The combined oral contraceptive

By Dr Brigid Monda

For a contraceptive method that has been in use for more than five decades now and with major improvements to its brands, our relationship with the pill still remains cautious. Many women who use it do so with mixed feelings because so many myths and half-truths about the pill abound. Its risks are wildly exaggerated and its health benefits vastly underestimated; yet the combined oral contraceptive pill is an extremely safe and very effective method of birth control when used correctly. It is also one of the most extensively studied medications ever taken by human beings.

How the pill works

The ovaries secrete the female sex hormones oestrogen and progesterone, which control the female reproductive cycle. They prepare the uterus for pregnancy; determine when ovulation will occur and when your period will come if pregnancy does not occur.

The combined oral contraceptive pill contains synthetic forms of both oestrogen and progesterone. These synthetic hormones prevent pregnancy mainly by inhibiting ovulation and the sperm will have no egg to fertilise and pregnancy will not occur. They thicken the mucus plug of the cervix (the lower part of the uterus that protrudes into the vagina), making it thick and impenetrable to the sperm. They also make the lining of the uterus thin, which hampers implantation of the egg if it got fertilised.

Some people believe that being on the pill is unnatural but this is not true. The pill mimics pregnancy and women were designed by nature to be either pregnant or breast-feeding during their reproductive lives. This means a woman’s hormonal state while on the pill is similar to that of a natural state — pregnancy.

Another myth is that a woman on the pill should take breaks during some months but there is nothing magical or medically necessary about the traditional ‘three week on and one week off’ cycle. This is usually advised because the pill was developed to mimic the natural menstrual cycle but the pill can actually be taken continuously for several months while skipping the seven-day break in between.

Benefits of the modern contraceptive pill

When taken correctly, it is 99.9 per cent effective in preventing unwanted pregnancy.

Cardiovascular disease

It is easy to use, safe for most women and is a reversible method of contraception that has no effect on one's fertility. It in fact protects against infertility.

It relieves period and ovulation pain and prevents anaemia by decreasing the number of days of bleeding and the amount of blood lost during menses. It makes the menstrual cycle more regular and reduces Premenstrual Syndrome (PMS). It can be safely used up to the age of 50 years with careful monitoring in women who smoke or have risk of cardiovascular disease, combining safe effective contraception, hormone replacement therapy and prevention of osteoporosis.

The pill also prevents a woman developing ovarian cysts and protects against ovarian cancer because it suppresses ovulation. Its effect on the lining of the uterus also reduces the risk of developing cancer of the uterus. Women on the pill are less likely to develop non-cancerous breast lumps as well as colorectal cancer, rheumatoid arthritis and thyroid disease.

The pill protects against Pelvic Inflammatory Disease (PID) — a major cause of infertility and ectopic pregnancies, by thickening the cervical mucus plug. This makes it difficult for the PID causing bacteria to penetrate the uterus and fallopian tubes and also by reducing the amount of menstrual blood lost, it reduces the amount available for the bacteria to grow in.

It improves acne and increases libido because the fear of pregnancy is eliminated. It can also be used to postpone one’s period when a woman, for example, is travelling or when a couple is on their honeymoon.

The pill in certain doses can also be used for emergency contraception after an unprotected act of sexual intercourse including burst condoms and sexual assault.

It can be used to regularise an irregular cycle and heavy menstrual bleeding and can also be used to stop abnormal uterine bleeding in women on other hormonal types of contraception like Depo Provera or Jadelle.

Disadvantages of the pill

It has to be taken every day, does not protect against STDs including HIV, causes nausea (which can be avoided by taking the pill at night), breast fullness, tenderness and weight gain.

Side effects

The pill most often improves acne but in a small minority, the acne gets worse. This is because the type of progestin present in that particular brand of pill works like an androgen (the male sex hormone) and makes the acne worse.

Pills may also cause Chloasma or ‘the mask of pregnancy,’ particularly in women exposed to a lot of sunlight. This darkening of the skin on the upper lip, under the eyes and on the forehead, although not dangerous is cause for concern because of the cosmetic effect.

Breast tenderness

It results from the oestrogen component of the pill. Try wearing a bra with better support and avoiding vigorous exercise when you experience the most discomfort.

Nausea

Oestrogen again is the culprit and it mainly affects new users of the pill. It, however, usually subsides after the first few cycles. One easy remedy is taking your pill after a meal or at night before bed.

Headaches

Also called an ‘Oestrogen Withdrawal Headache’, because of the drop in oestrogen during the week off the pill. To avoid these headaches, you can simply continue with a new pack skipping the one-week off period. This has no side effects and the pill is still effective.

But pay close attention to headaches that are different or more severe than those you had before starting on the pill because it could be a warning of something else.

Weight gain

It results from fluid retention or oestrogen induced fat deposition in the thighs, hips and breast. The progestin component causes an increase in appetite and so an increased intake of food. The best solution is eating right and exercising.

Spotting or breakthrough bleeding between periods on the pill

This is due to the low oestrogen levels in the pill. This breakthrough bleeding is not harmful but can be annoying. If it happens, do not stop taking the pill because it will stop once you are into your second or third packet. If the bleeding occurs after sex, make an appointment with your doctor as soon as you can because this could be the sign of some other problem.

Absent periods

It is really quite common to have some delay before the resumption of normal periods after stopping the pill because of the effect it has on the lining of the uterus. It is more common in women who had problems with their cycles before they started the pill. Libido

Some pill users may experience a decrease in the sex drive. For others, the opposite is true. They enjoy sex more since they do not have to worry about a pregnancy.

Quote: "For most women, including women who want to have children, contraception is not an option; it is a basic health care necessity." Louise Slaughter}