tag:theconversation.com,2011:/global/topics/contraceptive-pill-1650/articlesContraceptive pill – The Conversation2022-12-01T19:03:31Ztag:theconversation.com,2011:article/1947182022-12-01T19:03:31Z2022-12-01T19:03:31ZFifty years ago, the new Whitlam government removed the luxury sales tax on the pill. It changed Australian women’s lives<figure><img src="https://images.theconversation.com/files/498211/original/file-20221130-22-pr7fvm.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.broadagenda.com.au/2020/do-fourth-wave-feminists-get-their-second-wave-foremothers/">Broad Agenda</a></span></figcaption></figure><p>Amid the scale and sweep of the list of decisions made by the Whitlam government in their first week in office, most people remember the big changes: freeing all draft resisters from prison, or official recognition of Communist China. </p>
<p>The removal of the sales tax on the contraceptive pill, and adding it to the Pharmaceutical Benefits Scheme, which came into effect on December 9 1972, is easily overlooked. Yet this reform was both symbolic and materially important. It signalled to Australian women that their new government would be much more responsive to their demands for reproductive rights and freedoms, and ushered in a wave of feminist reforms under the Whitlam government.</p>
<h2>The popularity of the pill</h2>
<p>The <a href="https://www.nma.gov.au/defining-moments/resources/the-pill#:%7E:text=The%20release%20of%20the%20oral,unwanted%20pregnancies%20and%20plan%20parenthood.">introduction of the contraceptive pill</a> in January 1961 had brought the topic of contraception into the open in Australia. It was hailed as a reliable and convenient way for married couples to plan their families. </p>
<p>The pill also made an important contribution to the changing sexual climate of the late 1960s. By removing the fear of pregnancy, the pill helped to change women’s attitude towards sex. Concerns about side-effects, cost and availability deterred some women from taking it, but by the early 1970s, one in every four Australian women had a prescription.</p>
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<a href="https://theconversation.com/the-relation-between-politics-and-culture-is-clear-and-real-how-gough-whitlam-centred-artists-in-his-1972-campaign-181243">'The relation between politics and culture is clear and real': how Gough Whitlam centred artists in his 1972 campaign</a>
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<p>However, many doctors refused to prescribe the pill to single women, and it remained out of reach to many working class women due to its cost. At the time, Australia had banned the advertising of contraceptives, and the sales taxes and tariffs applied to contraceptives added to their expense. As the Women’s Electoral Lobby liked to point out, the 27% sales tax on the pill was the same as that applied to mink coats. </p>
<h2>Growing calls for reproductive rights</h2>
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<span class="caption">An early contraceptive pill from about 1963. The introduction of the pill changed Australian women’s lives.</span>
<span class="attribution"><a class="source" href="https://www.nma.gov.au/defining-moments/resources/the-pill#:~:text=The%20release%20of%20the%20oral,unwanted%20pregnancies%20and%20plan%20parenthood.">National Museum of Australia</a></span>
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<p>Given many women’s difficulties obtaining the pill, it is unsurprising that access to abortion became a significant political issue in the 1960s. The Abortion Law Reform Association (ALRA) was formed in 1967, and by 1971 it had branches across Australia. </p>
<p>The laws criminalising abortion were state-based, and these <a href="https://www.aph.gov.au/about_parliament/parliamentary_departments/parliamentary_library/pubs/rp/rp9899/99rp01">laws were liberalised</a> in Victoria in 1969 and NSW in 1971. This liberalisation did not grant women the “right” to abortion, but clarified the conditions under which a doctor could perform an abortion lawfully. </p>
<p>Under the liberalised law, a doctor could perform an abortion legally when they believed that it was “necessary to preserve a woman from serious danger to her life or to her physical or mental health”. </p>
<p>These reforms were focused on doctors’ rights, rather than women’s. But at the same time, the women’s liberation movement was demanding bodily autonomy and reproductive freedom for women. They wanted abortion on request, free birth control, and free childcare, arguing that women could only fully participate in society as equal citizens if they had control over their fertility. Contraception was a fundamental feminist issue.</p>
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<h2>Whitlam, WEL and reproductive rights</h2>
<p>As part of his reshaping of the Labor party to make it electable and modern, Whitlam extended the ALP’s language of equal opportunity beyond class to encompass migrants, women and Indigenous Australians. </p>
<p>While Labor’s 1972 election platform only addressed women’s specific needs in relation to childcare, Whitlam was a vocal supporter of women’s access to affordable contraception and abortion, as was his wife, Margaret.</p>
<p>Yet it was the <a href="https://welvic.org.au/about-wel/">Women’s Electoral Lobby</a> that was perhaps most crucial in reshaping Labor policy on women’s issues. Formed in March 1972 by abortion law reform campaigner Beatrice Faust, WEL wanted to place women’s concerns on the political agenda by surveying all candidates in the 1972 election on issues women believed were important. One-third of those questions were on contraception and sex education. </p>
<p>Apart from the candidate survey, which generated huge publicity in the lead up to the 1972 election, WEL also engaged in lobbying, and made a submission to a 1972 tariff inquiry calling for a reduction in tariffs on contraceptives. As Marian Sawer notes in her <a href="https://books.google.com.au/books/about/Making_Women_Count.html?id=DrlkaO61h74C&redir_esc=y">history of WEL</a>, this put family planning issues on the ALP’s agenda. Within a week of WEL’s submission, the shadow health minister, Bill Hayden, said a Labor government would remove the sales tax on contraceptives and support the development of a network of family planning clinics. </p>
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<p>This early action made the contraceptive pill cheaper; the Whitlam government’s subsequent actions made contraception more widely available. The government made numerous grants to family planning organisations, and between 1973 and 1974, around 100 family planning clinics opened throughout Australia. </p>
<p>These clinics were important for several reasons: they took away some of the stigma of having to approach your doctor for a prescription for the pill, especially for young single women, and the location of clinics in working class areas helped increase uptake of the pill among working class women. </p>
<p>This early decision on the pill was the first of the Whitlam government’s reforms on reproductive rights. The government made an unsuccessful attempt to reform the law on abortion in the ACT. However, while it failed to change the law, it did create the Royal Commission on Human Relationships, a far-reaching inquiry into sexuality, gender and family life. In the words of Elizabeth Reid, the Whitlam government’s advisor to women’s affairs (the first position of that kind in the world), the commission helped foster a “<a href="https://hercanberra.com.au/life/the-revolutionary-in-whitlams-government-who-fought-for-women/">revolutionary consciousness</a>” that she saw as vital to driving structural and cultural change. </p>
<p>It inquired into why women had abortions and planned their families, recommending new laws and practices to respond to changing times. The government also funded women’s refuges and women’s health centres, which helped share new knowledge about contraception. It expanded the provision of childcare, and, through Reid, started the long, slow process of making Australian governments more responsive to women’s needs. It is an ongoing journey.</p>
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<p>In his book The Whitlam Government, Whitlam remarked that </p>
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<p>the many and diverse achievements of the Government did much to correct an alarming history within the Labor Party of ignorance and inactivity on women’s issues.</p>
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<p>His government recognised women as independent political subjects with roles to play beyond motherhood. It also recognised the central principle of second wave feminism: namely, that women needed bodily autonomy and control over their fertility before they could participate in society on their own terms. </p>
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Read more:
<a href="https://theconversation.com/damned-whores-and-gods-police-is-still-relevant-to-australia-40-years-on-mores-the-pity-47753">Damned Whores and God’s Police is still relevant to Australia 40 years on – more's the pity</a>
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<p>The decision was also an important signal to the women’s movement: an assurance that they took women’s concerns seriously, and that the rights of women were important to the Labor party as they built an expanded coalition of voters. </p>
<p>The removal of sales tax on the pill was fitting recognition of women’s new political engagement, and the beginning of a productive relationship between the government and the women’s movement. </p>
<p>On the 50th anniversary of this symbolic and important decision, it’s worth remembering what governments and activists can achieve when they work together to improve the lives of Australian women.</p><img src="https://counter.theconversation.com/content/194718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Arrow receives funding from the Australian Research Council. She has worked as a campaign volunteer for the Australian Labor Party. </span></em></p>The Whitlam government’s removal of the sales tax may seem small, but it increased access to the pill for many women and in doing so, changed their lives.Michelle Arrow, Professor of History, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1833672022-07-25T20:02:00Z2022-07-25T20:02:00ZWhat to expect when coming off the pill, and 5 things to do before you do<figure><img src="https://images.theconversation.com/files/471783/original/file-20220630-15-dvkid7.png?ixlib=rb-1.1.0&rect=0%2C5%2C3528%2C2359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Unsplash/Drew Dizzy Graham</span></span></figcaption></figure><p>“The pill” (the combined oral contraceptive pill) has been giving Australian women control over their reproductive health since the 1960s and remains the <a href="https://www.ogmagazine.org.au/16/2-16/combined-oral-contraceptives/">most commonly used</a> method of contraception by Australian women. </p>
<p><a href="https://alswh.org.au/shorthand/reproductive-health-report/#group-section-The-Pill-QkSUaAOLBq">Its use peaks</a> with around 60% of Australian women in their late teens and early 20s using the pill, and drops to around 35% by the mid to late 20s. </p>
<p>Used perfectly, the pill <a href="https://shvic.org.au/for-you/contraception/daily-contraceptive-pills/contraceptive-pill">prevents pregnancy</a> 99.5% of the time, but in the real world where pills are occasionally forgotten it works 93% of the time. </p>
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Read more:
<a href="https://theconversation.com/how-effective-is-the-pill-122189">How effective is the pill?</a>
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<p>In Australia, half of the women who start on the pill won’t be taking it <a href="https://alswh.org.au/shorthand/reproductive-health-report/#group-section-The-Pill-QkSUaAOLBq">six months later</a>. Women come off the pill for lots of different reasons, including:</p>
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<li><p>trying to fall pregnant</p></li>
<li><p>trying a different contraceptive option</p></li>
<li><p><a href="https://www.bmj.com/content/bmj/3/5773/495.full.pdf">side effects</a> (including headaches, bloating, weight gain, not having a regular period, unpredictable nuisance or “breakthrough” bleeding, nausea, depression, reduced libido)</p></li>
<li><p>developing a medical condition where the pill is no longer safe (the most common of these is migraine or deep vein thrombosis, or smoking over the age of 35)</p></li>
<li><p>no longer needing contraception </p></li>
<li><p>wanting to know what their natural cycle and periods are like. </p></li>
