Today's birth control pills include hundreds of options to prevent pregnancy and/or address reproductive health issues such as cramps, acne and cysts.
By MARY SHEDDEN
Long gone are the days when the term "the pill" applied to one medication with just one function: birth control.
Today's birth control pills include hundreds of options to prevent pregnancy and/or address reproductive health issues such as cramps, acne and cysts. Though there are many alternative forms of contraception these days — from patches to implants and vaginal rings — an estimated 11.6 million women ages 15 to 44 use the pill, making it by far the leading method in the United States. When used properly, they can be more than 90 percent effective in preventing pregnancy.
And yet, since the first birth control pills appeared in 1960, potential health problems have been an ongoing source of concern, primarily because of a link to blood clots and an increased risk of cervical, liver and breast cancers.
More recently, however, numerous scientific studies have linked the medication to reduced risks for ovarian and endometrial cancers, according to the National Cancer Institute.
Tampa gynecologist Jill Hechtman says that although all the research and controversy may be puzzling, women should remember that every kind of birth control pill has its benefits, risks and side effects. "Every single one has its own positives and negatives," she says.
Adding to the confusion are some high-profile lawsuits and Food and Drug Administration penalties against the makers of Yaz, the nation's most popular oral contraceptive. In 2008, Yaz was preferred by 18 percent of the women taking oral contraceptives, according to IMS Health's annual review of pharmaceutical sales.
Earlier this year, the FDA ordered Bayer Healthcare to correct its ads promoting Yaz's power to quell acne and cramps — and apologetic TV commercials now on the air reflect just that. Several class action suits targeted Yaz for containing hormones that boost potassium levels, which can be dangerous for women with kidney, liver, or adrenal disease.
Hechtman says while Yaz isn't for everyone, it can be a reasonable option for some women, including those at risk of polycystic ovarian syndrome, a disorder characterized by infrequent or prolonged menstrual periods, excessive hair growth, acne and obesity, according to the Mayo Clinic.
Hechtman, who does not receive financial support from any drug maker, says a woman and her health care provider should weigh the scientific facts alongside the woman's medical history and lifestyle needs. For example, several oral contraceptives minimize or eliminate menstrual cycles altogether, something Hechtman says is healthy when done appropriately.
"All birth control can be effective unless you don't use it properly," she says.
Women who want birth control to help treat conditions such as cramping or heart disease, as well as those who smoke, first need to consider the risks of any form of birth control. They'll find that most of the birth control pills on the market today contain a combination of estrogen (hormones naturally produced by the ovaries) and progestin (which mimics the reproductive hormone progesterone).
Pills containing higher levels of estrogen have been cited in some studies for possibly increasing health risks. "That's what we think increases the risk of blood clots and heart attacks," Hechtman says. Low-estrogen combination pills are popular, but they've been found to increase the risk of breakthrough bleeding.
That doesn't mean progestin-only or "mini" pills are the solution. Hechtman says these pills have to be taken at the same time every day, and they, too, tend to increase the chance of spotting between periods.
Finally, Hechtman warns, what works for a friend may not be the best option. She says some women try several different oral contraceptives before finding one that meets their needs with minimal side effects.
"The most important thing you can do is talk to your doctors about what you are looking for."
WHICH PILL IS RIGHT FOR YOU?
Today, hundreds of different kinds of birth control pills exist, many of which treat health conditions unrelated to birth control. There are several key types of pills on the market including:
Traditional pill: Taken every day, it releases estrogen and progestin for 21 days, and a placebo is used the other seven days when the period happens. Comes in both monophasic – where the same amount of hormones are released in each dose – and triphasic – where hormone dosage changes each week.
Extended cycle, three month: A low-estrogen dose is taken every day for three months, with a seven-day placebo regimen that allows for menstrual bleeding.
Extended cycle, one year: A low-dose pill designed to be taken for a full year, with no hormonal breaks. Menstrual bleeding is suppressed altogether.
Mini-pill: The progestin-only pill is taken at the same time every day and in a cycle similar to traditional birth control pills. Periods do take place.
Sources: Mayo Clinic, Centers for Disease Control and Prevention
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Resources: tbo .com/content/2009/oct/20/todays-pill-offers-much-more-birth-control/news-breaking/
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