ON THE PILL: In this seven-part series we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.
More than half of 18- to 19-year-old women in a recent survey agreed that “women should ‘take a break’ from oral contraceptive pills every couple of years”.
You may be surprised to know there is no biological evidence for “giving your body a break” and, in fact, it could do your health more harm than good.
There are many different types of contraceptive pills, most commonly containing both oestrogen and progestogen (called combined oral contraceptive pills).
Doctors use detailed medical eligibility criteria to assess whether a method of contraception is suitable for you on the basis of your medical history. The pill is not suitable for some people. Others may start taking it but find that it doesn’t suit them.
But for many women the pill provides a convenient, easily accessible method of contraception. In fact, it’s the most popular form of contraception for women under the age of 30.
Studies in the United States and Australia have found that many women worry about overdosing or having a build-up of hormones in their body if they use hormonal contraception. These types of misconceptions about the way the pill works fuel the erroneous idea that it’s good to take a break from the pill.
For some people, the pill can be associated with unpleasant side effects such as breast tenderness, bloating, headaches and nausea.
But rather than being an effect of the hormones themselves, these unpleasant side effects are most commonly associated with the hormone-free interval which allows a “withdrawal” bleed to occur, mimicking a natural menstrual cycle.
These side effects may be lessened by new pills or pill regimes with reduced or no hormone-free intervals (and therefore fewer or no withdrawal bleeds).
Once a doctor prescribes the pill for you, it’s generally recommended that you keep taking it for at least three months to allow any unpleasant side effects to resolve themselves.
Whether or not a particular pill is problematic for a woman does not change with the duration of use. In fact, any initial side effects you had on starting will be experienced again after a break. For these reasons, it’s best to find a pill that suits you and stick with it.
Of course, as you age your contraceptive needs will change, so it’s important to review your contraception periodically. Research shows that Australian women reduce their reliance on the oral contraceptive pill over time as they try to conceive, have children, complete their families, and move towards menopause.
Serious health risks?
Like all medicines, there is a small risk of serious health effects associated with the pill. The risk of serious adverse side effects is highest in the first few months of starting the pill, or when restarting after a break. So it may be more risky to start and stop the pill than it is to use the pill over many years.
Despite the very low risk of health complications associated with the pill, people’s fears are exacerbated by “pill scares” – misrepresented studies reported in the media – which are usually not based on an accurate understanding of the risks.
One of the most serious adverse health effects associated with the pill is thrombotic complications such as stroke, myocardial infarction, and venous thromboembolism (VTE) – in other words, blood clots in the brain, heart, legs, arms and groin. This is why the pill may not be suitable for older women, particularly those who smoke.
However, the pill is suitable for women in mid-life who aren’t at increased risk of heart disease.
Although potentially very serious, the absolute risk of blood clots is very low. This risk is marginally higher than for women not taking the pill, but is lower than the risk associated with pregnancy, delivery and the postpartum period.
Some people may be concerned about the risk of cancer associated with long-term use of the pill. There is a slightly increased risk of cervical cancer but a reduced risk of ovarian and endometrial cancer. The findings about the risk of breast cancer are not conclusive.
It’s also important to note there are a number of non-contraceptive benefits of the pill, including better cycle control; improved premenstrual symptoms, acne, pain, heavy menstrual bleeding and iron-deficiency anaemia; and a reduction in ovarian cysts, benign breast disease and possibly pelvic inflammatory disease.
These non-contraceptive side effects often form the basis for women’s choice of contraception.
One of the concerns women have about long-term pill use is that they will find it difficult to conceive. Research across a number of countries shows women want their fertility to return quickly after they stop using the pill.
Many factors influence the time it takes for a woman to conceive so it’s difficult to determine the role of the oral contraceptive pill. Some research documents a temporary delay in conceiving, usually only lasting a few months.
However, a review of 17 studies found typical one-year pregnancy rates following discontinuation of the pill ranged between 79% and 96%, which is similar to women who stopped using condoms or weren’t using another form of contraception.
What should you do?
If the pill suits you, there’s no need to “give your body a break”.
But it’s important to have regular health checks and also review your contraceptive needs periodically. This is particularly relevant at significant times in your reproductive life – on becoming sexually active, being with a new partner, if you’re thinking of having a baby, after having a baby, and when you’ve decided not to have any more children.
It’s always worth finding out about the latest contraceptive options so you can be sure you’re using contraception that’s right for you.