Oral Contraceptive Pills, aka “the pill”, have been around for over 60 years. First approved for use in the United States in 1960, 1.2 million American women were using the pill within the first 2 years of its distribution. Today, the pill is still the most popular method of reversible contraception in the U.S., with 16% of women between ages 15 and 44 taking the pill – that accounts for 30% of all American women! To say that A LOT has changed between its initial approval and today, however, would be an understatement. From the pill dosage, risks and benefits, and reasons we love it – there is much to praise the pill for in its modern form.
Evolution of the pill
The first iterations of oral contraceptive pills contained much higher doses of hormones than our modern day pills, to the effect of 5-10 times the amount of estrogen and progesterone! These high dose pills were associated with much higher risks for adverse events: things like blood clots, heart attacks, strokes, and cancers. And as you may imagine, pill side effects at high doses were also more common. While our pills today still do carry some risks, they are significantly lower than they were at the outset. To put this in perspective: nowadays, the risk for developing a blood clot during the course of normal pregnancy is higher than it is with birth control pill use. The risk of developing a blood clot with pill use is 3-9 in 10,000 users per year. The overall risk of developing a blood clot amongst all women of reproductive age is 1-5 per 10,000, and the risk of developing a blood clot during pregnancy is 5 times as high.
How it works
The pill contains 2 hormones: estrogen and progesterone. Estrogen and progesterone are normally produced by the ovaries, and on a basic level they communicate with the brain via a feedback loop, which results in the normal menstrual cycle. Estrogen and progesterone levels fluctuate throughout the menstrual cycle, ovulation occurs, and “pre-menstrual” symptoms can occur in response to these changing hormone levels.
When a woman takes birth control pills, however, this communication cycle is disrupted, hormone levels do not fluctuate, and ovulation does not occur. The result, when taken perfectly, is a highly effective contraceptive method! The pill is 99% effective for pregnancy prevention when taken at the same time every day. Since we as humans are not perfect though, the average efficacy rate is closer to 93-94%. Things like missed or late doses reduce the pill’s contraceptive efficacy.
Why we love it
OBGYNs have a reputation for “pushing the pill.” While I find the negative connotations of this a little unfair, there is a lot of truth behind the fact that we do recommend the pill often, and for a number of reasons. You could even say that we love the pill! Since the pill prevents estrogen and progesterone levels from fluctuating throughout the month, it is a wonderful option for managing a variety of symptoms that result from these typical hormonal swings. From mood changes to cancer risk reduction, here is a list of conditions and non-contraceptive benefits the pill is useful in treating:
- PMS
- PMDD
- Menstrual cramps
- Heavy menses
- Menstrual headaches
- Ovarian cyst prevention
- Reduced risk for ovarian cancer
- Reduced risk for uterine cancer
- Acne/ pre-menstrual skin changes
- PCOS
- Endometriosis
- Fibroids
- Premature ovarian failure
Before starting treatment for any health condition, it is important to understand underlying causes, treatment options and associated risks, benefits and potential side effects, and rationale for choosing a particular option. This should be an open conversation with your healthcare provider and you should be involved in your health care choices, something called shared-decision making. There is not a one size fits all approach and we want you to feel educated and confident in your health care. Maybe you’ll love the pill as much as we do, but if not, that’s ok too!
