The Pill – Birth Control for Control Freaks?

The pill was a game changer. I bow down to its creators – activist Margaret Sanger, birth-control-pillsEndocrinologist Gregory Pincus, chemist Carl Dieresis, Gynecologist John Rock and biologist, feminist and heiress Katherine McCormick.   In 1960, when the pill was approved for contraceptive use in the US, it changed how women exercise self- determination.  Imagine always fearing an unwanted pregnancy and suddenly being relieved of that fear. Granted it was only ‘approved’ for married women with appropriate rationale for ‘delaying’ pregnancy, but many women sought out the pill and took full control of their reproductive choices.  Often they did so without involving husbands, boyfriends or any other sexual partner.  Not surprisingly, it spread like wildfire, despite (mostly religious) controversy and efforts to mislead people about damaging side effects.

Taking the pill is safe, and convenient. It doesn’t interfere with having sex. Many women say it improves their sex lives because it helps them feel more spontaneous.

How good is it?

Effectiveness, not surprisingly, is an important and common concern when choosing a birth control method. Birth control pills are quite effective. The label and other materials usually say the efficacy is about 98% ‘when used correctly’.  But let’s talk about realistic use rather than perfect use since one is likely and the other impossible.  The realistic efficacy is about 85-87% meaning 13-15 women using the pill alone as their birth control method will find themselves pregnant at some point.  Add some good and cheap fertility awareness/ovulation tracking and the efficacy goes way up.  Or, add proper use of condoms and the chance of pregnancy is pretty much eliminated not to mention the added value provided by protecting both partners from many STIs.

Adolescent or young women are frequently prescribed birth control pills for reasons other than for birth control.  The Pill offers loads of benefit to women with irregular menstrual periods, menstrual cramps, acne, PMS Polycystic Ovary Syndrome (PCOS), excess hair growth and other hormonal challenges. As a significant side benefit, hormonal contraceptives actually protect against certain cancers.  A woman is half as likely to get cancer of the uterus or ovaries if she has taken birth control pills.

Weighing the Risks

That two popular contraceptive pills, Yaz and Yasmin carry an increased risk of blood clots compared with other oral  contraceptives has been a hot topic for many journalists this past week.  News sources all over Canada are reporting that recent deaths are linked to these dangerous pills causing blood clots and that 8 of the 23 deaths were women under 20.

That’s scary.  When healthy young women die it is a tragedy.

It’s also terrible if incomplete information circulates leading women to stop taking their birth control.  We need to understand the risk of these pills, other pills, other birth control options as well as the risk of using no birth control at all. Let’s remember that all medications have risks associated with them.  As André Picard reported in the Globe and Mail, “about 4,000 Canadians a year die from misuse of painkillers (including ordinary drugs like Aspirin).  About 40 a year die from Tylenol – four times as many deaths as oral contraceptives.”

I let my kids have a wee swig from the bottle if they’re a bit warm, have an earache or other aches and pains resulting from your run of the mill crash and burn scenarios. My little one would take Tylenol for a paper cut if I let him. The risks of this pain relief use are significantly higher than those related to using oral contraceptives. Even Yaz or Yasmin.

Options for Sexual Health released an update to respond to the media alarm bells.  Here are some of the things they encourage you to consider:

  • The Society of Obstetricians and Gynaecologists of Canada identify the risk of women developing a venous thromboembolism (VTE or blood clot) each year to be:
    • woman of reproductive age: 4 to 5 of 10,000 women (0.0004%)
    • woman on the pill: 8 to 9 out of 10,000 (0.0009%)
    • while pregnant: as many as 29 out of 10,000 (0.0029%)
    • postpartum: as many as 300 to 400 out of 10,000 (0.04%)
  • A woman’s risk of developing VTE is highest in the first year of using any hormonal contraceptives.  (According to André Picard, the risk of all drugs is always highest the first time they are taken. Oral contraceptives are not special in that regard.)
  • When women stop taking contraceptive pills, they have an increased risk of pregnancy. When news like this comes out, women stop taking their birth control pills and there is an associated increase in the occurrence of pregnancies and abortions
  • Women have additional increased risks of developing VTE if they are over the age of 35, smoke, or are overweight.  Also, when using any hormonal contraceptive product, all women should be aware of the warning signs of a blood clot.

