The 20th century was probably the most revolutionary in history. And, without a doubt, one of the achievements that brought the greatest benefit to humanity was the emergence of hormonal contraception, the famous “pill”.
Women take control
Until the 1960s, most women used contraceptive methods of limited effectiveness. Some were largely dependent on chance; for example, extending breastfeeding, avoiding intercourse on certain days of the calendar, using cervical mucus or temperature techniques.
Other procedures, such as using a male condom or coitus interruptus (also known as “reverse”), they did not allow women to have control over the situation. Birth control pills allowed them to freely decide when to avoid pregnancy.
Hormonal problem
Hormonal contraception consists of the external administration of sex hormones, estrogens and progestogens, which prevent a woman from becoming pregnant through various mechanisms:
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They thicken the cervical mucus, which blocks the passage of sperm.
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They slow down the maturation of the uterine mucosa (endometrium), preventing implantation of a fertilized egg.
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They block the production of pituitary hormones (gonadotropins), thereby preventing ovulation.
This type of contraception is reversible and can be made in pill form, as well as transdermal patches, vaginal rings, subcutaneous implants, or injections. Although these other forms of treatment have similar effectiveness, they differ in the discomfort or side effects they cause. In addition, some require medical intervention to start or stop taking them, while oral contraceptives provide greater autonomy.
In any case, it is also necessary to remember that hormonal contraceptives, unlike barrier methods, do not protect against sexually transmitted infections.
Efficiency over 99%
Over the past six decades, hundreds of millions of women have taken “the pill.” Few drugs have been studied so thoroughly for their effects, both beneficial and undesirable. And today we know that the benefits far outweigh the risks.
Combined oral contraceptives (estrogen and progestin), when used correctly, have a failure rate (defined as the number of unintended pregnancies per 100 women over one year) of less than 1%, as do intrauterine devices and injectable progestins. This effectiveness is exceeded only by surgical sterilization (tubal ligation or vasectomy). The most common cause of failure is missing one or more feedings during a cycle.
What to consider before taking them
In general, most women can use hormonal contraceptives. The only exceptions are those who have high blood pressure, coronary heart disease, cerebrovascular disease, or certain types of migraine. Those with risk factors for venous thromboembolism, including obesity, or who have had breast cancer should also not take them.
Although it has been described for many years that oral contraceptives can reduce vitamin or folate levels, this effect does not seem to be important for women with good nutritional status. Folic acid supplements will be necessary for women wishing to become pregnant to promote proper neurological development of the embryo.
If other medications are taken at the same time as oral contraceptives, interactions may occur that increase or decrease the effects of these medications, so consult your doctor.
In addition, contraceptive effectiveness may be reduced in patients undergoing certain treatments: some antiepileptic drugs or rifampicin (an anti-tuberculosis antibiotic) reduce the level of contraceptives and may negate their effect. In the case of other antibiotics, although much has been written about this, such interactions have not been confirmed.
The most important risks
As for undesirable effects, symptoms may appear in the first months of use depending on the estrogens or progestogens introduced. Nausea, breast pain, increased hair, irregular bleeding, irritability, decreased libido, a feeling of bloating or weight gain are common. These effects may vary depending on the manifestation and usually improve spontaneously within a short time or with a change in the dose of estrogens or type of progestogen, although in some cases they may require discontinuation of treatment.
Aside from these possible inconveniences, the main risks of the “pill” are its cardiovascular effects and the possibility of developing certain tumors.
Thus, when taking hormonal contraceptives, women are 3-4 times more likely to develop venous thromboembolism than those who do not take them. However, in absolute figures, this risk is small: it is approximately half the risk of venous thrombosis during pregnancy.
Hormonal contraceptives are currently not recommended after age 35 for women who smoke, are obese, or have a family history of cardiovascular disease. Combined oral contraceptives, which include estrogen and progestin, with low doses of estrogen are less likely to cause cardiovascular problems and may be considered safe up to age 45 and beyond. On the other hand, those containing newer progestins appear to be associated with a higher risk of venous thrombosis.
These drugs are also linked to certain types of cancer. Although studies vary, the odds of developing breast cancer increase by 20 to 40 percent during treatment, although they appear to normalize after stopping treatment. They also increase the likelihood of developing liver tumors — up to four times — and, in women with positive HPV serology, cervical cancer.
Contraceptive of choice
The other side of the coin is that hormonal contraceptives are associated with a reduced risk of ovarian and endometrial cancer and other health benefits: they regulate cycle length and reduce premenstrual symptoms; relieve pain caused by menstruation and ovulation; reduce the amount of menstrual bleeding and the risk of iron deficiency anemia; they improve acne and endometriosis, and reduce the incidence of benign breast tumors, pelvic inflammatory disease, ovarian cysts and osteoporosis.
In short, oral contraceptives have been a highly effective reversible method of preventing pregnancy for decades, giving women greater autonomy and requiring no outside intervention. For young, nonsmoking women who are not obese, have no history of heart disease or breast cancer, and who want to take a pill every day, they can be considered the contraceptive method of choice.