Oral contraceptives contain two synthetic hormones, estrogen and progestin. The combined Pill works by suppressing ovulation; no egg, no pregnancy risk. Some also change the composition of cervical mucus so it is difficult for sperm to swim through. They slow the passage of the egg down the tubes, and change the uterus lining to prevent implantation if fertilization occurs.
The main side effects are spotting and breakthrough bleeding. The lower the dose of estrogen, the more likely this will be. The Pill can produce symptoms of pregnancy: nausea, weight gain, breast swelling, and headaches. As the body adapts, the symptoms usually cease. In some cases, the "mask of pregnancy" appears strange brown patches on the face or neck. Chloasma, its medical name, can last some while after coming off the Pill.
Mini-Pills contain only progestin. They prevent pregnancy by keeping the cervical mucus thick, slowing down egg transport, and stopping implantation. They suppress ovulation, but not as well as the combined Pill. The side effects include irregular periods, spotting or breakthrough bleeding, shorter and scantier flow; periods can stop altogether.
Implantation involves six match-stick sized silicon tubes being implanted, fan-shape, under the skin of the upper arm. The tubes contain progestin, which is released at a slow, steady rate over five years. They act like the mini-pill.
The side effects include irregular bleeding in 75 percent of users. Periods can come at odd intervals, 3 or 7 weeks apart, or one is missed altogether. The flow lasts longer, 8 days instead of 5. The manufacturers state these effects lessen after 2 years. The cost of implant and medical procedure is estimated at about $500, which puts it out of range for many young women. Yet it compares well with an average $900 for five years of the Pill.
Mornings after pills are multiple and very high doses of female hormones taken as soon as possible after unprotected intercourse. They prevent pregnancy by stopping implantation, if an egg has already been fertilized.
|Health Risks and Benefits
Cardiovascular Disease. Estrogen in the Pill interferes with blood clotting in complex ways. Progestins cause small and subtle changes in blood pressure, blood sugar, and insulin, and larger changes in cholesterol and related lipids. The overall added risk appears very low in young women and non-smokers who have no predisposing factors for heart disease. After the woman comes off the Pill, the effects disappear rapidly; former users seem to have no effects no matter how long they used the Pill.
Cancers. The Pill reduces the risk of cancer of the uterus and ovary. This benefit affects women soon after starting on the Pill, becomes stronger with longer use, and lasts for many years after use is stopped. Some studies suggest that prolonged Pill use in the teens or early 20s increases the risk of breast cancer. They also suggest that as these women become older, they may be less likely to develop breast cancer than never-users of the Pill. It can be seen that the link with breast cancer is still very unclear.
The Pill is contraindicated with the following conditions:
- High blood pressure.
- Severe varicose veins.
- Surgery in the next 4 weeks.
- Hepatitis or other liver disease.
- Cancer of the breast, or reproductive organs.
- Heart disease, stroke, or blood disorders.
The Pill provides no protection against sexual disease. It can upset the ecology of the vagina, with a risk of recurrent yeast.
Benefits of the Pill:
- Periods arrive every 28 days on the dot.
- There is a lighter, scantier flow.
- Relief from period pains and cramps.
- Relief from PMS.
- Relief from irregular or heavy bleeding.
- Relief from acne in some women.
- Relief from fear of pregnancy.
- Reduced risk of cancer of the ovary and uterus.
- No clear information on cancer of the breast.
This is a surgical procedure which cuts and seals off part of each oviduct. The egg cannot be transported to meet the sperm. Tubal ligation is done under local anesthesia, on an outpatient basis, with a few hours spent in the recovery room. There is no interference with natural hormone production, and the couple are free of fears of pregnancy as it is extremely effective. It is appropriate only for those who have completed their families, as it is a permanent method of contraception. The tubes can be unblocked and sewn together, but reversal is a difficult, costly, and not always successful operation.
In male sterilization, the sperm-carrying tubes leading from the testicles are cut and sealed off. The sensations at orgasm remain the same, the only difference being that no sperm are present in the ejaculate. Vasectomy is a simple procedure, far more so than tubal ligation. The side effects are minor and temporary: swelling, bruising, and discomfort. Vasectomy should be regarded as irreversible. Though reversal is possible, it is costly and not always successful.
Once again, vasectomy is being linked to a slight increase in prostate cancer. The link is considered very slight. One study involved 1,697 men who were hospital patients. Of the 220 with prostate cancer, 10 percent had vasectomies. Of the 960 men with other cancers, 3.3 percent had vasectomies. Of the 517 men without cancer, 2.4 percent had vasectomies. A second study compared 614 patients with prostate cancer against 2,588 male patients with other cancer. About 5 percent of men with prostate cancer had vasectomies, compared with about 4 percent of the other patients. While these results are unlikely to be due to chance, it cannot be entirely ruled out.
The Male Pill
A new contraceptive Pill for men now undergoing clinical trials could be the first reversible method since the condom. When sufficient testosterone enanthate TE is injected, the brain senses it, and signals the testicles to suppress further sperm production. It works like the Pill in that the shots control the man's hormone production.
The problem with finding a male contraceptive to date has been the unacceptable lowering of a man's libido (sex drive). This new approach may overcome it. If the TE trials are proven safe and effective, the shots should be available in about six years. Men will then have a reversible option to vasectomy. Women will be freed from some of the burden of fertility control.
RU-486 contains Mifepristone, a drug which induces miscarriage during the first seven weeks of pregnancy. It is used as an alternative to surgical abortion in France. These are clinical trials for testing the effectiveness and potential problems of new drugs.
RU-486 blocks progesterone. Three pills are taken followed by an injection of synthetic prostaglandin, which makes the uterus contract. RU-486 has been effective in inducing abortions in 96 percent of those who used it. Close monitoring with 4 visits to the physician's office are essential: before, during, and after drug administration. One death is linked with RU-486.
The ethics of abortion are not at issue here. The concerns of this book are female reproductive health. Paradoxically, there is a lifesaving aspect to the drug; it can slow down certain tumours which need the hormone to grow. It has been used in Cushing's disease, and advanced breast cancer. RU-486 also blocks the stress hormones which act on almost every cell in the body and can lower immune function. For this reason, it may have sweeping powers against a variety of ailments as yet unknown.
Birth control is not a new concept. Barriers such as sponges have been used for centuries, as have "outer-course" and withdrawal. Nor is the sheath a new device. What is new is the huge advances made by medical researchers in finding other methods to protect against pregnancy. Usually, the more complex the advance, the more protection it offers, and the greater the risk of side effects.
Other methods of fertility control are being studied. They include: a hormone-releasing IUD, a hormone badge taped to the arm which releases a contraceptive through the skin, a hormone-emitting vaginal ring which the woman can insert and remove at will, and a female condom. Some of these new methods may reduce contraceptive failure, and the high rate of unintended pregnancy.
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