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<p>If you’re preparing to come off the pill, it’s hard to know what to expect – particularly if you’ve been on it for a long time.</p>
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Read more:
<a href="https://theconversation.com/theres-convincing-evidence-the-pill-can-cause-depression-and-some-types-are-worse-than-others-184248">There's convincing evidence the pill can cause depression, and some types are worse than others</a>
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<h2>What may happen when you come off the pill</h2>
<p>Regardless of how long you’ve been taking the pill, the synthetic hormones are cleared from the body within days. Your body returns to releasing different amounts of oestrogen and progesterone throughout the cycle – although what’s “normal” for your body may have changed. </p>
<p>Teenagers can have irregular periods for the first few years before a more regular rhythm establishes. A lot might have changed since you first went on the pill – your body could have developed a medical condition, have a different lifestyle, changed size or shape, or had children. This can all impact how natural hormones in your body can impact you. </p>
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<a href="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman looking off into sunset" src="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Regardless of how long you’ve been taking the pill, the synthetic hormones are cleared from the body within days.</span>
<span class="attribution"><span class="source">Unsplash/artem kovalev</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Here are some of the changes you might expect when coming off the pill.</p>
<p><strong>Periods!</strong> </p>
<p>For many women, <a href="https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use">periods come back within a month</a> of stopping the pill, with almost all women getting their period within three months. Your periods may start off irregular, but generally return to the natural menstrual cycle within three months. Women on the pill often have quite light periods, so coming off the pill you might experience heavier or longer periods. The natural cycle can also be impacted by exercise, diet, stress and underlying medical conditions. It’s a good idea to see a doctor if you haven’t got your period back within three months.</p>
<p><strong>Fertility</strong> </p>
<p>Women can expect their <a href="https://www.bmj.com/content/371/bmj.m3966">fertility to return to their baseline</a> “natural” level around three cycles after coming off the pill. That being said, you can definitely get pregnant as soon as you come off the pill. Being on the pill does not impact long-term fertility, even if it was taken for many years, so there’s no medical need to take a “break” from the pill to “normalise” things for the body.</p>
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<em>
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Read more:
<a href="https://theconversation.com/no-women-dont-need-to-take-a-break-from-the-pill-every-couple-of-years-87940">No, women don't need to 'take a break' from the pill every couple of years</a>
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<p><strong>Underlying medical issues</strong> </p>
<p>For some women, coming off the pill can reveal problems the pill has been masking. For women with endometriosis, the pill commonly reduces their symptoms of painful periods, cramping, heavy bleeding and painful sex - and suppresses growth of the endometrial tissue in areas other than inside the uterus, where it belongs. Coming off the pill can cause a ramping up in period and pelvic pain. For women with a history of polycystic ovarian syndrome, periods are likely to return to being irregular once coming off the pill.</p>
<p><strong>Acne</strong> </p>
<p>For women who experience hormonally driven acne (commonly seen around the jawline and which fluctuates with the period cycle), acne can flare after coming off the pill. Getting older or lifestyle changes can impact this though, so it’s not a given acne will return.</p>
<p><strong>Mental health</strong> </p>
<p>There is <a href="https://www.nps.org.au/australian-prescriber/articles/hormonal-contraception-and-mood-disorders">growing evidence</a> the hormones in the pill can bring on or worsen depression for some women, and is one of the <a href="https://www.bmj.com/content/bmj/3/5773/495.full.pdf">most common reasons</a> for stopping the pill. However, for women who experience depressive symptoms in the week leading up to their period (a condition known as premenstrual dysphoric disorder) taking the pill stabilises the mood and <a href="https://www.nps.org.au/australian-prescriber/articles/hormonal-contraception-and-mood-disorders">works as an antidepressant</a>. It goes without saying then that women coming off the pill can see changes to their mood or anxiety levels, and it’s good to keep your mental health care provider in the loop.</p>
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<p>
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Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
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<h2>5 things to do before coming off the pill</h2>
<ul>
<li>talk to your GP or other health professionals beforehand, particularly if you have had heavy periods, painful periods or other issues in the past. If you’re not happy with your particular type of pill, know there are other options for contraception including other contraceptive pills which may not cause the same side effects</li>
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<span class="caption">If you’re not happy with your particular type of pill, know there are other options for contraception.</span>
<span class="attribution"><span class="source">Unsplash/Prince Akashi</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<ul>
<li><p>have a plan for alternative contraception if you’re likely to be at risk of pregnancy and want to avoid it. If you have a regular partner, you might wish to have a conversation with them and discuss other options</p></li>
<li><p>consider monitoring and writing down your cycle and symptoms (heaviness and painfulness of periods, mood and anxiety) for 2–3 months before coming off the pill and afterwards. This can help you and your doctor recognise if coming off the pill uncovers some unexpected issues. Seek medical advice early if you are having heavy or painful periods</p></li>
<li><p>try to choose a time when life isn’t too stressful or chaotic, if possible. This will help you to work out if your symptoms are related to hormones, life in general - or both!</p></li>
<li><p>if you’re coming off the pill to prepare to conceive, it’s a good opportunity to book in for a prenatal check up. This can include talking about preparing yourself physically and mentally, supplements, and doing some blood tests to check for immunity against some viruses.</p></li>
</ul><img src="https://counter.theconversation.com/content/183367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phoebe Holdenson Kimura does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re preparing to come off the pill, it’s hard to know what to expect, particularly if you’ve been on it for a long time.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1458912020-09-21T14:30:19Z2020-09-21T14:30:19ZHow periods and the pill affect athletic performance<figure><img src="https://images.theconversation.com/files/359058/original/file-20200921-20-ub74do.jpg?ixlib=rb-1.1.0&rect=20%2C0%2C3460%2C2322&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These effects may have the greatest impact on elite athletes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/harrison-nj-may-26-2019-us-1415704871">Leonard Zhukovsky/ Shutterstock</a></span></figcaption></figure><p>The menstrual cycle, the pill and their potential impact on sporting performance have long been considered a taboo subject. Yet for most females who undertake any form of exercise or high-performance sport, there are a <a href="https://www.bbc.co.uk/sport/53705777">range of challenges</a> that can affect their athletic performance, including from their menstrual cycle and their use of contraceptive pills. But a historic lack of scientific research in these areas still means we have very limited knowledge of the specific effect that both have on athletic performance. However, what research we do have on these subjects shows both can have an impact on athletic performance – which may be especially important for elite athletes. </p>
<p>During the average menstrual cycle, levels of the sex hormones oestrogen and progesterone change throughout each phase. These hormonal fluctuations <a href="https://link.springer.com/article/10.2165/11317090-000000000-00000">cause changes</a> in body temperature, the storage and use of energy, and the ability of muscles to produce force.</p>
<p>The cycle is divided into three phases. Menses (days one to five of the cycle) is where both oestrogen and progesterone levels are low. This is followed by the follicular phase during which oestrogen concentration rises to a peak (between days 10-14). Immediately preceding is ovulation, where progesterone remains almost unchanged. Thereafter, during the luteal phase, the concentrations of both oestrogen and progesterone are high (days 19-24). If no implantation of a fertilised egg occurs, both oestrogen and progesterone levels fall, and the cycle recommences.</p>
<p>It’s the fluctuations in <a href="https://d1wqtxts1xzle7.cloudfront.net/39713069/The_menstrual_cycle_and_sport_performanc20151105-20491-1s5i7m.pdf?1446732079=&response-content-disposition=inline%3B+filename%3DThe_Menstrual_Cycle_and_Sport_Performanc.pdf&Expires=1600681032&Signature=PQ86Ff8ilwrtV1t0O3L-2AelR7PGBbv72HiTcMAEFTCphD3M%7EKJiEL-mtV%7EIwy7GAohBAemmX42H3ayB9Wtzs5NLMf5BSJnMXszpCw%7E-c0VsxiWd4XH5RHlcUxS7pYSJMdG4QKlV%7EuHrMjtrMPnyP-ew1b3QACAv0JzxqPS7OWaxUzPvhZy4bwXv5hn5kmueagWyhSVaqOiS50ZY26DG4jlF0BZRtJCxjtaeTs6uKK9-3ZuZuHcT1aUiZ3FjQkSKmcO7rS6fMZALs1KT6FuIzTWR%7Ef0mBUa3zYnZeD%7Ehwo-beEQ7sa6FuHyH0OLTizzcbAaQz3Rbm8TaMEM0W1vzug__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA">oestrogen and progesterone</a> which are thought to have an impact on sporting performance. Research shows both oestrogen and progesterone promote the uptake and storage of <a href="https://journals.physiology.org/doi/pdf/10.1152/ajpendo.00271.2002">muscle glycogen</a>. Both hormones also <a href="https://journals.physiology.org/doi/full/10.1152/ajpendo.00271.2002">change the ability</a> to use this stored form of carbohydrate for energy – both during exercise and at rest.</p>
<p>Glycogen is the stored form of carbohydrate in the muscle which plays a significant role in <a href="https://www.nature.com/articles/s42255-020-0251-4">supplying energy</a> to the body during exercise. Use of muscle glycogen appears to be <a href="https://journals.physiology.org/doi/pdf/10.1152/ajpendo.00271.2002">more proficient</a> during the luteal phase, when oestrogen and progesterone are high. This suggests that during menses and the folicular phases exercise requires us to use more of our stored glycogen, so may cause more fatigue.</p>
<p>Another common aspect of the menstrual cycle is the fluctuation in body temperature, largely because progesterone induces heat production. Increased progesterone concentrations is associated with an <a href="https://journals.sagepub.com/doi/pdf/10.1177/074873048800300304">increased core body temperature</a>. When core temperature is raised, blood is directed to the skin in order to remove heat and lower internal temperature. However, this can compromise oxygen delivery to the muscles, resulting in greater perceived effort and potentially earlier onset of fatigue. The luteal phase in particular is characterised by higher core temperature and increased heart rate. </p>
<p>Several studies have also observed that <a href="https://www.researchgate.net/profile/Dan_Gordon/publication/257306035_The_effects_of_menstrual_cycle_phase_on_the_development_of_peak_torque_under_isokinetic_conditions/links/54cb794c0cf26a838e4cfd7c.pdf">muscular strength is lower</a> during menses compared to the other phases. This time it’s oestrogen causing this effect. Indeed, a number of the key cellular structures involved in generating muscular force are sensitive to fluctuations in oestrogen. Low concentrations of oestrogen circulating during menses may make strength training feel harder, and fatigue likely to occur earlier. Some evidence also suggests that there’s both increased sensations of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058897/">pain and exertion</a> during the follicular phase as well, making exercise feel more challenging. </p>
