Side Effects Of Contraceptive Pills

Desirable side-effects

The pill is associated with quite a number of beneficial effects on the body, ranging from the useful to the lifesaving. One of the most obvious benefits of the pill is freedom from the fear of pregnancy, which is a very important plus factor to many women. However there are also other, non-contraceptive benefits to some pill-users.

One of the greatest is the regulation of the menstrual cycle. Irregular periods, spotting (mid-cycle bleeding), mid-pain at ovulation, pre-menstrual tension, painful periods and heavy bleeding are all virtually eradicated in most pill-users. However, women with very irregular cycles are not generally considered good candidates for the combined pill. Because the withdrawal bleeding is generally much lighter than normal periods, women on the pill are far less likely than other women to suffer from iron-deficiency anaemia. Another benefit is that women using ordinary combined pills can time their periods to avoid special occasions such as holidays, conferences and, of course, their own wedding days! Pills can only be used in this way to postpone a period, simply by taking the pills for longer than 21 days before a break; they should never be used to try and bring on a period earlier, as this is quite likely to result in ovulation and possible pregnancy. If in doubt, consult your doctor or family planning practitioner.

Pill-takers have a much reduced rate of upper genital tract infections and pelvic inflammatory disease (Pp) than women who don’t take the pill. This is thought to be because the pill decreases the amount of blood lost during menstruation, which can be a culture medium for bacteria, and because they make the cervix less easily penetrated by germs. Because pills suppress ovulation, the incidence of ectopic pregnancy is very low indeed.

There is some evidence that use of the pill helps to protect against ovarian and endometrial cancer. There is also decreased incidence of ovarian cysts, rheumatoid arthritis, non-malignant breast diseases, duodenal ulcers, toxic shock syndrome and endometriosis among pill-users. Women who already have endometriosis (an unpleasant but fairly common condition which in severe cases can lead to infertility) find that the pill is very effective in treating the condition. The kind of depression and loss of libido that is associated with pre-menstrual tension is often removed completely by the pill. In addition, it is also thought, though not yet proved, that the pill reduces the incidence of trichomoniasis vaginitis (Tv), an unpleasant infection. Fibroids are less likely to arise in pill-users, but women who already have fibroids in the uterus may find that the pill aggravates the fibroids’ degeneration.

Good or bad?

Some side-effects of the pill vary greatly with the woman who is taking it. Asthma, epilepsy, hirsutism (excess hair), greasy hair, migraine, breast tenderness and skin conditions such as eczema may all be improved or made worse by the pill. This will depend on the woman’s body and on the type of pill used. Many of these conditions, if they are aggravated by one type of pill, can be lessened by switching to another under your doctor’s guidance. Breast enlargement is a common effect of combined pills, especially in the first few months. For some women this is a boon — for others it is distressing.

Undesirable side-effects

The pill is also associated, directly and indirectly, with quite a few undesirable side-effects. These can range from the irritating to the life-threatening.

Mild side-effects can include headache, photosensitivity (unusual sensitivity to light), extra vaginal discharge through cervical erosion, less vaginal lubrication, and problems with contact lenses because of changes in the fluid over the cornea. Hay fever can begin in sensitive people when they start taking the pill. Moving on to somewhat more serious effects, the pill can occasionally act as a catalyst for unusual conditions such as chloasnia (benign pigmented areas on the face also known as the ‘mask of pregnancy’), jaundice, gallstones, and benign intracranial pressure. The pill may in rare cases reduce the body’s defence against chicken pox, eczema, allergies, gastric flu, malaria and joint inflammations; it appears in some way to alter the body’s immune systems. Pill-users may become more prone to cystitis and other similar infections; the urine is thought to become a better culture medium for bacteria, and also pill-users often make love more frequently than other women, and sex can stimulate an attack of cystitis.

Taking ordinary combined pills can interfere with the quality and quantity of milk produced by a breastfeeding mother, and so should be avoided if you want to breastfeed. Your doctor or family planning practitioner will advise you on alternative methods during this time. It appears that loss of scalp hair can occur after some women stop taking the pill, although this is rare. Underweight women are particularly likely to experience nausea during the first few months of the pill; this can be minimized by taking the pill last thing at night, so that you sleep through the worst symptoms, or perhaps by changing to another brand of pill. Some women who are suffering from mild or moderate depression may find that this is aggravated by the pill, although it doesn’t appear to aggravate severe depression.

Some women also experience a loss of libido, although others experience an increase. The pill should never be given to girls who have not yet finished growing, as development of their joints can be permanently affected. Some women on the pill experience a milky discharge from the nipples; this should always be reported to your doctor as it may require treatment. In very rare cases pill-users may develop one kind of chorea, uncontrollable movements of parts of their body: this will disappear as soon as they stop the pill.

What about cancer?

This is a common fear linked with the pill. At present the news seems roughly balanced be tween the good and the bad, with a possible bias towards the good. Breast cancer is so common (1 in 11 women in the USA will develop it) that any change made by the pill, however small, would be statistically significant. It seems from present research that the pill may actually slow down the development of breast cancer, although any woman who presently has or who has had cancer should stop taking all hormones except those prescribed by her specialist. One of the latest studies suggests there is no increased risk of breast cancer if the pill is taken after age twenty-five, and no increased risk before that age if the pill is low in progestogen.

There seems to be no link between the pill and cancer of the liver, although long-term pill-users may develop benign liver tumours. Similarly there seems to be no link between pill use and cancer of the cervix (also a very common cancer), except in that widespread use may encourage sex at a younger age, which does increase vulnerability. Cancer of the endometrium was more likely in women who took sequential pills, but these are now not available for this very reason (they are not the same as phased pills). Combined pills actually seem to help protect against this cancer. The strange condition known as molar pregnancy, or hydatidiform mole, is not caused by the pill, but the pill can interfere with its treatment. Malignant melanoma (a type of skin cancer) does seem to be slightly increased in pill-users living in sunny countries.

Potentially life-threatening risks do occur in some users but it’s important to remember that the reason for the medical checks is to screen out women who are likely to be at risk. Hypertension (raised blood pressure) is common to a very mild and perfectly safe degree in most pill-users, but can occasionally be severe. Because the pill interferes with the blood’s clotting mechanism in several ways, problems of the cardiovascular (heart and blood) system are among the most dangerous potential side-effects of the pill. These can include blood clots in the legs, abdomen, lungs, heart (heart attack) or brain (stroke).

Virtually all of these conditions are made far more likely if the woman smokes. It is important to point out that taking the pill on its own carries a far smaller health risk than smoking on its own. Combined, the two can be very dangerous, but as Guillebaud points out, ‘pill-taking makes your smoking more dangerous’, not the other way around. A woman under thirty-five on the pill has a 1 in 10,000 chance of dying if she smokes, 1 in 77,000 if she does not. A woman aged thirty-five to forty-four has a 1 in 2,000 chance of dying if she takes the pill and smokes, 1 in 6,700 if she takes the pill but does not smoke. If a woman who smokes wants to go on the pill, i.e. if she is thinking about two different risks to her health, she would do much better to go on the pill and give up smoking than to carry on smoking and use another form of contraceptive. Many doctors are of the opinion that a woman taking the pill should never smoke at all (actually, many doctors are of the opinion that no-one should ever smoke at all).

Heart attack and stroke incidence are increased in pill-users, and also in smokers, but also in women who are over thirty-five, who are very overweight, or who have diabetes, hypertension, or a personal or family history of cardiovascular disease. The more of these factors you combine, then the more likely you are to be at risk if you take the pill. Clots in the legs are more likely if you are overweight, pregnant, diabetic, confined to bed, or undergoing surgery.