There's more to the contraceptive pill than meets the eye. HealthAnswers checks out why an icon for the Sixties deserves more respect. In the first part of a two-part feature, we discuss the history of the Pill and its benefits.

Corinne Foo
Medical Doctor

What is this little entity - audaciously, even unoriginally, nicknamed the "Pill"? The Pill is in fact not just one pill, but a whole lot of little pills. Since the world of family planning hatched this oral coup-de-grace in 1960, the Pill has evolved into today's mind-boggling range of choices - such that contraception can be personally tailored to suit your medical history, lifestyle and habits.

How Many Types Of Pills Are There?

1. Initially there was the first generation of the combined contraceptive pill. These were made with high doses of synthetic progesterones (collectively known as progestins), and oestrogen. To reduce the risk of potentially life-threatening blood clots developing in the legs (a condition known as thromboembolism), the dose of oestrogen was decreased over the years.

2. The first-generation Pill fell out of favour when the second generation of the combined pill came about. This new range comprises the monophasics - or pills whose compositions remain unchanged throughout the month; and biphasics and triphasics - which are made of two and three different hormonal combinations respectively.
   
   These are meant to mimic the natural hormonal cycle of the average woman. For example, with the triphasic pill Trinordiol, the pill user takes three different sets of tablets: one set for the first 10 days, another for the next five days, and a third set for the final six days of the cycle. Then comes seven pill-free days. In many women, these tablets can prevent breakthrough bleeding, which appears as spotting at various times in the cycle.

3. Third-generation combined pills use newer types of progestins. These reduce the side-effects such as acne and excessive hair-growth, and are more suitable for women with diabetes and high triglyceride and cholesterol. In Australia these are marketed Diane 35 ED, Minulet, Marvelon and Mercilon. These cost several times as much as the second generation pills.

4. The mini-pill is a different from the above. It is so-called because it contains only progestin and lacks the oestrogen component. It is available for women who cannot tolerate the combined pills.

5. In recent years post-coital contraception has become part of the repertoire of uses of the Pill. Although this has been studied for nearly two decades, it's only been in the last few years that the US Food and Drug Administration (FDA) has allowed the use of certain types of the Pill for this purpose.
   
   The formulations available in Australia include Nordette and Postinor. When administered within 72 hours of unprotected intercourse, emergency contraception reduces the risk of pregnancy by 75 percent. But this has to be put into perspective: the risk of pregnancy here is still much greater than the risk of pregnancy occurring with the regular and proper use of contraceptives.

What Are The Health Risks With The Use Of The Pill?
The risks of heart attacks and strokes increase with age, smoking, hypertension and pills with higher oestrogen content. The risk of thromboembolism also becomes pretty significant.

The Pill prevents pregnancy but doesn't provide any protection against sexually-transmitted diseases (STDs). Before prescribing the Pill, the physician should take a detailed personal and family history, and an accurate blood pressure measurement of the patient. Some doctors even perform a Pap smear to check for precancerous cells in the cervix.

How Fail-Proof Is The Pill?
What exactly goes into the Pill? Each one is an oral contraceptive that combines the two key female hormones progesterone and oestrogen, in formulations that inhibit the fertilisation of a human egg.

When used correctly, failure rates of the various types of the Pill average about five to eight percent. Some modes of contraception are undoubtedly more superior than the Pill; for example, hormonal implants like Implanon, and injectibles like Depo-Provera, fail at most between two to three per cent of the time.

What Else Can The Pill Do?
To start with, the Pill is very effective at preventing pregnancy. Its contraceptive effects are reversible, at best usually quite immediately, and at worst within a few months. Then there is the pyschological and physical plus point of being able to separate the act of administering the contraceptive from the act of coitus - unlike with barrier contraceptives.

The Pill also imparts many other, non-contraceptive benefits. It protects against ovarian and uterine cancers, lessens premenstrual symptoms and decreases menstrual cramps. It can improve acne and endometriosis, and diminishes the incidence of benign cysts in the breasts and ovaries. There's a lot of good that one little Pill can do.

In tomorrow's article, we will discuss which group of women stand to gain the most from its use, and who should avoid using it.

Date reviewed: 27/02/2005