<figure class="align-center ">
<img alt="Female olympic weightlifter performing a deadlift." src="https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359059/original/file-20200921-14-yqfkik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Muscular strength may be lower during menses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rio-de-janeirobrazil-april-10-2016-404292715">A.RICARDO/ Shutterstock</a></span>
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<p>However, <a href="https://link.springer.com/article/10.1007/s40279-020-01319-3">recent reviews</a> have concluded that despite these biological responses, the impact on sporting performance seems to be minimal. But given that at the elite level differences between winning and losing are themselves minimal, this should potentially be taken into consideration.</p>
<h2>The pill</h2>
<p>Not only is the pill a common contraceptive method it’s also used by many women to alleviate symptoms of dysmenorrhoea (painful cramps) and menorrhagia (abnormal, heavy, or prolonged bleeding). Many athletes also use the pill to regulate and manipulate their cycles to <a href="https://www.pennmedicine.org/news/news-blog/2017/may/hormonal-changes-affect-female-athletic-performance-period">coincide with training and competition schedules.</a> </p>
<p>In general, pills work by downregulating the production of sex hormones through a constant release of low doses of synthetic oestrogen and progesterone. Throughout the so-called pseudo-cycle, the hormone concentrations for both oestrogen and progesterone stay at levels comparable to the menstruation phase of women who do not take the pill. </p>
<p><a href="https://link.springer.com/article/10.1007/s40279-020-01317-5">Recent research</a> suggests that performance levels while taking the pill remain the same. However, thhere’s potentially a slightly negative impact of suppressing the ovarian hormones while taking the pill on <a href="https://link.springer.com/article/10.2165/00007256-200737070-00001">athletic performance</a> compared with non-pill users. This suggests that the consistently elevated concentrations of progesterone and oestrogen, as seen with a mono-phasic pill may impact on energy availability and use. </p>
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<strong>
Read more:
<a href="https://theconversation.com/menstruation-is-not-a-taboo-in-womens-sport-period-92378">Menstruation is not a taboo in women's sport, period</a>
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<p>This could potentially impair both strength and endurance exercise performance. However, pill use (or non-use) should be judged on an individual basis, especially given that the benefits of taking the pill can outweigh possible performance detriments from taking it. But in general, the pill may have less overall impact on athletic performance. </p>
<p>However, researchers still know very little about the impact of the pill on athletic performance, including downsides, because the area is vastly under-researched. Currently, there’s also no research into the impact that other forms of contraception – such as injections, the coil and implants – have on athletic performance. </p>
<p>In the end, the impact a woman’s period or contraceptive use has on her performance is highly subjective. For example, former British tennis player Heather Watson exited the first round of the Australian Open in 2015 due to what she called “girl things” (“dizziness, nausea, low energy levels and spells of feeling light-headed”) – highlighting how the menstrual cycle is still a <a href="https://www.bbc.co.uk/sport/tennis/30908551">taboo topic</a>. By contrast, when Paula Radcliffe first broke the marathon world record in Chicago in 2002, she was actually suffering period cramps in the <a href="https://www.bbc.co.uk/sport/athletics/30927245">final parts of the race.</a> </p>
<p>But even in this day and age, scientific research on how periods and the pill affect athletic performance is lacking in both quantity and quality – meaning clear solutions and practical recommendations for those affected haven’t really been found yet.</p><img src="https://counter.theconversation.com/content/145891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Gordon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some evidence shows that hormonal fluctuations throughout the menstrual cycle can both increase and decrease athletic performance.Dan Gordon, Principal Lecturer Sport and Exercise Sciences, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1314132020-02-11T10:55:33Z2020-02-11T10:55:33ZContraceptive pill: interrupted supply is a bigger problem than it might appear<figure><img src="https://images.theconversation.com/files/314513/original/file-20200210-109943-2kmlxz.jpg?ixlib=rb-1.1.0&rect=0%2C250%2C4905%2C2936&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/colorful-oral-contraceptive-pill-247345093">areeya ann/Shutterstock</a></span></figcaption></figure><p>Hormonal contraceptives are in <a href="https://www.bbc.co.uk/news/health-51378514">short supply in the UK</a>. This has affected injectable and oral contraceptives and follows on from a reported shortage of hormone replacement therapy (HRT) earlier in the year. Shortages of contraceptives may seem less urgent that shortages of, say, diabetes or cancer drugs, but they can lead to unplanned and unwanted pregnancies.</p>
<p>Combined <a href="https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/">oral contraceptive pills</a> and <a href="https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec-2014/">injectable contraceptives</a> work by turning off ovulation, so that a woman’s ovaries don’t produce an egg and therefore no fertilisation or pregnancy can occur. As long as egg production is stopped, these methods are effective. </p>
<p>But the ovaries are not turned off immediately on starting to use these contraceptives. It usually takes seven days of taking the pill or seven days after an injection for the hormone levels in the blood to be high enough to turn ovulation off. The effect wears off in about seven days as well, so a woman becomes fertile again within a week of stopping or interrupting her pill. </p>
<p>The injectable contraceptive is longer-lasting, turning ovulation off for 13 weeks, but this effect becomes unreliable after 14 weeks. If a woman is unable to access her usual pill or is unable to get her injection, she is a risk of becoming pregnant. Not only that, if she is then able to obtain her supply, she must wait seven days more, after restarting, for the pill or injection to work again.</p>
<p>The situation for women experiencing shortages of a <a href="https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015">progesterone-only pill</a> (so-called mini or pop pills) is even more difficult because these pills need to be taken regularly every day. It is an older type of progesterone-only pill that is experiencing shortages, and this type must be taken each day within three hours of the usual time a woman takes her pill. </p>
<p>These types of progesterone-only pills work through the effect of progesterone on the cervical mucus. This becomes thickened and blocks sperm from passing through from the vagina, stopping the egg from being fertilised. The effect wears off within 48 hours of missing a pill, but it returns within two days of restarting the method.</p>
<h2>Consequences of pill shortage</h2>
<p>While shortages of contraceptive drugs do not put a woman at immediate risk of ill health in the way shortages of disease-treating drugs might, the effect on a woman’s psychological wellbeing and the risk of unexpected and unwanted pregnancy are serious consequences.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314515/original/file-20200210-109939-3snvij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Unwanted pregnancies could go up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/single-sad-woman-complaining-holding-pregnancy-1104503756">Antonio Guillem/Shutterstock</a></span>
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<p>In 1995 there was a <a href="https://www.ncbi.nlm.nih.gov/pubmed/9368943">well-publicised “pill scare”</a> where media reports highlighted the increased risk of clots in the leg and lung for women using newer combined oral contraceptives pills, in comparison to older versions of the pill. Many women abruptly stopped taking their pill and it is widely accepted that this led to an <a href="https://www.bmj.com/content/313/7063/1005.3">increase in unintended pregnancies and abortions</a> the following year. <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/conceptionstatistics/2014">Rates of conceptions in England and Wales</a> increased from 74/1,000 in 1995 to 76/1,000 in 1996, producing a peak in an otherwise downward trend for conceptions from 1990 to 2001. At the same time the British Pregnancy Advisory Service <a href="https://www.bmj.com/content/312/7037/996.1">noted a 10% rise</a> in the number of abortions it carried out in the three months between December 1995 and February 1996. </p>
<p>The <a href="https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2018">abortion rate in England and Wales in 2018</a> was 17/1,000 women and has remained largely stable for the last ten years. While there are many reasons for women requesting an abortion, unwanted pregnancy due to difficulty obtaining her usual contraceptive method is a preventable likely cause. The present difficulty with supplies of these contraceptives has the potential to cause an increase in unintended pregnancies and subsequent abortions in the coming year.</p><img src="https://counter.theconversation.com/content/131413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has received funding from Bayer. </span></em></p>Hormone-based contraceptives are in short supply.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1168262019-05-30T05:56:49Z2019-05-30T05:56:49ZOver-the-counter contraceptive pill could save the health system $96 million a year<figure><img src="https://images.theconversation.com/files/277142/original/file-20190530-69091-4ejdko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More women would favour the pill over less reliable forms of contraception if it was available without prescription.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/174193232?src=9IltURTWVeZct-Dn3o3FkA-1-5&size=huge_jpg">Image Point Fr/Shutterstock</a></span></figcaption></figure><p>For many young women who take the contraceptive pill and don’t experience any side effects, seeing a doctor to renew your prescription each year is a nuisance. </p>
<p>For some women, it’s enough to <a href="https://doi.org/10.1016/j.contraception.2006.07.006">put them off taking the pill</a>, placing them at increased risk of unwanted pregnancy. </p>
<p>So why isn’t it available over the counter at pharmacies?</p>
<p>Our research, <a href="https://link.springer.com/article/10.1007%2Fs40273-019-00804-6">published this month in the journal PharmacoEconomics</a>, found such a move could save the nation A$96 million a year in health care costs and save 22 lives over 35 years.</p>
<h2>What’s the problem?</h2>
<p>The oral contraceptive pill <a href="https://www.nma.gov.au/defining-moments/resources/the-pill">was first available in Australia</a> in 1961 and has since become the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27373543">most popular type of contraception</a> in Australia.</p>
<p>More than half a century of research has generated an extensive body of evidence showing the modern contraceptive pill is safe and effective. Despite this, women in <a href="https://www.contraceptionjournal.org/article/S0010-7824(12)01029-3/fulltext">most developed countries</a> need a current prescription from a doctor to access the pill. </p>
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Read more:
<a href="https://theconversation.com/freer-sex-and-family-planning-a-short-history-of-the-contraceptive-pill-92282">Freer sex and family planning: a short history of the contraceptive pill</a>
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<p>But this is slowly changing. <a href="https://medsafe.govt.nz/profs/class/Minutes/2016-2020/mccMin1Nov2016.htm">New Zealand</a>, the <a href="https://www.contraceptionjournal.org/article/S0010-7824(12)01029-3/fulltext">Netherlands</a>, and <a href="https://www.pharmacytoday.org/article/S1042-0991(15)30225-5/fulltext">Oregon and California in the United States</a> have opted to reclassify the pill to be available over the counter.</p>
<p>The idea of reclassifying the pill has had a mixed response in Australia. </p>
