Understand the problems – both the hypothetical and the real
In deciding whether to continue with (or change to ) the Pill, or the Mirena, or Implanon, you need to weigh up the pros and cons for you. My last blog post talked about the pros: the possible reasons people use these medications. This post focuses on being aware of some of the potential issues with the Pill, technically known as the combined oral contraceptive Pill. The next post will consider the alternatives to the pill.
How does it work?
The Pill contains a synthetic type of oestrogen and progestogen that gives messages to a part of your brain to stop you producing your own oestrogen and progesterone, by making your brain think you are pregnant. It aims to stop you ovulating, but does not always do this (ovulation occurs 2% of the time on the regular oestrogen Pill and 1% of the time on the lower oestrogen Pill). This means you are not having normal cycles, and you are not producing your own progesterone (which occurs with ovulation). The progestogens you are receiving in the Pill do not have identical physiological effects to your own body’s progesterone. So in summary, the Pill makes your body behave in a “high-oestrogen” way, which may explain some of the side effects and risks.
What are the less serious side effects? (note, if these are more than mild, they could be considered serious!)
- Breast tenderness
- Mood changes
- Breakthrough bleeding
What are the more serious side effects?
- Loss of sexual arousal and pleasure, orgasm and lubrication
- Folate and other nutrient deficiency, which can lead to neural tube defects if a pregnancy occurs
- Insulin resistance, a precursor of diabetes
- Increased risk of thrombosis (a blood clot that can lead to death even in young women)
- Increased risk of cervical cancer and breast cancer
There are other reasons you may not feel comfortable with using the Pill.
Masking the underlying cause of the problem
Many women first go on the Pill due to acne or painful, heavy periods. While the Pill can improve these symptoms, this benefit is actually a double-edged sword. Two common underlying causes here are polycystic ovarian syndrome (the most common hormonal disorder in young women) and endometriosis (a serious inflammatory disorder leading to scarring and possible infertility). The Pill actually only acts to mask these problems, not fix them. Being on the Pill can have the negative effect of delaying diagnosis and proper treatment.
Fertility problems: it’s worth thinking about.
Even if you are not thinking about children just yet, it is important to consider the risks of staying on the Pill long-term and only coming off when you’re in your thirties and planning to have children. If you have underlying endometriosis or polycystic ovarian syndrome, these are masked by the Pill, and you may find that you have fertility problems when you come off the Pill. It is better for these to be identified and treated as early as possible, rather than finding out it’s too late.
Especially if you haven’t been 100% happy on the Pill, the side effects and risks may not be worth it. It’s important to remember that in practice, 8 out of 100 women will fall pregnant in one year. For some, these statistics for contraceptive effectiveness are not convincing enough.