the hormone content of the pill enough to limit side effects while still maintaining its effectiveness. The current OCP’s generally contain 15-50 mcg of estrogen or less. The amount of progesterone varies. It is estimated that 90 per cent of women of childbearing age should be able to take OCP’s without menstrual irregularities. Indeed, 80 per cent of women can take OCP’s without noticing any unpleasant side effects after three cycles of use.
How does the OCP work?
The OCP has three actions that prevent pregnancy. First, it inhibits ovulation. Second, it changes the cervical mucus to a thick, sticky material making it difficult for sperm to penetrate. Third, the OCP renders the endometrial lining of the uterus thin and inactive – basically, unable to support the implantation of an embryo.
Types of OCP’s
OCP’s come in two types of preparations. The first is the combination pill. It contains both estrogen and progesterone and is taken for 21 days with a 7-day break before starting the next package. The 7-day break allows the endometrial lining to shed and you have a period.
Certain pills are called “monophasic” or “triphasic”. This refers to varying amounts of progesterone, i.e. a package of triphasic pills will have differing concentrations of progesterone in the first pills of the month compared to the middle and the end. This is an attempt to mimic the body’s natural variation in the hormone.
The second type of OCP is the progesterone only pill – often called the “mini pill”. These preparations contain NO estrogen. They are taken continuously without a break for bleeding.
Side Effects
The most commonly encountered side effects associated with OCP use are nausea, headaches, weight gain, breast tenderness and break through bleeding (i.e. spotting between periods) and decreased libido.
Most of these side effects are attributed to the either the estrogen or the progesterone content of the pills. Many women find that these unpleasant effects spontaneously resolve after 2 or 3 cycles. Others may not tolerate the OCP well because of it’s androgen effects (male hormones) i.e. acne, oily skin & scalp, rash, itchy skin or increasing hairiness.
When side effects persist after a reasonable trial of medication (3 months) a different OCP with less androgen activity can be tried. The androgen activity is directly related to the progesterone content (almost all types of progesterones have androgen activity). In Canada, there are at least 20 different OCP’s that your doctor can choose from.
Complications of OCP’s
Oral contraceptives are a good choice for contraception in women who are “healthy”. There are many complications associated with their use in women who already have risk factors for disease. These include increased incidence of heart attacks, strokes, thrombophlebitis (blood clots) and gallbladder disease. Most of this increased risk is associated with the estrogen component of the pills which is why current OCP’s contain much less estrogen than previously.
Women who smoke should not take OCP’s. Period. Women who smoke and are over age 35 put themselves at serious risk of developing life-threatening disease.
· If your cholesterol level is high, the OCP is not a good choice for you.
· If you have a blood-clotting problem (i.e. your blood has a tendency to clot easily), you should not be on the OCP.
· If you have high blood pressure (hypertension), you should not be on the OCP.
· If you have diabetes or are obese you should not be on the OCP.
Is The Pill for me?
Remember:
· OCP’s can be used by healthy women between 35 and 45 years of age who DO NOT SMOKE.
· OCP’s do NOT need to be discontinued every few years to give your system “a break”.
· OCP’s containing estrogen should be stopped 1 month prior to elective surgery to decrease the chance of a post-operative phlebitis (blood clot in a leg vein that can travel to the heart).
· There is a very low risk of “post pill amenorrhea” (cessation of menstruation) following discontinuation of the OCP. The range is 0.2% to 3.1% and is NOT related to length of time on the OCP. In other words, it could take a couple of months for you to get pregnant after stopping the Pill.
The OCP and Cancer
The big question on everyone’s mind when it comes to “The Pill” is whether or not it “causes cancer”. There have been many studies looking at this question over the last 40 years. Allow me to distil down the salient points.
· There MAY be a slight increase in risk for developing breast cancer among OCP users, however women who develop breast cancer* while on the pill are less likely to have a tumour that has spread. Early diagnosis in these individuals may result in higher cure rates than for women who have never used the OCP. · The OCP is actually PROTECTIVE against ovarian and endometrial cancers.
· The OCP does NOT cause cervical cancer; however, it does not protect against it, either.
The Bottom Line
The OCP is a highly effective, easy to use, reliable form of contraception. The majority of healthy women can use it without any untoward side effects. There are numerous choices of OCP. If you find you are experiencing any bothersome side effects, a different preparation can be tried. OCP’s vary in their estrogen, progesterone and androgen activity. By selecting a preparation with more or less of one component, your doctor can individualize your contraceptive choice.
For a complete review of this topic, please visit any of the following websites:
WebMD HealthLine NCBI (a more scholarly review.) Women’s Health Matters
More :
Part-1 : Natural Family Planning
Part-2 : Barrier Methods of Contraception
Part-3 : Contraceptive – IUD
Part-5 : Which contraceptive should I choose?
© Nov. 2020 Ask The Lady Doctor by Dr Shannon Lee Dutchyn, MD, CCFP, FCFP