<p>Queensland Health will soon undertake a <a href="https://www.brisbanetimes.com.au/politics/queensland/pharmacists-will-be-allowed-to-prescribe-repeats-of-the-pill-under-trial-20190416-p51erb.html?_ga=2.51857964.486050177.1556776624-814079846.1556776624">pilot</a>, in which pharmacists will be allowed to prescribe repeats of the pill. </p>
<p>The Victorian Liberal Party last year <a href="https://www.abc.net.au/news/2018-10-21/contraception-pill-would-be-available-to-victorian-women-over-t/10401730">promised</a> to make the pill accessible over the counter if elected. But it lost the 2018 state election. The <a href="https://www.abc.net.au/news/2018-10-21/contraception-pill-would-be-available-to-victorian-women-over-t/10401730">Labor government said</a> it would look at the proposal but has not yet made any announcement.</p>
<p>In New South Wales <a href="https://ajp.com.au/news/queensland-trial-a-fundamental-corruption-says-ama/">some doctors’ groups</a> oppose reclassification, and the state’s health minister recently <a href="https://ajp.com.au/news/hazzard-rejects-uti-pharmacist-prescribing-proposal/">rejected the idea</a>.</p>
<p>Nationally in 2015, a <a href="https://www.tga.gov.au/book/part-final-decisions-matters-referred-expert-advisory-committee-3">committee of Australia’s Therapeutic Goods Administration</a> (TGA) rejected a proposal to make the pill available over-the-counter. This was largely based on safety concerns, such as a small increased risk of stroke and venous thromboembolism.</p>
<p>The committee didn’t consider the potential health benefits and cost savings from making the pill more accessible to women.</p>
<h2>So what are the risks and benefits?</h2>
<p>As with all medications, the pill has some potential side effects. <a href="https://www.aafp.org/afp/2010/1215/p1499.html">These include</a> headaches, breast tenderness, bleeding irregularities, nausea, reduced libido and, less commonly, <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">depression</a>. </p>
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Read more:
<a href="https://theconversation.com/informed-consent-women-need-to-know-about-the-link-between-the-pill-and-depression-92424">Informed consent: women need to know about the link between the pill and depression</a>
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<p>More serious, but rarer, problems can include <a href="https://doi.org/10.1016/j.contraception.2006.01.001">venous thromboembolism</a>, <a href="https://doi.org/10.1002/14651858.CD011054.pub2">heart attack and stroke</a>. </p>
<p>Use of the pill instead of condoms may also increase the risk of sexually transmitted infections.</p>
<p>Reclassifying the pill could reduce unintended pregnancies from women using less effective contraception methods (such as withdrawal or the rhythm method), and reduce the number of miscarriages, stillbirths, ectopic pregnancies (when a fertilised egg implants outside the uterus), and abortions. </p>
<p>It could cut the risk of <a href="https://doi.org/10.1016/j.ygyno.2006.03.046">endometrial</a> and <a href="https://doi.org/10.1097/AOG.0b013e318291c235">ovarian</a> cancer.</p>
<p>Overall, reclassifying the pill could reduce health-care costs associated with unintended pregnancies and GP consultations for prescriptions. </p>
<h2>How do the risks and benefits stack up?</h2>
<p><a href="https://dx.doi.org/10.1007/s40273-019-00804-6">We recently modelled the risks and benefits</a> to women and the health-care system if the pill was reclassified in Australia. </p>
<p>We estimated more women would use the pill, and fewer would use no contraception or less effective contraceptive methods such as withdrawal and the rhythm method. </p>
<p>It would also mean fewer women using long-acting reversible contraceptives – such as implants placed in the arm, IUDs (intra-uterine devices) and injections – which tend to be <a href="https://www.fpnsw.org.au/media-news/media-releases/better-access-long-acting-reversible-contraceptive-methods-important-women">more effective</a> at preventing pregnancy than the pill. </p>
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Read more:
<a href="https://theconversation.com/dont-want-to-take-a-contraceptive-pill-every-day-these-are-the-long-acting-alternatives-92116">Don't want to take a contraceptive pill every day? These are the long-acting alternatives</a>
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<p>Our modelling suggests if the pill became available without a doctor’s prescription, we would see an 8.3% reduction in pregnancies, resulting in fewer miscarriages, abortions, ectopic pregnancies, and stillbirths. </p>
<p>On the downside, each year around Australia we could expect to see 122 more cases of sexually transmitted infections, 97 more cases of depression, five more strokes, and four more heart attacks. </p>
<p>But we estimated there would be 22 fewer deaths due to pregnancy, ovarian cancer and other complications. Overall, the net health benefits of reclassifying the pill outweigh the risks. </p>
<p>The move would also save the nation A$96 million per year in avoided health costs. </p>
<h2>Where to from here?</h2>
<p>The Therapeutic Goods Administration (TGA) is <a href="https://www.tga.gov.au/scheduling-news">currently investigating</a> whether some prescription-only medicines, including the pill, should be reclassified so only a pharmacist must be consulted. </p>
<p>The TGA says there would be benefits to the consumer, but it would require “strong caveats and controls around when pharmacists can/cannot supply” the pill.</p>
<p>The <a href="https://www.tga.gov.au/book/part-final-decisions-matters-referred-expert-advisory-committee-3">TGA’s 2015 decision to reject reclassifying the pill</a> was based on submissions from stakeholders and deliberation. But it didn’t analyse all of the health benefits, risks and cost savings. </p>
<p>This latest review must take these factors into account and come to a decision that benefits individual women and the health system as a whole. </p>
<p>Further research is needed to develop a protocol for pharmacists to follow when supplying the pill without a prescription. The <a href="https://www.brisbanetimes.com.au/politics/queensland/pharmacists-will-be-allowed-to-prescribe-repeats-of-the-pill-under-trial-20190416-p51erb.html?_ga=2.51857964.486050177.1556776624-814079846.1556776624">upcoming Queensland pilot</a> may provide some new insights.</p>
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Read more:
<a href="https://theconversation.com/no-women-dont-need-to-take-a-break-from-the-pill-every-couple-of-years-87940">No, women don't need to 'take a break' from the pill every couple of years</a>
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<p><em>* This article originally said the modelling showed the change could save 22 lives a year rather than over 35 years. This has now been corrected.</em></p><img src="https://counter.theconversation.com/content/116826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was funded by a grant from the Australian Self-Medication Industry. The funding agreement ensured the authors’ independence in designing the economic evaluation, its inputs, interpreting results and writing the article.
</span></em></p>New modelling shows skipping the need for a doctors’ prescription and going straight to a pharmacist for the pill could save the health system A$96 million a year and improve women’s health outcomes.Bonny Parkinson, Senior Research Fellow, Macquarie UniversityMutsa Mutowo, Research Fellow, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1093922019-01-22T16:14:55Z2019-01-22T16:14:55ZContraception: the way you take the pill has more to do with the pope than your health<figure><img src="https://images.theconversation.com/files/254115/original/file-20190116-163262-1n5rhnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/colorful-oral-contraceptive-pill-247345093?src=wALwnxcE3Oufr8wGAPpndA-1-6">Areeya_ann/Shutterstock.com</a></span></figcaption></figure><p>The way women have been advised to take the combined contraceptive pill for the last 60 years unnecessarily increases the likelihood of taking it incorrectly, leaving them at risk from unplanned pregnancy. And this far from ideal situation is the result of a cosmetic quirk of pill design, based on long redundant historical context.</p>
<p>This is because standard combined oral contraceptive pills – such as <a href="https://www.medicines.org.uk/emc/product/1130/pil">Microgynon</a>, <a href="https://www.medicines.org.uk/emc/files/pil.4212.pdf">Rigevidon</a> or <a href="https://www.medicines.org.uk/emc/product/1359/pil">Marvelon</a> – are designed to be taken for 21 days, followed by a seven-day break, during which time the woman doesn’t take the pill and experiences vaginal bleeding. Pill-taking women therefore have what seems like a “period” every month.</p>
<p>But this “period” is far from necessary. Shortly before his death in 2015 I attended a lecture given by <a href="https://srh.bmj.com/content/41/2/158">Carl Djerassi</a>, the “father of the pill”. He remarked that the seven-day break, and resultant withdrawal bleed, was designed into the pill in the late 50s in an attempt to persuade the Vatican to accept the new form of contraception, as an extension of the natural menstrual cycle. As is <a href="https://theconversation.com/how-the-catholic-church-came-to-oppose-birth-control-95694">well known</a>, this did not succeed: <a href="https://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae.html">Pope Paul VI</a> forbade artificial contraception. Despite this, the seven-day break has remained as a component of the combined oral contraceptive pill. </p>
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Read more:
<a href="https://theconversation.com/how-the-catholic-church-came-to-oppose-birth-control-95694">How the Catholic Church came to oppose birth control</a>
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<p>This is a problem. The seven-day break is <a href="https://www.popline.org/node/350430">a hazard</a> that may increase the risk of pregnancy while taking the pill. This is because the level of contraceptive hormones in the body is the crucial factor in turning off ovulation, without which pregnancy cannot occur. It takes approximately seven daily doses of contraceptive pill to reach sufficient levels to turn the ovaries off. But the seven-day break allows these levels to fall again. If pill-taking is not resumed by the ninth day after stopping, ovulation <a href="https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/">will occur</a>.</p>
<p>Missing an occasional pill is unlikely to cause hormone levels to drop to a level which would risk ovulation. But taking a deliberate seven-day break lowers hormone levels to a point after which further missed pills, either before or after the break, may allow ovulation to happen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254149/original/file-20190116-163289-2dt32a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some brands, such as this one, have placebo pills rather than a pill-free break.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/contraceptive-birth-control-pill1-tablet-contains-1010733040?src=7XZs3fj15XogP8bx3FaiBQ-1-10">Vitahima/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>The seven-day break is therefore an <a href="https://www.popline.org/node/350430">inbuilt hazard</a>. Many women accidentally <a href="https://www.tandfonline.com/doi/abs/10.3109/13625187.2010.529969">prolong their pill free week</a> by forgetting to restart the next packet on time, or by missing pills in the first or last week of the packet. The <a href="https://www.contraceptionjournal.org/article/S0010-7824(04)00155-6/abstract">reduction of hormones</a> in these circumstances can lead to unexpected ovulation, and, if intercourse has taken place, to pregnancy. But by shortening the pill-free interval (from seven to four days) and reducing the number of times a year that the woman is prompted to have a pill-free interval, the risk of accidental ovulation, and therefore unwanted pregnancy <a href="https://www.contraceptionjournal.org/article/0010-7824(96)00137-0/fulltext">is reduced</a>.</p>
<h2>New patterns of pill taking</h2>
<p>As a result, many clinicians <a href="http://www.rcgpac.org.uk/wp-content/uploads/2017/10/Enhanced-efficacy-with-continuous-use-of-COC-v-10-10.pdf">now favour</a> extended or continuous pill regimens where three or more packets of pill are taken consecutively and only then does a woman have a pill-free week, or a shortened pill free interval of four days. These less frequent breaks are sufficient to avoid continuous stimulation of the womb’s lining, which can cause unhealthy overgrowth of the tissue (<a href="https://patient.info/health/endometrial-hyperplasia-leaflet">endometrial hyperplasia</a>). They also prevent inconvenient “breakthrough” bleeding which eventually occurs if the lining is not allowed to shed.</p>
