Birth control pills more varied, safer

PHOTOGRAPHER: Marc Schultz

Many of the newer birth control pills that are on the market today give women more options when controlling their cycles.

Birth control pills have been used in this country for almost 50 years. Safe and effective, they have been one of the most extensively studied medications in the United States.

The first birth control pill, Enovid, was introduced in 1960. Since then, more than 45 brands have become available to women.

Doctors say birth control pills have changed significantly since their introduction. Most importantly, the dosages have been markedly reduced, and the side effects have decreased. The currently prescribed pills have approximately 1⁄10 the amount of medication used in the first pills of the 1960s.

“These pills are remarkably effective,” said Dr. Norman Angell, associate professor and chief of gynecology at Albany Medical Center. “They have a greater than 99 percent effectiveness if people take them properly.”

Regulating hormones

Some women start taking their pills the first day of their periods. Others choose to take their pills the first Sunday after their period starts.

“The reason for that is birth control pills are set up so if you start your pill on Sunday you’ll probably have your period between Tuesday and Friday, and you’ll never have menses on the weekends,” Angell explained.

Most birth control pills control two hormones: estrogen and progesterone. These hormones are synthetic versions of naturally occurring female hormones. They work primarily by preventing ovulation.

Traditional birth control pills make your reproductive system mimic a regular 28-day monthly cycle. For the first 21 days, you take active pills containing reproductive hormones. For the last seven days, you take a placebo. While you’re taking the placebo pills, you bleed vaginally as if you were having a regular menstrual period.

By contrast, extended-cycle birth control pills contain active hormones for every day of the month. The newest extended-cycle regime is a low-dose pill called Lybrel, which is designed to be taken continuously for one year with no breaks for hormone-free intervals. Lybrel is meant to suppress all menstrual bleeding.

Two other specially designed extended-cycle regimes, Seasonale and Seasonique, are also currently on the market. With both pills, you take active hormone pills every day for three months, then you take one week of placebo pills (Seasonale), or low dose estrogen pills (Seasonique). You’ll experience menstrual bleeding during that week.

Angell said the only difference between traditional birth control pills and extended-cycle birth control pills is the packaging.

“They’re exactly the same hormones,” he said. “You just take them differently.”

Regularity is new

Angell said it’s a myth that having your period is a sign of good health or cleansing your body.

“You’re not cleaning your body of anything,” he said. “In fact, a monthly menses is a very recent biological fact, because of the pill. Without any means of preventing pregnancy, most women were either pregnant or nursing. They may have had two or three menses, and then they were pregnant again. So a monthly menstrual cycle is less than 100 years old.”

By continually taking the pill, women prevent hormonal fluctuations that are responsible for bleeding, cramping, headaches and other discomforts associated with getting their period. However, women are at greater risk for breakthrough bleeding — bleeding between periods.

Another myth is that birth control pills cause women to gain weight.

“In our society, gaining weight is almost inevitable, and if you happen to be taking the pill, I think it’s easier to blame the pill than the fact that you’re eating too much and not exercising,” said Angell. “Several studies have proven this is a nonscientific issue.”

Angell said birth control pills also prevent some types of cancer.

“If you use birth control pills for five years, you will have lifelong protection against endometrial cancer and ovarian cancer, the two biggest reproductive organ cancers,” said Angell, who has been practicing since 1982.

Dr. Gerard McGrinder, chairman of obstetrics/gynecology for Ellis Hospital and Bellevue Woman’s Care Center, said women who are taking antibiotics should check with their pharmacist to make sure that their birth control pills are still effective.

“There are very few antibiotics that have an effect on how well the pill works, but it’s best to be safe,” said McGrinder.

While McGrinder said birth control pills are safe for most women, women over age 35 who smoke, have high blood pressure, a history of deep vein thrombosis in their families or a history of clotting problems should not take the pill.

Desire to get pregnant

One of the advantages of the birth control pill is that it’s quickly reversible, he added.

After you stop taking the pill, you may have only a two-week delay before you ovulate again. Your period should follow about four to six weeks after you take the last pill.

Once ovulation resumes, you can become pregnant.

“I recommend that women go off the pill about two months before they want to become pregnant,” said McGrinder.

Some women will say they had a hard time getting pregnant after they stopped the pill, said Angell. However, when you ask, a large number of them had irregular periods before they took the pill.

“That’s why they were put on the pill in the first place,” he said. “So the woman with irregular periods may have trouble getting pregnant because she has irregular periods not because she was on the pill.”

In the future, Angell predicted that more women may opt for other means of birth control such as Depo Provera, a hormone shot to prevent pregnancy; OrthoEvra, a patch that slowly releases hormones through the skin; Nuva Ring, a small flexible ring that’s inserted into the vagina and releases hormones for three weeks; Lunelle, a monthly hormone injection; or Mirena, an IUD effective for five years.

“I think it’s a matter of convenience,” he said. “I think it’s great that women have so many choices now.”