Birth-Control Pill

Alert: Should women still be taking the pill?

By Adrienne Benassy
01/02/2013

Since the introduction of the birth-control pill in the 60s, it has been a symbol of sexual freedom and of women’s control over their bodies. But this freedom has a price: our health.

There is a misconception that clouds our thinking around the contraceptive pill. It's omnipresence in women's lives has lead to a belief that it is almost natural and stopped us from considering the potential harm it can do.

In France, women have accused the contraceptive pills of being directly responsible for their heart attacks. An anti-acne drug often used as a contraceptive, better known as “Diane 35”, has caused the death of four women. These scandals have left women without answers to one crucial question: should they still be taking the contraceptive pill?

"Nobody, nobody, nobody should take the 3rd and 4th generation pills »

On the 14th of December 2012, Marion Larat has filed a lawsuit against Bayer, alleging that she suffered a cerebrovascular accident as a result of taking a pill produced by the German laboratory (Meliane). At only 25 years of age, she is no longer in control of her right-hand and regularly suffers from epilepsy. “Nobody, nobody, nobody should take the 3^rd and 4^th generation pills” she warns.

Since then, more than 14 victims of contraceptive pills in France have filed a lawsuit against the laboratories Bayer, Effik, MSD France, Biogaran and against the French National Agency for Medicine Security.

Why are they dangerous?

All contraceptive pills increase the risks of:

• Thrombophlebitis: formation of blood clots
• Pulmonary embolism: a blockage of the main artery of the lung or one of its branches by blood clots that have travelled from elsewhere in the body through the bloodstream.
• Myocardial infarction: commonly known as a heart attack, it results from the interruption of blood supply to a part of the heart, causing heart cells to die.
• Cerebrovascular accident (CVA): commonly known as a stroke, it is the rapid loss of brain function due to disturbance in the blood supply to the brain.

It is during the first year that the risks linked to the birth control pill are at their highest. Combining the contraceptive pill with smoking, especially after 35 is also very dangerous for women’s health.

Why have the 3rd and 4th generations pills been prescribed so much?

Even though the notice mentions the risks linked to these contraceptives, one in three of all females of reproductive age take the pill in the UK. Why such a widespread use of birth controls pills if they are so risky?

• The pills of 3^rd and 4^th generation have fewer side effects.To avoid larger breasts, weight gain, nausea or emotional sensitivity, women take these pills. Doctors recommend them especially to younger girls, arguing that they will be able to start contraception with a lighter product.   

• Buying the pill is too easy? In France, most women consult a gynaecologist before taking the pill, but most of the time GP’s also prescribe it, especially in the UK. Furthermore, some pharmacies sell it without prescription in case of emergency.
   
• There’s not enough prevention: The risky side effects might be enough to deter some women from taking birth-control pills, but many women are just not aware of them. The birth control pill has always been a good choice of contraception for women but is not always the safest option available and doctors or pharmacists do not do enough prevention.

Stopping the pill could be more risky

The London-based European Medicines Agency (EMA) said that blood-clot risk with all birth control pills was “very small” although it was higher for third-and-fourth generation ones. “There is no reason for any woman to stop taking her contraceptive. If a woman has concerns, she can discuss this with her doctor” stated the EMA.

For gynaecologists, stopping the pill would result in an increase in unintended pregnancies, which present far more risks of blood clots and heart attacks than taking the pill.

In an attempt to control the situation, the French Health Minister, Marisol Touraine, asked the EU to limit the use of pills of 3^rd and 4^th generation and said the government would stop reimbursing prescription costs of third and fourth generation pills.

Nevertheless gynaecologists stress the fact that pregnant women are twice more likely to have thromboembolic accidents than women who take the pill. Furthermore, they consider it would be far worse to stop the use of this method of contraception and see an increase in abortions.

What should women do?

It is advisable to:

• Avoid taking birth control pills, especially 3^rd and 4^th generation, for non-contraceptive reasons, such as menstrual regulation or acne. 
• Increase awareness concerning the pill’s dangers.
• Encourage having proper gynaecological examinations prior to taking birth-control.
• avoid taking the pill if you are a smoker

What alternatives are on offer?

Implants or the Cézarette (oestrogen-free, progestogen-only oral contraceptive pill) are the only hormonal contraceptives that do not present any kind of risks, but they have very strong side effects such as weight gain and/or migraines.

The modern intrauterine device (IUD or Coil) is another alternative to the pill, but is not recommended for women that have an instable sexual relationship. The IUD is a form of birth control in which a small “T”-shaped device, containing either copper or progesterone is inserted into the uterus. Nevertheless the IUD can be risky: 2 women out of 10 000 suffer from blood clots and risks of infection exists, which can lead to sterility in some very rare cases.

In conclusion, the pill may not be very dangerous but it does increase risks of thrombophlebitis, pulmonary embolism, myocardial infarction and cerebrovascular accidents. Women should be more aware of these risks when making descisions about which contraceptive method they will use, but first and foremost gynaecologist should keep a constant eye on women’s health to prevent accidents.

Differences between pills

All contraceptive pills include the cobination of progestogen that blocks ovulation, and oestrogen, that eases its consumption. The word 'generation' refers to the evolution of its composition and the risks vary in function of the different generations.

NB: The Dianette (Diane 35 in France) pill is used for severe acne, abnormal hair growth and also provides contraception for women, but it should not be used solely as a contraceptive. Dianette tablets contain two active ingredients, cyproterone acetate (anti-androgens, which are male hormones produced also by women) and ethinylestradiol. This anti-acne which also serves as a contraceptive present a higher risk of developing blood clots in a vein, in the leg(deep vein thrombosis) or in the lungs (pulmonary embolism) or a blood clot in an artery causing a stroke or a heart attack. This risk is even higher for women who smoke or who are obese. There is also an increase in the diagnose of breast cancer. Dianette has been withdrawned of the market in France because of its high risks.