<p>Some women already “tri-cycle” 30 microgram (standard dose) or 20 microgram (lower dose) pills in this way, running two or three packets together before taking a break, often to reduce the side effects of hormone withdrawal, such as migraines. But for more extended continuous pill-taking, use of lower-dose pills containing 20 micrograms of oestrogen <a href="https://srh.bmj.com/content/familyplanning/early/2018/06/26/bmjsrh-2017-200036.full.pdf">is recommended</a> to offset the increased yearly dose of oestrogen when fewer breaks are taken. This is because the total dose of oestrogen over time may be associated with the small, but well known, <a href="https://www.nhs.uk/news/cancer/combined-pill-may-raise-breast-cancer-risk/">increased risk of breast cancer</a>.</p>
<p>Using established contraceptive pills in this way is “<a href="https://www.gov.uk/drug-safety-update/off-label-or-unlicensed-use-of-medicines-prescribers-responsibilities">off licence</a>”, meaning that the prescriber, not the manufacturer, will bear legal responsibility for harm due to their use. Nonetheless, extended or continuous pill use, off licence, is professionally acceptable, and <a href="https://dtb.bmj.com/content/52/8/90">newer pills</a> are being developed <a href="https://bodyandhealth.canada.com/drug/getdrug/seasonale">and licensed</a> by pharmaceutical companies which are meant to be taken in an extended way, with fewer pill-free intervals.</p>
<h2>Light or absent bleeding</h2>
<p>As well as providing fewer opportunities for ovulation to occur, these extended regimens also mean that a woman has fewer bleeding days. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/25072731">review</a> found such regimens to be both safe and effective.</p>
<p>But many women express concern that not bleeding every month may be harmful to their health or fertility. Beliefs that menstrual blood “builds up inside” if bleeding does not occur or that the body needs to “cleanse” itself every month are common. This may be due to a misunderstanding about why bleeding does not occur with some hormonal contraception. </p>
<p>In a natural menstrual cycle, the lining of the womb builds up over the first half of the menstrual cycle under the influence of oestrogen, reaching its peak thickness at the time of ovulation. It is then maintained for 14 days by progesterone, after which, if no pregnancy occurs, it is shed through the opening of blood vessels within the womb’s lining, and the woman experiences a period. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=505&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=505&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=505&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=635&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=635&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254150/original/file-20190116-163283-10co786.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=635&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The natural menstrual cycle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/menstrual-cycle-menstruation-follicle-phase-ovulation-296962544?src=gl8-K3mp-h20JXEQw2mtnQ-1-33">Designua/Shutterstock.com</a></span>
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</figure>
<p>In most contraceptive methods which cause a lack of vaginal bleeding, the supply of continuous low-dose progesterone greatly reduces the thickening of the lining, so that there is no need for it to be shed. In continuous long-acting methods like the IUS or contraceptive injection, women experience greatly reduced or no bleeding because the lining is largely dormant. With the combined oral contraceptive pill, lighter bleeding is experienced because the thinner lining sheds as a result of withdrawal of hormones, not because of a need to shed a proliferated lining.</p>
<p>Many women and girls welcome the reduction in bleeding days and the lessening of social disruption, and missed school and work days menstrual periods can cause. With the increased recognition of “<a href="https://theconversation.com/period-poverty-why-one-in-ten-young-women-struggle-to-afford-pads-and-tampons-85715">period poverty</a>” and the problems some women face in paying for menstrual protection, reduced bleeding days may also be financially beneficial for some.</p>
<p>Ultimately, the decision to bleed or not to bleed should be one made by individual women, in accordance with their lifestyle needs. Cleaving to a 21/7 pattern of pill taking, which was instituted for social not medical reasons, on the grounds of either tradition or unfounded health concerns, should no longer be the default position in regard to contraceptive pills.</p><img src="https://counter.theconversation.com/content/109392/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has received funding from Bayer PLC and is engaged as an advisor to Natural Cycles, which markets a contraceptive app.</span></em></p>Having a ‘period’ on the pill is far from necessary.Susan Walker, Senior Lecturer in Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1044122018-11-12T19:01:02Z2018-11-12T19:01:02ZAdenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it<figure><img src="https://images.theconversation.com/files/244685/original/file-20181108-74787-10fe5m2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's hard to know how many women are affected by adenomyosis.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/FjAD28N8-IQ">Leon Biss/Unsplash</a></span></figcaption></figure><p>Adenomyosis is a condition of the uterus (womb), where the tissue that grows on the <a href="https://www.ajog.org/article/0002-9378(72)90781-8/abstract">lining of the uterus</a> (also known as the endometrium) is also present on the inside muscular wall of the uterus. Adenomyosis can cause symptoms such as heavy bleeding during your period, bleeding when you are not due for your period, period pain (dysmenorrhea), pain during or after sex (dyspareunia) and infertility. </p>
<p>Although women with adenomyosis <a href="https://jeanhailes.org.au/health-a-z/vulva-vagina-ovaries-uterus/adenomyosis">often also have endometriosis</a>, they are different conditions. With endometriosis, cells similar to those that line the uterus are found in other parts of the body such as the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum). </p>
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Read more:
<a href="https://theconversation.com/considering-surgery-for-endometriosis-heres-what-you-need-to-know-102254">Considering surgery for endometriosis? Here's what you need to know</a>
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<p>The area of the uterus affected by adenomyosis is known as the endometrial-myometrial junction, which is where the endometrium and the myometrium (the muscular part of the uterus) meet.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244680/original/file-20181108-74775-zdzlpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adenomyosis is when tissue that lines the uterus is present inside the muscular wall of the uterus.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Disruption in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/16631411">endometrial-myometrial junction</a> is now considered an important contributor to reproductive problems such as recurrent implantation failure, a condition that can prevent women falling pregnant. Adenomyosis can either be quite spread out, known as generalised adenomyosis or localised in one place, also known as an adenomyoma.</p>
<p>Adenomyosis can have a number of causes though none have been definitively identified. There is an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16563868">association between the presence</a> of adenomyosis and the number of times a women has given birth: the more pregnancies, the more likely you are to have adenomyosis. Women with adenomyosis have also often had a trauma to the uterus such as surgery in the uterus, like during a caesarean section.</p>
<h2>How common is adenomyosis?</h2>
<p>Like endometriosis, we don’t know exactly how many women may be affected by the condition. What makes the impact of adenomyosis so tricky to determine is that it is <a href="https://www.ncbi.nlm.nih.gov/pubmed/19392615">quite commonly found during regular screening tests</a>, even when women are not complaining of any symptoms, which means many women may have it and not know about it. </p>
<p>Because it’s often found <a href="https://www.ncbi.nlm.nih.gov/pubmed/15919780">in women with other conditions like endometriosis</a>, it’s difficult to determine which condition caused the symptoms. We don’t currently know why some women with adenomyosis have symptoms and others don’t.</p>
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Read more:
<a href="https://theconversation.com/vulvas-periods-and-leaks-women-need-the-right-words-to-seek-help-for-conditions-down-there-53638">Vulvas, periods and leaks: women need the right words to seek help for conditions 'down there'</a>
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<p>There are also a number of different criteria for diagnosing adenomyosis, which can differ in <a href="https://www.ncbi.nlm.nih.gov/pubmed/16563870">important factors</a>. For instance, the number of sections of adenomyosis that need to be affected for a diagosis when looking at tissue samples under a microscope. This makes it a problem when we try to work out how common adenomyosis is. </p>
<p>There can also be differences of opinion among the experts who look at these tissue samples. Experts can look at the same slides and <a href="https://www.ncbi.nlm.nih.gov/pubmed/8811382">come to very different conclusions</a>.</p>
<h2>How is it diagnosed?</h2>
<p>Unlike endometriosis, which can only be definitively diagnosed through a key-hole surgery, a diagnosis of adenomyosis can be done through both invasive and non-invasive methods. The most common invasive method is a uterine biopsy (tissue sampling). A biopsy of the uterus can also be performed to make the diagnosis by an abdominal key-hole surgical procedure (laparoscopy) but this remains limited to <a href="https://www.ncbi.nlm.nih.gov/pubmed/17428879">clinical trials</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244966/original/file-20181111-116820-3lldd0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adenomyosis can be diagnosed through ultrasound.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Biopsies going through the vagina up to the uterus may have a role in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/9798358">diagnosis of adenomyosis</a>, but can potentially damage the uterus and therefore are avoided in women wishing to fall pregnant. The ultimate biopsy is a hysterectomy (the removal of the uterus). This is the most accurate method but is obviously a significant surgical procedure and will prevent women having children. A diagnosis of adenomyosis has been made in between <a href="https://www.ncbi.nlm.nih.gov/pubmed/8811382">10-88% of hysterectomy specimens</a> showing how common this condition is.</p>
<p>Non-invasive diagnosis can be made by different types of imaging. Ultrasound is commonly available and can be done either using the probe on the abdomen or, preferably, placing the probe in the vagina. </p>
<p>However, ultrasound isn’t always the best choice as it <a href="https://www.ncbi.nlm.nih.gov/pubmed/17465285">only detects adenomyosis about 50-87% of the time</a>. Magnetic resonance imaging (MRI) is a better choice as there are a number of typical features seen during MRI. These vary throughout the cycle and in response to hormonal therapy but can <a href="https://www.ncbi.nlm.nih.gov/pubmed/16631411">reliably predict adenomyosis</a>. </p>
<h2>What are the treatments?</h2>
<p>Management options for adenomyosis include <a href="https://www.ncbi.nlm.nih.gov/pubmed/20409633">hormonal therapy</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19527389">surgery</a>. These are mainly targeted at reducing symptoms such as pain. There isn’t much research into whether these increase the chance of getting pregnant.</p>
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Read more:
<a href="https://theconversation.com/what-happens-to-endometriosis-when-youre-on-the-pill-89035">What happens to endometriosis when you're on the pill?</a>
