The Pill turns 50: Does it still pose risks?

The Pill turned 50 yesterday -- it was introduced on May 9 exactly five decades ago. Dr Rishma Dhillon Pai discusses the advantages and risks it poses to the women of today.

If you are taking birth control pills, you are not alone. Many women rely on these pills, also called oral contraceptives or contraceptive pills, to avoid or delay pregnancy. As such, they are a very convenient tool for family planning.

Oral contraceptive pills are made using small amounts of oestrogen and progesterone. But these hormones are also found naturally in your body. They play an important role in your reproductive system by regulating the menstrual cycle; besides, progesterone also supports the process of pregnancy.

When taken artificially in the form of a pill, these hormones prevent conception by suppressing ovulation, or the release of eggs from your ovaries. The progesterone in the pill also ensures some additional checks to rule out pregnancy. For instance, it thickens the cervical mucus, so that even if an egg is released, the sperm finds it difficult to swim to the fallopian tubes to fertilise it. It also thins the walls of the uterus to prevent an egg, if at all fertilised, from implanting itself in the uterus. The result is that these pills, when taken properly, enjoy a 92 to 99.7 percent success rate in preventing pregnancies.

Mini birth control or contraceptive pills are made using only progesterone. They are useful if you cannot take oestrogen for some reason; for instance, if you are breastfeeding. You need to bear in mind, however, that mini pills are slightly less effective than combination pills.

Taking the pill

Typically, birth control pills come in packs of either 21 or 28 pills (tablets). Ideally, after consultation with your gynaecologist, you are supposed to take the first pill on the first day of your period, though it is okay to start anytime between the 1st to the 5th day. Thereafter, you should take one pill everyday for the next 21 days. At the end of this time, if you have a 21-pill pack, stop taking the pills for the next seven days. Then start the cycle again with a new pack.

If you are using a 28-pill pack, continue taking the last seven pills before starting with a new cycle. These extra pills are dummy pills without hormones. They are provided for your convenience, so that you don't lose the habit of taking a pill daily.

Risks

If you have been taking birth control pills regularly, you may want to know if they pose any threat. These pills work by creating an imbalance in the natural hormone levels in the body. This may lead to certain side effects:

• You may experience some bleeding or spotting, also known as breakthrough bleeding. Don't stop the pill immediately as the bleeding often subsides after a few cycles. Taking your pill at the same time each day may help the problem to a certain extent. If bleeding persists, you need to consult your doctor.
• Nausea is another unpleasant side effect that you may experience. You may experience some relief by taking the pill with your meals or before sleeping. This is a temporary symptom and may disappear within two or three cycles.
• You may also notice swelling or tenderness in your breasts.
• Increase in hunger or changes in bodyweight are other common side effects of these pills, as is water retention.
• You may experience mood swings or notice a change in your sex drive on taking them.
• Dryness in the eyes may occur; this could be a problem if you wear contact lenses. If eye drops or lubricants don't help, you should see your doctor.
• You may notice chloasma, or darkening of skin especially around the face. Screening yourself against sunlight may help, but if the symptom persists, you may have to switch to pills containing only progesterone.
• Side effects usually subside within a few months of starting the pill. If they don't, you could try switching to another brand after consulting your doctor.

Rarely, oral contraceptives can also pose greater risks:

• Taking birth control pills sometimes causes a slight increase in blood pressure, though this does not usually lead to high blood pressure. If it does, however, you may have to stop taking them.
• Oral contraceptive pills can increase your tendency to develop a serious blood clot such as deep vein thrombosis or a pulmonary embolism. However, unless you have a history of clotting disorders -- or other risk factors are present -- the likelihood of this happening is rare.
• Contraceptive pills increase the possibility of heart attack in smokers; the risk is even greater in women above 35 years of age. Similarly, women suffering from high blood pressure or obesity who are on the pill may be more susceptible to heart attack.
• Women who smoke or suffer from high blood pressure are at greater risk of suffering stroke if they are on birth control pills. Similarly, women who suffer from migraine attacks -- especially when accompanied by visual effects such as bright spots or flashing lights, numbness or tingling, loss of coordination or speech difficulty -- are at higher risk from stroke if they are on the pill.
• Studies have pointed to higher incidence of breast cancer in women who are, or up to a decade ago were, taking combination oral contraceptive pills, though it is not clear whether the pills actually cause or aggravate the cancer.
• Combination pills have also been linked to greater risk of cervical cancer, jaundice or benign tumours in the liver.

While the risks associated with oral contraceptive pills are rare, always consult your doctor if you notice symptoms such as shortness of breath, chest or abdominal pain, blood in your cough, swelling or pain in the legs, numbness in the limbs, jaundice, lump in the breast, severe headaches or depression.

Because oral contraceptive pills today use far lower doses of hormones than earlier and the progesterone used is a significantly improved version of that used in the older generation pills, the risks associated with them have gone down considerably. In fact, most healthy women take them without suffering any serious consequences.