So it’s true – birth control pills are not without risks.  But all of the birth control pills on the market have undergone rigorous testing and before they’re prescribed, high risk factors are assessed.  And you know what, the risk of blood clots is small.  Real, but  small.  Combined with all the ‘other benefits’, the pill is wildly popular among young women and with good reason.

It’s good but is it THAT good?tumblr_pill_500

I’m a bit confused by the popularity of the pill compared to other hormonal methods.  Since they work in essentially the same way, I don’t understand why parents of teen girls are more accepting of birth control pills than other contraceptive methods.  As a 17 year old, I was fairly responsible in that I used protection to avoid unwanted pregnancy but the truth is I wasn’t great at taking the pill at the same time every day.  I wasn’t irresponsible, it’s just that the kind of regimented use required by the Pill was not part of how my world operated.

I think that continues to be true for many young women.  Which leaves people playing a dangerous game of ‘will I get pregnant?’ despite a bunch of other great birth control methods that do not require the same level of daily personal diligence.

So where am I going with all of this?   It certainly is not to dissuade people from choosing the pill.  Rather it is to remind all of us, as parents and influencers, that there are loads of great choices and each ought to be assessed by potential users.  I fear that with the Yaz/Yasmin scare, we are limiting rather than growing the options for young women.  Many women would benefit from other hormonal or barrier methods which require less precision.   For instance, the patch needs to be replaced every week and the vaginal ring needs to be removed and a new one inserted every month.  Depo-Provera requires a shot by a health professional every three months.  Non-hormonal methods like the IUD requires a visit to a doctor every 3-5 years for insertion.

If excessive parental freak out over potential blood clots persist, we may be creating less access to protected sex while likely having no impact on the amount of sex that is happening.  It’s our job to influence our daughters with sound information so their ability to manage their own fertility isn’t compromised.

And now, because it’s Friday, some videos:

The first is for Nuvaring.  But for an awesome comedic take, check out SNL’s skit on Nuva Bling.  It’s faboosh!

Kick ass Alesse is up next.

*My likley unnecessary disclaimer: I don’t recommend any particular birth control method.  Advertisements often tell a story intending to draw in certain audiences and compel them.  Of course, it doesn’t matter what an ad states as the gospel, women need to thoughly investigate their options and related risks with the help of medical professionals.

This article has 4 comments

  1. Personally, I had to go off the pill. It messed with my body in way too many ways and I’ve felt so much better for the past several years since being off it. I also happened to have a young friend pass away 3 months after going on the pill (of a blood clot.) some people obviously can be on the pill with no side effects and I truly wish I were one of them. But I know more and more of my married friends are choosing to go with other methods these days due to side effects they experienced.

    • Thanks for your comment. The pill is definitely not for everyone. Good for you for knowing your body and what works and doesn’t work. It takes time and attention to figure it all out so it’s a good thing there are numerous options for people to explore.

      And I’m sorry about your friend. The consequences of a blood clot can be devastating indeed.

  2. I was on the Pill when I was young, before I got into the really stable long term relationship that I’m in now. I was very careful about timing when I took it, so it may have been the best option for me then. I didn’t like the side effects, however. Though they were relatively minor in the grand scheme of things–I’d rather not use hormonal birth control.

    It was really interesting to see a comparison of the VTE risk for women in general–thanks for that. The media does tend to sensationalize these things.

    Will I see you at the big Vancouver Mom shindig tonight? I’ll be one of the Ambassadors at the door–hope to connect in person!

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