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<p>Hormonal treatments focus on suppressing menstruation. This can be achieved by combined oestrogen and progesterone therapy (such as the combined oral contraceptive pill), progestogen-only treatment (such as a Mirena) or placing women into an “induced” menopause (through <a href="http://endometriosis.org/treatments/gnrh/">GnRH analogs</a>).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244964/original/file-20181111-36763-55s5dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Hormonal treatments, such as the contraceptive pill, aim to suppress menstruation.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/psgqUnk8zvM">Thought Catalog/Unsplash</a></span>
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<p>Surgical treatment is most effective when the adenomyosis is localised to a smaller area and can be removed, and this type of surgery doesn’t prevent women falling pregnant in the future. If the adenomyosis is spread throughout a larger area then treatments include destroying the lining of the uterus (endometrial ablation) provided adenomyosis is not too deep, and hysterectomy, both of which will prevent further pregnancy. </p>
<p>Other treatment options are interventional radiology such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/21377897">uterine artery embolisation</a>, where the blood supply to the uterus is cut off and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26349572">magnetic resonance-guided focused ultrasound</a> where the adenomyosis is destroyed with ultrasound energy.</p>
<h2>Does it affect fertility?</h2>
<p>There is some evidence adenomyosis can reduce fertility, but this is still controversial. Clinical studies are limited by difficulties and differences in diagnosis and their study designs have problems. </p>
<p>Some MRI studies <a href="https://www.ncbi.nlm.nih.gov/pubmed/7867272">show changes</a> consistent with infertility, but because patients presenting with infertility in their 30s and 40s <a href="https://www.ncbi.nlm.nih.gov/pubmed/12751776">are more likely to be diagnosed with adenomyosis</a>, it’s difficult to say if adenomyosis is the cause of their fertility issues. </p>
<p>When couples are undergoing assisted reproduction (such as IVF) there is limited evidence to support a negative impact on oocyte and embryo quality, implantation and pregnancy rates. Overall, there appears to be limited negative impact of adenomyosis on allowing the embryos to implant or overall pregnancy rates. </p>
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<strong>
Read more:
<a href="https://theconversation.com/women-now-have-clearer-statistics-on-whether-ivf-is-likely-to-work-81256">Women now have clearer statistics on whether IVF is likely to work</a>
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<img src="https://counter.theconversation.com/content/104412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mike Armour receives funding from Pelvic Pain Foundation of Australia</span></em></p><p class="fine-print"><em><span>Anusch Yazdani does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adenomyosis is a different condition to endometriosis, though many women who have one will have the other.Anusch Yazdani, Associate Professor, The University of QueenslandMike Armour, Post-doctoral research fellow, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/945442018-06-25T10:34:54Z2018-06-25T10:34:54ZHow Catholic women fought against Vatican’s prohibition on contraceptives<figure><img src="https://images.theconversation.com/files/224300/original/file-20180621-137720-o2jmwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People dressed as sperm cells at Papal Nuncio building in The Hague for the sixth birthday of the encyclical, 'Humanae Vitae.'</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nationaalarchief/3328265536/">Nationaal Archief</a></span></figcaption></figure><p>Fifty years ago a fierce debate erupted in the Catholic Church over the papal document <a href="http://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae.html">“Humanae Vitae,”</a> which reiterated the church’s ban on artificial contraception. Six hundred scholars, including many clergy, <a href="http://www.kha.at/downloads/statementbycatholictheologians.pdf">dissented from its teaching</a>, sparking a debate that caused a crisis over authority in the worldwide church. </p>
<p>While much attention is focused on the epic battle between theologians and the institutional church, which undoubtedly was significant, as a <a href="https://directory.roanoke.edu/faculty/160">historian of Catholic women</a>, I find the responses of Catholic laywomen even more compelling. </p>
<p>As theologians dissented, bishops raged and popes dug in their heels, Catholic laywomen and their partners made their own family planning decisions, as they had for many years before and would for decades after. </p>
<h2>What is Humanae Vitae?</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=857&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=857&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=857&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1077&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1077&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224297/original/file-20180621-137746-1heyc56.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1077&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pope Paul VI.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Paulaudenece1977.jpg">Ambrosius007</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p><a href="http://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae.html">Humanae Vitae</a> was a papal encyclical released by Pope Paul VI in 1968. However, it wasn’t the first papal document to prohibit contraception use. Thirty-eight years prior to that encyclical, Pope Pius XI had released a <a href="https://w2.vatican.va/content/pius-xi/en/encyclicals/documents/hf_p-xi_enc_19301231_casti-connubii.html">document called “Casti Connubbi,”</a> barring Catholics from using artificial contraception. </p>
<p>There were some clear differences between the two encyclicals. The first insisted that procreation was the chief purpose of the sexual act. The second said that the “unitive” purpose – that is, the use of sex as a means of expressing love and strengthening the marital union – was equally important.</p>
<p>But Paul VI ultimately insisted that the unitive could not be separated from the procreative. According to the Catholic Church, each and every conjugal act must be open to life.</p>
<p>Even though Humanae Vitae largely affirmed an established teaching, <a href="http://press.georgetown.edu/book/georgetown/sex-violence-and-justice">it was still controversial</a>. This was because the debates among theologians and laypeople in the 30 years following Casti Connubi caused many to believe that the 1968 encyclical would overturn the Church’s ban on artificial contraception. </p>
<h2>Role of Catholic women</h2>
<p>What is important to note is that well before the 600 theologians expressed dissent, Catholic laywomen had already begun to reject this teaching. One major reason was what many believed to be a major flaw in the Vatican’s argument.</p>
<p>As early as the 1940s, large numbers of Catholic couples were encouraged to use the <a href="https://case.edu/affil/skuyhistcontraception/online-2012/Rhythm-method.html">rhythm method</a>, or timing sex to coincide with “the safe period” in a woman’s cycle, most commonly determined by charting a daily temperature reading. This was the accepted way to avoid conception, as they were not allowed to use a barrier method to achieve the same end.</p>
<p>Many failed to <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199734122.001.0001/acprof-9780199734122">understand or accept</a> this logic. If the church was admitting that couples could choose to limit their family size, why wouldn’t it allow them a more effective means of doing so, is what many women asked. They were also not convinced every sexual act need be open to life if the couple was open to having children.</p>
<p>So, starting in the 1940s, Catholic laywomen and men began to publicly discuss the church’s teaching on contraception. By the early 1960s, <a href="https://jhupbooks.press.jhu.edu/content/fertility-doctor">when the birth control pill came into common use</a>, these questions became especially pressing. Catholic laywomen regularly wrote in the Catholic press and elsewhere expressing their views as married women and <a href="http://www.cornellpress.cornell.edu/book/?GCOI=80140100616460">fostering a conversation that called the ban into question</a>.</p>
<p><a href="http://www.cornellpress.cornell.edu/book/?GCOI=80140100616460">They wrote eloquently</a> about their marriages, their sex lives, their struggles with endless pregnancies and, increasingly, their frustration with rhythm. The only method of family limitation allowed them failed over and over again while the necessity of denying themselves sex caused rifts in couples already stressed by the care of large families. </p>
<p>Those frustrations often included the priests who promoted rhythm. “To me and many Catholics rhythm is a manifestation of an attitude of many clergymen looking down from their pedestals, offering us glib platitudes and the letter of the law, without seeing our real problems,” wrote Carolyn Scheibelhut, an American Catholic laywoman, in a letter to the editor of the Catholic magazine Marriage, in 1964. </p>
<h2>Did the Vatican hear laywomen’s voices?</h2>
<p>Laywomen’s voices finally reached the Vatican through the <a href="https://books.google.com/books/about/Turning_Point.html?id=0a2RAAAAIAAJ">papal birth control commission</a> assembled by Pope John XXIII, between 1963 to 1966, to study the issue of artificial contraception.</p>
<p>Patty Crowley, co-founder of <a href="https://books.google.com/books/about/Disturbing_the_Peace.html?id=SnslAQAAIAAJ">the Christian Family Movement</a> and one of the few married women invited to participate, brought with her the results of a survey of Catholic couples who overwhelmingly described their struggles with the teaching, despite often heroic attempts to abide by it.</p>
<p>She later <a href="https://books.google.com/books/about/Turning_Point.html?id=0a2RAAAAIAAJ">remarked</a>, “It just struck me as ridiculous….How could they be talking about marriage and birth control of all things without a lot more input from the persons involved?” Crowley <a href="https://www.wjkbooks.com/Products/0664222854/in-our-own-voices.aspx">testified before the commission</a>, telling them that, besides being unreliable, rhythm was psychologically harmful, did not foster married love or unity and, moreover, was unnatural.</p>
<p>In what was surely a first in this group of primarily celibate men, Crowley explained that the majority of women most desire sexual intercourse during ovulation, precisely when they were taught to avoid sex. “Any simple psychology book tells us that people who are in a constant state of stricture in an area that should be open and free and loving are damaging themselves and consequently others,” she insisted.</p>
<p>Collette Potvin, another married woman <a href="https://books.google.com/books/about/Turning_Point.html?id=0a2RAAAAIAAJ">who testified</a>, recalled thinking “When you die, God is going to say, ‘Did you love?’ He isn’t going to say, ‘Did you take your temperature?’”</p>
<p>Persuaded by these testimonies and others, the commission voted to overturn the ban. Leaked to the press in 1967, this decision raised the hopes of laypeople all over the world. These expectations fed the outrage when Pope Paul VI chose to disregard the <a href="https://www.bloomsbury.com/uk/encyclical-that-never-was-9780722034057/">majority report of his own commission</a> in 1968.</p>
<h2>Use of contraception today</h2>
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<img alt="" src="https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224302/original/file-20180621-137725-58uwac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Majority of Catholic women around the world use contraceptives.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dioceseofsaginaw/14368610797">Catholic Diocese of Saginaw Follow</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>So, do the majority of Catholic women follow the teachings of Humanae Vitae on contraceptive use?</p>
<p>Available data show they do not. Their choice to disregard this teaching <a href="https://www.ncbi.nlm.nih.gov/pubmed/4682130">started well before the letter was released.</a> Among American Catholic women, for example, as of 1955, 30 percent used artificial contraception. Ten years later, that number had reached 51 percent, all before the ban was reiterated in 1968. </p>
