Is the Pill really the best choise for you?

Is the Pill really the best choice for you?

The oral contraceptive pill is the most commonly used contraception worldwide and it has been for over 50 years. As we all know, every medication comes with its side effects, some big, some small. However, with an incredible number of 100 million women that take these pills every day, even a small side effect can severely affect this great population of healthy women. You may have noticed the sudden outburst in the news about the Diane-35 pill causing an enhanced risk of thrombosis. The outrage in the media is actually strange, since it had been known for years already that all oral contraceptive pills cause an increased risk of thrombosis. This shows that society knows too little about the potential risk of using the contraceptive pill.

The contraceptive pill caused a true revolution in the 1960’s, as the great reliability of the pill took away women’s concern of getting pregnant and gave them a worry-free sex life for the first time. Although a great amount of women were very content with the pill and their sexual freedom, there was also a group of women that complained about decreased libido, painful breasts, mood swings, nausea and weight gain due to the pill. Nevertheless, the pill remained popular, probably because it’s easy and highly effective. Only there are other easy and highly effective contraceptive methods, like the intra uterine device (IUD). Maybe those are less often used because a lot of women aren’t properly informed about the pill and other contraception methods.  

So let’s start with the pill. The combination pill contains two synthetic hormones: estrogen and progestogen. Both hormones inhibit the pituitary gland to produce and secrete follicle stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones normally stimulate growth of the follicle that will eventually become the egg. They also stimulate ovulation of the egg whereby it is released from the ovary to be fertilized by the sperm cells. Besides inhibiting ovulation, the hormones in the pill also make the wall of the cervix thicker and more viscous, which makes it harder for sperm to pass and reach the egg. And finally, they change the endometrium (the inner layer of the uterus), which makes implantation of a potentially fertilized egg impossible.

These hormones in the pill are also the cause of the increased risk of thrombosis. Averagely, a two to six fold increase has been registered compared to non-users, depending on estrogen dose and kind of progestogen used. The higher the estrogen dose, the higher the risk of thrombosis. The first generation pills had many complications and are off the market today. Saver progestogens have been produced ever since, but the newest third and fourth generation progestogens actually induce a higher risk than the second generation progestogens. Levenorgestrel has showed to be the safest. Since all pills that are on the market are equally reliable in preventing pregnancy, the best pill to use is one with a low estrogen dose and levenorgestrel as the progestogen.

 The effect on thrombosis risk of different kinds of progestogens in the Pill.
www.bmj.com/content/339/bmj.b2921.full

The hormonal IUD is a T-shaped piece of plastic that releases small amounts of levenorgestrel. The amount of levenorgestrel in the blood is about 30 times lower than that of the pill and remains constant. The Mirena is oftenly used andworks for 5 years, while another IUD, called Jaydess, releases even less hormones and works for 3 years. The IUD itself causes a so called ‘foreign body reaction’ in the uterus, which is an induced inflammatory reaction that makes the internal uterus lethal for embryos, but isn’t dangerous to the uterus. The additional effect of the hormone in the IUD is the suppression of the endometrium, which makes it impossible for the fertilized egg to implant itself. Also, this causes a decrease in menstrual bleeding, and in some cases completely stops.

A completely hormone free contraceptive is the copper IUD. Besides from the foreign body reaction caused by the IUD, copper decreases sperm motility and viability by increasing copper concentration in the cervical mucus, which decreases the rate of fertilization. When fertilization does occur anyway, implantation is inhibited because of changes in the endometrium. The regular copper IUD is also T-shaped, but some women experience a bit more heavy periods with this IUD. Another relatively new copper IUD, called Gynefix, is a small cord with copper rings that is attached to the upper uterine wall and has shown not to enhance menstrual bleeding and pain.  

IUD’s and their position in the uterus. From left to right:  Copper IUD, hormonal IUD, Gynefix. www.theholykale.com, www.gynefix.pl

So why would you put your health at risk, while there is a perfectly safe alternative for contraception that doesn’t mess around with your natural hormonal system and doesn’t have those side effects? It only requires your attention once in 5 years, which makes the visit to the doctor totally worth it. 

By Kim de Wit