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
By Kim de Wit
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