<p>By 1970 the number of Catholic women in the U.S. using birth control hit 68 percent, and today there is <a href="https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states">almost no difference</a> between the birth control practices of Catholics and non-Catholics in the United States. <a href="https://www.theguardian.com/global-development/datablog/2016/mar/08/contraception-and-family-planning-around-the-world-interactive">Globally, as of 2015</a>, there is little difference between Catholic and non-Catholic regions. For example, the percentage of contraceptive use in heavily Catholic Latin America and the Caribbean was 72.7 percent, – a 36.9 percent increase since 1970 – compared to 74.8 percent in North America.</p>
<p>I would argue the 50th anniversary of Humanae Vitae is a moment to remember the laywomen who changed Catholic history before, during and after 1968. It was laywomen’s collective decision to disregard the teaching that truly shaped Catholics’ modern attitudes toward birth control.</p><img src="https://counter.theconversation.com/content/94544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary J. Henold is affiliated with Roanoke Indivisible.</span></em></p>On the 50th anniversary of Humanae Vitae, an encyclical released by Pope Paul VI calling for prohibition on contraceptive use, a scholar describes the struggles of Catholic women, as well as their activism.Mary J. Henold, John R. Turbyfill Professor of History, Roanoke CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/925092018-05-21T19:49:16Z2018-05-21T19:49:16ZHere’s what’s on the horizon for a male contraceptive pill – but don’t hold your breath<figure><img src="https://images.theconversation.com/files/217427/original/file-20180503-153914-16y2xw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men currently only have two contraceptive options: condoms or a vasectomy.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/ZbWuFoNau98">Javier Canales</a></span></figcaption></figure><p><em>ON THE PILL: In this <a href="https://theconversation.com/au/topics/pill-series-52834">seven-part series</a> we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.</em></p>
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<p>The female contraceptive pill has helped millions of women take control of their fertility and reproductive health since it <a href="https://peopleshistorynhs.org/encyclopaedia/birth-control-on-the-nhs/">became available in 1961</a>. Yet a male equivalent has yet to be fully developed. This effectively leaves men with only two viable contraceptive options: condoms or a vasectomy. </p>
<p>The idea of creating a male contraceptive has been around almost as long as the female contraceptive. In theory, targeting the production of sperm should be a simple process. The <a href="http://www.open.edu/openlearn/body-mind/health/health-sciences/the-science-sperm">biology of sperm production</a> and how they swim towards the egg are well understood. </p>
<p>Yet, studies aimed at developing an effective male pill have been dogged by issues such as severe side effects. Most recently, a <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">study</a> that injected men with the hormones testosterone and progestogen – similar to hormones found in the female pill – had to be stopped early. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-male-pill-is-still-so-hard-to-swallow-68133">Why the male 'pill' is still so hard to swallow</a>
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<p>The study, from 2016, showed pregnancy rates for female partners of men receiving the injections fell below that typically seen for women on the pill. </p>
<p>But the study was cut short due to reports of adverse side effects including acne, mood disorders and raised libido. For the men taking part, these side effects proved too severe for them to continue, despite the desired drop in sperm production. </p>
<p>However, many people <a href="https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/#Advantages%22%22">may see these side effects as relatively minor</a> compared to those suffered by women on the pill, which include anxiety, weight gain, nausea, headaches, reduced libido and blood clots.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">No human trials of the male pill have successfully provided contraception with tolerable side-effects.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oral-contraceptive-pill-on-pharmacy-counter-660070825">Areeya_ann/Shutterstock</a></span>
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<p>Male contraceptives have been under development for at least 50 years. However, the drive to bring a male contraceptive onto the market has stalled for two main reasons. </p>
<p>First, there is a general pessimism of men towards taking a contraceptive pill, especially <a href="https://www.thenewsminute.com/article/contraceptive-cruelty-how-patriarchy-determines-birth-control-use-india-55850">in countries such as India</a>. </p>
<p>Second, the global <a href="http://www.independent.co.uk/news/business/news/male-contraceptive-block-drug-companies-examples-female-pill-injection-india-startup-big-pharma-a7665511.html">success of the female pill</a> provides little incentive for pharmaceuticals to invest in a male pill. Globally, the female pill is the <a href="https://onlinedoctor.superdrug.com/birth-control-around-the-world/">third most-used form of contraception</a>, with a projected market value of nearly <a href="https://www.thepharmaletter.com/article/oral-contraceptive-pills-market-to-reach-22-9-billion-by-2023-study">US$23 billion by 2023</a>.</p>
<p>Despite these setbacks, a new way of thinking about male contraception is taking shape. Here, the focus has shifted from stopping sperm production to stopping the sperm being able to fertilise the egg. </p>
<h2>The clean sheet pill</h2>
<p>The <a href="https://www.parsemus.org/projects/clean-sheets-pill/">clean sheet pill</a> effectively works as its name suggests: preventing the release of sperm. </p>
<p>The clean sheet pill has two main selling points. First, by preventing the release of sperm and the fluid they are carried in, the clean sheet pill simultaneously prevents unwanted pregnancy and the spread of sexually-transmitted infections. </p>
<p>Second, because the pill does not affect the feeling of orgasm, there is no reduction in male sexual pleasure. </p>
<p>Unfortunately, the clean sheet pill has so far only been tested in animals. As such, a version for human use is probably ten years away from being developed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217419/original/file-20180503-153914-1p2mb6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The clean sheet pill is good idea but is still in the early stages of development.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/YYHWa4He1JM">Madi Doell</a></span>
</figcaption>
</figure>
<h2>Vasalgel</h2>
<p>One of the downsides of a vasectomy is that it can render a man permanently sterile. However, the recent development of a product call <a href="https://www.parsemus.org/projects/vasalgel/">Vasalgel</a> may offer men a serious alternative to a vasectomy. </p>
<p>Vasalgel is a long-term, non-hormonal yet reversible form of contraception. This offers benefits over both hormonal contraceptives with their side effects as well as the permanency of a vasectomy. </p>
<p>Vasalgel is polymer that is injected into the <a href="https://en.wikipedia.org/wiki/Vas_deferens">vas deferens</a>, the tube that carries sperm from the testes. This allows the movement of fluid, but stops the passage of sperm. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-male-contraceptive-could-help-men-bear-the-family-planning-burden-62790">A new male contraceptive could help men bear the family planning burden</a>
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<p>In a <a href="https://bacandrology.biomedcentral.com/articles/10.1186/s12610-017-0048-9">trial in monkeys</a>, Vasagel was found to be 100% effective at preventing conception. In <a href="https://bacandrology.biomedcentral.com/articles/10.1186/s12610-017-0051-1">separate studies in animals</a>, the effect of Vasagel was easily reversed with a simple second injection to dissolve the polymer. </p>
<p>If these effects are replicated in men, this could offer a low-cost, minimally invasive and effective contraceptive that is also reversible. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PtUJj_QRvFg?wmode=transparent&start=4" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">If the success of animal trials can be replicated in humans, here’s how Vasagel would work in humans.</span></figcaption>
</figure>
<h2>Heart-stopping poisons</h2>
<p>A deadly, heart-stopping poison might not sound like a good starting point for a new male contraceptive. However, researchers have shown that a toxic compound call <a href="https://en.wikipedia.org/wiki/Ouabain">oubain</a> can be be used to slow down the swimming of sperm. </p>
<p>Researchers already knew that oubain <a href="https://link.springer.com/article/10.1007/s11596-014-1236-x">could affect male fertility</a>. But the cardio toxic effects of oubain prevented scientists from exploring its effects on male reproduction in any detail. </p>
<p>By modifying the structure of the oubain molecule, <a href="https://pubs.acs.org/doi/10.1021/acs.jmedchem.7b00925">researchers showed</a> it can be used to reduce the motility (ability to swim) of rat sperm while being non-toxic to the heart. </p>
<h2>Research and development</h2>
<p>While research into male contraceptives have been ongoing for nearly 50 years, we still seem to be at least “five to ten years away” from an effective male pill. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-wont-have-a-male-contraceptive-until-we-change-our-understanding-of-risk-68375">We won't have a male contraceptive until we change our understanding of risk</a>
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</p>
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<p>Potential new targets for male contraceptives are being developed and tested scientifically all the time. However, without the significant input and push from big pharmaceutical companies, these discoveries may never see the light of day. </p>
<p>With the cost of developing a new drug to market estimated at <a href="https://cen.acs.org/articles/92/web/2014/11/Tufts-Study-Finds-Big-Rise.html">US$2.6 billion</a>, the burden of family planning looks to remain firmly on the shoulders of women for now.</p><img src="https://counter.theconversation.com/content/92509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins receives funding from the Biotechnology and Biological Sciences Research Council (BBSRC) under grant number BB/R003556/1. </span></em></p>Male contraceptives have been under development for at least the past 50 years, because of the success of the female pill and pessimism about men taking a pill.Adam Watkins, Assistant Professor, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/879402018-05-13T20:31:52Z2018-05-13T20:31:52ZNo, women don’t need to ‘take a break’ from the pill every couple of years<figure><img src="https://images.theconversation.com/files/216084/original/file-20180424-94115-scxxxt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pill is the most popular form of contraception for women under 30.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/klOo6lqKWjs">Tyler Nix</a></span></figcaption></figure><p><em>ON THE PILL: In this <a href="https://theconversation.com/au/topics/pill-series-52834">seven-part series</a> we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.</em></p>
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<p>More than half of 18- to 19-year-old women in a <a href="http://www.sciencedirect.com/science/article/pii/S1049386714000097">recent survey</a> agreed that “women should ‘take a break’ from oral contraceptive pills every couple of years”. </p>
<p>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.</p>
<h2>Suitability</h2>
<p>There are many different <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">types</a> of contraceptive pills, most commonly containing both oestrogen and progestogen (called combined oral contraceptive pills). </p>
<p>Doctors use detailed <a href="https://www.clinicalguidelines.gov.au/portal/2101/contraception-australian-clinical-practice-handbook-third-edition">medical eligibility criteria</a> 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.</p>
<p>But for many women the pill provides a convenient, easily accessible method of contraception. In fact, it’s the most <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">popular</a> form of contraception for women under the age of 30.</p>
<h2>Hormone build-up?</h2>
<p>Studies in the <a href="https://academic.oup.com/humrep/article/28/6/1620/605060">United States</a>
