In the last of a two-part feature (Part I), HealthAnswers discusses the issues you have to face if you thinking of using or are already on the Pill.
Corinne Foo
Medical Doctor
Who Uses The Pill?
In the US the Pill is the most popular method of birth control used. In Australia, the Pill is the most popular form of contrception for younger women. It is advisable for older women to avoid the pill because of the risks of breast and cervical cancer. Sometimes, women are also put on the Pill to regulate their menses or for the treatment of polycystic ovarian disease.
What Kind Of User Are You?
There are two types. A perfect user never misses taking a pill, takes each pill daily at precisely the same time, and never has vomiting or diarrhoea. While only one per 1000 perfect users becomes pregnant in a year, the sad news is that in reality the failure rate of the general population is based on the the lifestyle and habits of the typical user. The typical user is 50 times more at risk of pregnancy in a year than is the perfect user.
Who Can Use The Pill And Who Cannot?
The World Health Organisation developed four categories for risk stratification (see Table 1). Generally, women who fall into Categories 1 and 2 can be prescribed the Pill without too many restrictions. But there are things to note.
Although research has shown that women with breast or cervical cancers in the family can use the Pill without too many qualms (that is, they fall into risk Category 1), women who themselves have these malignancies must be careful. Those who have cervical cancer are classified under Category 2; and those with breast cancer shouldn't be prescribed the Pill at all.
Doctors are very careful with women who fall under Category 3. They include women who have a personal history of breast cancer but who haven't had a recurrence in the last 5 years, and those aged 35 and above who smoke fewer than 20 cigarettes daily.
Finally, Category 4 lists those women who should not use the oral contraceptive pill. In general, this covers women with medical conditions such as heart problems, hypertension, diabetes with complications; and heavy smokers aged 35 and above.
TABLE 1
World Health Organisation Precautions for the Use of Oral Contraceptive Pills
| Category 4 (refrain from use) |
| Venous thromboembolism* |
| Cerebrovascular or coronary artery disease* |
| Structural heart disease |
| Diabetes with complications |
| Breast cancer* |
| Pregnancy* |
| Lactation (<6 weeks postpartum) |
| Liver disease |
| Headaches with focal neurologic symptoms |
| Major surgery with prolonged immobilization |
| Age >35 years and smoke 20 cigarettes or more per day |
| Hypertension (blood pressure of >160/100 mm Hg or with concomitant vascular disease) |
| Category 3 (exercise caution) |
| Postpartum <21 days |
| Lactation (6 weeks to 6 months) |
| Undiagnosed vaginal or uterine bleeding* |
| Age >35 years and smoke fewer than 20 cigarettes per day |
| History of breast cancer but no recurrence in past 5 years |
| Interacting drugs |
| Gallbladder disease |
| Category 2 (advantages outweigh risks) |
| Severe headaches after initiation of oral contraceptive pills |
| Diabetes mellitus |
| Major surgery without prolonged immobilization |
| Sickle-cell disease or sickle-cell- hemoglobin C disease |
| Blood pressure of 140/100 to 159/109 mm Hg |
| Undiagnosed breast mass |
| Cervical cancer* |
| Age >50 years |
| Conditions predisposing to medication noncompliance |
| Family history of lipid disorders |
| Family history of premature myocardial infarction |
| Category 1 (no restrictions) |
| Postpartum >=21 days |
| Postabortion, with abortion performed in first or second trimester |
| History of gestational diabetes |
| Varicose veins |
| Mild headaches |
| Irregular vaginal bleeding patterns without anemia |
| Past history of PID |
| Current or recent history of PID |
| Vaginitis without purulent cervicitis |
| Increased risk of STD |
| HIV-positive or at high risk for HIV infection or AIDS |
| Benign breast disease |
| Family history of breast cancer or endometrial or ovarian cancer |
| Cervical ectropion |
| Viral hepatitis carrier |
| Uterine fibroids |
| Past ectopic pregnancy |
| Obesity |
| PID = pelvic inflammatory disease; STD = sexually transmitted disease; HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome. |
| *--Listed as a contraindication in Physicians' Desk Reference. Montvale, N.J.: Medical Economics, 1999. The PDR also lists the following as contraindications to the use of oral contraceptive pills: cholestatic jaundice of pregnancy or jaundice with previous use of oral contraceptive pills; hepatic adenoma or carcinoma; and endometrial cancer. |
What About Women Over The Age Of 35?
Women over 35 are not good candidates for the Pill if they smoke or have any type of heart disease. Other than that, the Pill actually confers many benefits- such as the prevention of osteoporosis, perimenopausal symptoms , and ovarian and uterine cancers.
And as for menopausal women, they need to be definitively diagnosed before the Pill can be stopped; otherwise the risk of pregnancy still exists. Once the Pill is discontinued, hormonal replacement therapy or HRT should be considered. Most gynaecologists in Australia would encourage women above 40 to consider a different form of birth control than the Pill.
What About Young Women?
Teenage women, who are prone to many sexual relationships because of their youth, are at high risk not just for unintended pregnancies, but also for sexually-transmitted diseases (STDs). The Pill is no protection against STDs. They should consider using an additional barrier method.
What If A Woman Cannot Adjust To The Pill?
The high discontinuation rate is caused most frequently by inaccurate patient knowledge. Women tend to be influenced by both real and perceived side effects; the most common - and badly tolerated - of these are breakthrough bleeding, nausea, headaches, breast discomfort, acne, mood swings and weight gain.
The best way to counter unwarranted cessation of Pill usage, obviously, is to properly advise every woman on the Pill. The fact is that these side effects subside with time. And physicians suggest that the woman should give the particular formulation that she's been prescribed a trial period of between two and three months.
Most studies of currently available formulations of the Pill have shown that these cause little or no change in weight, although a few contradictory reports exist. And while mood gyrations are a common complaint, it has not been proven that these are distinct from reactions to daily life; quite on the contrary, research has revealed that the Pill does reduce PMS.
What If A Woman Loses Interest In Sex Because She Is Using The Pill?
Some women also experience decreased libido, but very few complain of it.
First, not many women consider this an overwhelming problem. Secondly, there's also societal shyness. A loss of libido is just not spoken of. In fact, other than being labelled "a loss of libido", this side effect hasn't been accorded much research attention. Some gynaecologists have proposed that if this problem is a burdensome one, a change of the generation of the Pill might help. If all else fails, then perhaps a non-hormonal type of contraception may be a better option.
Living With The Pill
Humans are distinguished from animals by the fact that humans can wilfully control their fertility.
Much of the burden of contraception still falls on the woman. Because the use of the Pill is so intimately related to a woman's health and lifestyle choices, personal tailoring is required, and it's available. If you can't tolerate one type of the Pill, then another type may well be called for.
Each woman must engage her physician in helping her choose the best Pill for herself, and sometimes experimentation is called for before a final comfortable decision can be made. In the end, it pays to remember that one size doesn't need to fit all.
Date reviewed: 22 February,2005
