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    All About 'The Pill'

    birth control pills

    Standing in the checkout line at the grocery store, I’m always amused by the obnoxious medical headlines on women’s magazines. Today it was “10 Things Your Gynecologist Doesn’t Know That Might Kill You” (for the record, I do know all the things they listed). In fact, though, the opposite is more often true: there are some basic facts that my patients don’t know – especially about birth control – that could possibly improve their lives. I receive a handful of questions almost daily about “the pill” – most are misconceptions that have been around for ages and, unfortunately, have caused woman to unnecessarily avoid effective contraception. Here are a few facts that I routinely share with my patients:

    How the Pill Affects Your Hormones
    When I start women on the pill, they will often request a pill that won’t “mess up” (sometimes the language is more colorful) their hormones. In reality, that is the basis for how the pill actually works. The pill keeps the estrogen and progesterone at a steady state, which interrupts the feedback between the ovary and the brain, preventing ovulation. I think what most women actually mean is they don’t want a pill that will make them feel more emotional. In fact, the pill is technically one of the best treatments for PMS because it prevents the cyclical surge of hormones before the cycle. Of course, all women are unique in how their bodies react to different medications. I do see women who feel less emotional on one brand or combination of pills than the other. Don’t write off an entire class of drugs simply because one brand made you feel a little off – it may just be a matter of trial and error to find the best option for your body chemistry.

    For Some Women, the Pill Can Prevent Periods Altogether
    As the pill provides a low steady state of hormones to your body, in addition to preventing ovulation it also prevents as much tissue from building up in the lining of the uterus. This is great, because it leads to lighter and less crampy periods. Some times when women have been on the pill for a long time they will actually not have a period at all. While this can cause significant concern for some patients (that’s nice doctor talk for it “seriously freaks them out”), medically it is perfectly fine. The lack of a period when you are on the pill does not mean that all the tissue is getting backed up inside, it’s just that over time the lining becomes so thin that there is no tissue to shed off.

    The Pill Doesn’t Cause Cancer
    The pill actually reduces your risk of endometrial and ovarian cancer and, for the average-risk woman, doesn’t increase the risk of breast cancer.

    The Pill Doesn’t Cause Weight Gain
    The current formulations of the birth control pill are not associated with weight gain. The original birth control pill was up to 5 times the current dose and did have some very unpleasant side effects including weight gain, but our current low dose regimens have not been show to have any effect on weight. What often happens is that women start the pill about the time they head to college which is often a time they are gaining weight for other reasons.

    The Pill Does Have Side Effects
    When starting the pill, common side effects include nausea and irregular bleeding. These usually resolve in 2-3 months. In rare cases, the pill can also cause serious side effects like stroke or blood clots that can travel to your lungs. This is common fodder for law suits and scary TV commercials. Luckily, in the average healthy, non-smoking woman these risks are extremely low ( ~ 10/100,000). It’s also important to remember that these same risks are 10 times higher in pregnancy than when taking the pill.

    Is the pill the best contraceptive option for everyone? Of course not, but it is highly effective, inexpensive, and easy to use. If it is the best option for a patient, I hate to see a woman not use pill due to misinformation. I would encourage every woman to discuss her contraceptive options with her provider.


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