That magic little pill that so many women take, has an amazing place in the history of woman’s fertility and their personal control over the trajectory of their lives.
Since the 1960’s when the pill was first approved for use, it’s become one of the most widely used drugs on the planet. Over 100 million women take it worldwide and most of my female clients have been on the pill at some stage in their life for 5 years or more.
It’s genesis was actually in Mexico where it was discovered generations of women had been eating a type of wild yam for contraception. A researcher extracted progestin from these yams, which, when combined with oestrogen was the beginning of the pill as we know it. In many parts of the world all sorts of herbal remedies and foods (from pomegranates to papaya) were used by women as contraceptives. After first being dismissed as folklore a lot of these methods have since been found to exert some level of effectiveness. It seems we have been trying to thwart natures’ reproductive drive for some time!
Of course, the development of an effective contraceptive pill was a holy grail for pharmaceutical companies. The race was on in the 1950’s to produce an effective, safe, easy to use contraceptive, but drug trials were difficult as anti-birth control laws were common in the States. Eventually the trials that lead to the approval of the first pill were done on Puerto Rican women in 1956. This has since lead to accusations of racism and the quality of the trials have also been questioned. Some concerning side effects were ignored including congestive heart failure (leading to death) and pulmonary tuberculosis. In fact 25 the 220 women pulled out of the trial due to unmanageable side effects. Regardless, the FDA approved the pill for use a year later in 1957. Interestingly though, and to get around anti-birth control laws it was only approved for menstrual disorders. Despite this, the wool couldn’t be pulled over the conservative’s eyes and there was huge opposition from the Catholic Church and many GP’s. There was additional resistance when the side effects and risks were exposed in a book called The Doctors Case against The Pill. There were also Senate hearings about the safety of the pill after several complaints were made. But the popularity of the pill continued to grow around the world. This was the 70’s and with the backdrop of huge social change the feminist movement pronounced anyone against the pill effectively against women’s rights. The pill had become a central issue in the debate about the changing role of women as homemakers and their place in the workplace.
Here in New Zealand and Australia, we embraced the pill with enthusiasm. Our journey from traditional methods (abstinence, breastfeeding, withdrawal, and the ‘rhythm method’) to barrier contraceptives was the first step. Barrier methods included diaphragms, the cap, the vaginal sponge (hmmm) and condoms. Although controversial these forms of contraception were promoted by the New Zealand Family Planning Association formed at a time when septic abortions were so common that a government enquiry was held to examine the problem.
In 1961 we were among the first in the world to use the contraceptive pill. And even though it could only be prescribed to married women we, along with the Netherlands, led the world in proportion of women using it.
The pill really did change the sexual landscape forever, leading to a relaxation of the very conservative sexual morals of the time. After penicillin, it was probably the biggest revolutionary breakthrough in the field of pharmacology the 20th centaury ever saw. So lets get to know a bit more about it.
How does it work?
There are many different types of ‘the pill’, but the two main categories they fall into are the combination pill and the progestin only pill. The combination pill contains a combination of the synthetic hormones oestrogen and progestin while the other one contains, well, I’m sure you’ve figure it out. The main way they work is by preventing your pituitary gland making hormones (FSH and LH) that trigger your ovaries to ovulate. Other effects that wouldn’t prevent a pregnancy on their own but also discourage it are a thickening of the cervical mucus making it harder for sperm to get through, and making the lining of the uterus inhospitable to a fertilised egg.
Great! Are there any downsides? Well, a couple……..
‘The pill’ is a nutrient thief!
Even since the 70’s we have known that the pill depletes particular nutrients. In 1975 a study published in the American Journal of Clinical nutrition found that women on the new drug for 6-12months had lower levels of the vitamins B1, B2, B6 and folic acid. And in 1980 a review by Dr. J.L. Webb of all the available research concluded that the pill caused depletion of six nutrients in women, namely B2, B6, B12, folic acid and vitamin C and zinc. This information was published in the Journal of Reproductive Medicine, but I bet you never found it on the back of your pill packet. These depletions are not trivial either, the review in 1980 found that a women would have to take 12 times the normal RDI requirement to correct the depletion caused by the pill.
Is the pill causing your tummy troubles?
A very interesting link may exist between the synthetic oestrogen in the pill and digestive problems. A study by Hamed Khalili, a Harvard gastroenterologist found that the pill causes permeability of the gut lining and subsequent digestive issues ranging from IBS to Crohn’s disease and ulcerative colitis. It also appears to imbalance our gut flora making us more prone to overgrowth of candida, which can wreck havoc on our general health and of course cause that pesky problem of thrush.
Cancer risk…..mixed effects
One other benefit of taking the pill (apart from being a contraceptive) is that it does appear to reduce the risk of ovarian and endometrial cancer. By a decent 50%. But taking the pill might increase your risk of other types of cancer. Specifically it seems to increase the risk of breast, cervical and liver cancer. In fact the pill is classified as a carcinogen by the world health organization just like tobacco and asbestos. The risk of the above cancer returns to normal after 10 years off the pill.
The problem you’ve all heard about
When I talk to most women about the pill they tend to know one thing about it. That it can increase the risk of blood clots. This is the most widely known side effect and some of the new-ish pills seem to be much worse than their predecessors. An ingredient called drospirenone (DRSP), a synthetic form of progesterone has been shown to cause a 77% increase risk of hospitalisations for blood clots.
You find it in Yaz, Yasmin, Ocella and Safyral. There have been over 12,000 law suits filed against companies who produce contraceptives containing this ingredient. The risk is especially high if you are over 35, overweight and a smoker. There is also a slightly increased risk of heart attack and stroke. This one seems to be more correlated to the combination pill.
Is your libido MIA?
By suppressing our mid cycle testosterone surge the pill can lead a lot of women to lose interest in sex which is wonderfully ironic. I wish I had a fix for this, but if this is a side effect of the pill for you, you will have to find a way around it!
Are you taking the pill for reasons other than contraceptive?
One of the most upsetting things I see in the clinic is women in their late 20’s, or 30’s who have been on the pill since their teenage years. They went on for painful or irregular periods, or perhaps for acne and now the want to come off in order to start a family. These women have no idea what their true cycle is like, how much they bleed, if they have pain or even if they can ovulate! Some even think they have been ovulating and don’t understand what the pill has actually been doing to prevent pregnancy. That they haven’t been having a ‘real’ period all this time. If they went on the pill as a teen for irregular cycles or painful periods they may have been band-aiding their undiagnosed polycystic ovarian syndrome or endometriosis all these years. These years when they could have been getting to the bottom of and treating the hormonal imbalances. A lot of women also find they just don’t get a period at all for months and even years after stopping the pill. These unexpected surprises can be heartbreaking for a woman wanting to start a family.
At the end of the day
- The pill will be the right choice for some women. But before making that decision get all the facts. Research yourself; don’t rely on glossy pharmaceutical company websites to give you all the information you need.
- If you or your daughter has painful, irregular or very heavy periods, investigate! Don’t jump to going on the pill instead of insisting on scans and blood tests. If you find there is a hormonally driven condition get yourself to an experienced naturopath who can help you.
- If you take the pill also take care of your nutrient levels. Especially your B vitamins.
- Look after your microbiome and gut lining by taking a probiotic. This will go a long ways to reducing any damage that may be caused by the pill.
- Avoid the pill of you have a family history of blood clots, heart attack, Crohn’s disease, breast, cervical or liver cancer.
- If you would like to come off the pill talk to your doctor about non hormonal alternatives such as the cap (my favourite), the diaphragm, and the copper IUD.
- Don’t forget that only condoms prevent you from contracting STD’s.
By Annaliese Jones