and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26359250">Australia</a> 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. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-the-pill-increases-your-risk-of-cancer-6931">Monday’s medical myth: the pill increases your risk of cancer</a>
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<p>For some people, the pill can be associated with unpleasant <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">side effects</a> such as breast tenderness, bloating, headaches and nausea. </p>
<p>But rather than being an effect of the hormones themselves, these unpleasant side effects are most commonly associated with the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26390802">hormone-free interval</a> which allows a “withdrawal” bleed to occur, mimicking a natural menstrual cycle. </p>
<p>These <a href="http://srh.bmj.com/content/39/4/237.full">side effects may be lessened</a> by new pills or pill regimes with reduced or no hormone-free intervals (and therefore fewer or no withdrawal bleeds).</p>
<p>Once a doctor prescribes the pill for you, it’s generally recommended that you keep taking it for <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/">at least three months</a> to allow any unpleasant side effects to resolve themselves. </p>
<p>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. </p>
<p>Of course, as you age your contraceptive needs will change, so it’s important to review your contraception periodically. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19913147">Research</a> 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.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=418&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=418&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216086/original/file-20180424-94160-15832pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=418&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are many different types of oral contraceptive pill.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1061861099?src=-2eq5oPR8qcUqC3vlg4oAg-3-12&size=medium_jpg">Shutterstock</a></span>
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</figure>
<h2>Serious health risks?</h2>
<p>Like all medicines, there is a small risk of serious health effects associated with the pill. The risk of serious adverse side effects is <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">highest</a> 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.</p>
<p>Despite the very low risk of health complications associated with the pill, people’s fears are exacerbated by “<a href="https://theconversation.com/dont-panic-about-the-pill-its-safer-than-driving-to-work-42325">pill scares</a>” – misrepresented studies reported in the media – which are usually not based on an accurate understanding of the risks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-panic-about-the-pill-its-safer-than-driving-to-work-42325">Don't panic about the pill – it's safer than driving to work</a>
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</em>
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<p>One of the most serious adverse health effects associated with the pill is <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">thrombotic complications</a> 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. </p>
<p>However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29462093">the pill is suitable</a> for women in mid-life who aren’t at increased risk of heart disease.</p>
<p>Although potentially very serious, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26390802">absolute risk</a> of blood clots is <a href="https://www.ncbi.nlm.nih.gov/pubmed/27051991">very low</a>. 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.</p>
<p>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 <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61684-5/fulltext">cervical cancer</a> but a reduced risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/26390802">ovarian and endometrial cancer</a>. The findings about the risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/8899264">breast cancer</a> are not conclusive.</p>
<p>It’s also important to note there are a number of <a href="http://onlinelibrary.wiley.com/doi/10.1002/psb.1600/full">non-contraceptive benefits</a> 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. </p>
<p>These non-contraceptive side effects often form the basis for <a href="https://www.ncbi.nlm.nih.gov/pubmed/2681143">women’s choice</a> of contraception. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216089/original/file-20180424-94118-lwzcu5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pill can help reduce period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1069512443?src=mwuaZZwEP1ydKP3OQTE2OQ-1-8&size=medium_jpg">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Fertility</h2>
<p>One of the concerns women have about long-term pill use is that they will find it difficult to conceive. <a href="https://www.ncbi.nlm.nih.gov/pubmed/20818837">Research across a number of countries</a> shows women want their fertility to return quickly after they stop using the pill. </p>
<p>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 <a href="https://www.ncbi.nlm.nih.gov/pubmed/19268187">research</a> documents a temporary delay in conceiving, usually only lasting a few months. </p>
<p>However, a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22018120">review</a> 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.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-the-pill-affects-long-term-fertility-8150">Monday's medical myth: the pill affects long-term fertility</a>
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<h2>What should you do?</h2>
<p>If the pill suits you, <a href="https://www.mayoclinic.org/healthy-lifestyle/birth-control/expert-answers/birth-control-pills/faq-20058110">there’s no need</a> to “give your body a break”. </p>
<p>But it’s important to have regular health checks and also <a href="https://www.ncbi.nlm.nih.gov/pubmed/23210098">review your contraceptive needs</a> 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.</p>
<p>It’s always worth finding out about the <a href="https://theconversation.com/explainer-what-are-the-options-for-birth-control-18613">latest contraceptive options</a> so you can be sure you’re using contraception that’s right for you.</p><img src="https://counter.theconversation.com/content/87940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayne Lucke is the Director of the Australian Research Centre in Sex, Health and Society at La Trobe University. She receives funding from the Australian Research Council and the National Health and Medical Research Council. She has served as a Director of Family Planning Queensland and been Chief Investigator on an ARC Linkage Grant that involves cash and in-kind support from Family Planning New South Wales and Bayer Australia. The Australian Research Centre in Sex, Health and Society receives funding from diverse sources listed in the annual report available from the website: <a href="http://www.latrobe.edu.au/arcshs">http://www.latrobe.edu.au/arcshs</a>.</span></em></p>There is no biological evidence for “giving your body a break” and in fact, it could do your health more harm than good.Jayne Lucke, Professor & Director of the Australian Research Centre in Sex, Health & Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/922822018-05-13T20:31:42Z2018-05-13T20:31:42ZFreer sex and family planning: a short history of the contraceptive pill<p><em>ON THE PILL: In this <a href="https://theconversation.com/au/topics/pill-series-52834">seven-part series</a> we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.</em></p>
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<p>Since the oral contraceptive pill appeared on the market almost 60 years ago, it has been the preferred form of birth control for millions of women around the world. The pill is now so widely available, it’s easy to forget that its development symbolised a revolutionary shift in family planning and women’s reproductive rights.</p>
<p>Before the development of the pill, contraceptive options were <a href="https://www.fpa.org.uk/factsheets/contraception-past-present-future">extremely limited</a>, and generally required the cooperation of the male partner. It was also <a href="http://www.jurist.org/feature/2014/01/legal-history-of-contraceptives-in-the-us.php">illegal</a> in many countries. </p>
<p>In 1916, Margaret Sanger, who would go on to establish Planned Parenthood, had a vision of a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462239/">new form of contraception</a>: one that could be taken orally, did not interfere with sexual intercourse, and which would not compromise future fertility. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/contraception-is-essential-for-the-health-of-mothers-babies-and-future-generations-55095">Contraception is essential for the health of mothers, babies and future generations</a>
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<p>Sanger’s motivation to create such a pill was spawned by her experiences as a nurse in New York’s slums. There she witnessed women suffering the effects of repeated pregnancy and childbirth, and deaths from backstreet abortions.</p>
<p>Although most women shared Sanger’s desire for better contraceptive options, progress was slow. Due to the many scientific, social, political and legal hurdles to overcome, it was almost 50 years before her vision would become a reality.</p>
<h2>Scientific development</h2>
<p>Female fertility depends on the maturation and release of an egg from the ovaries. This process is regulated by a <a href="https://womhealth.org.au/conditions-and-treatments/understanding-your-menstrual-cycle-fact-sheet">hormonal feedback loop</a> which includes the ovary, brain, and pituitary gland. <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-the-pill">The pill works</a> by interfering with this feedback loop, and suppresses egg production. It also causes the cervix to produce a thick mucus which prevents sperm movement.</p>
<p>Manipulating this feedback loop for contraceptive purposes dates back long before the pill. Some traditional medicines <a href="https://teara.govt.nz/en/artwork/26966/poroporo-plant">contain compounds</a> that act in the same way as the pill.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tv-news-stories-about-birth-control-quote-politicians-and-priests-more-often-than-medical-experts-63093">TV news stories about birth control quote politicians and priests more often than medical experts</a>
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<p>However, only in the 1930s was it conclusively shown that fertility could be suppressed in rabbits who received injections of progesterone, a hormone normally produced by the ovaries during the menstrual cycle. </p>
<p>Although effective, these early experiments were <a href="http://onlinelibrary.wiley.com/doi/10.1002/cmdc.201100321/abstract">highly inefficient</a>. The only source of progesterone was ovarian tissue from animals, and thousands of ovaries were required to produce just a few milligrams of progesterone.</p>
<p>This problem was overcome in the early 1940s when a <a href="https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/progesteronesynthesis.html">method</a> was developed to extract large quantities of progesterone from a species of wild yam native to Mexico. This new form of progesterone also provided another major advantage: it could be given orally, and eliminated the need for injections.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217431/original/file-20180503-153881-6ja2ve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The oral contraceptive has gone through many improvements to become the pill we know today.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Another advantage of the yam extract was that it also <a href="https://www.tandfonline.com/doi/pdf/10.3109/13625187.2010.513071">contained small amounts of mestranol</a>, an oestrogen. <a href="https://www.tandfonline.com/doi/pdf/10.3109/13625187.2010.513071">Previous studies</a> had shown that oestrogen could reduce breakthrough bleeding, a common side-effect of progesterone treatment.</p>
<p>All of the elements required for the pill were now in place. But before Sanger’s “magic pill” could be released onto the market, it needed to be tested in women.</p>
<h2>Human clinical trials</h2>
<p>Initial plans to test the pill in the United States were short-lived, due to difficulties in recruiting enough women to take part in the trial and high drop-out rates because of the side effects.</p>
<p>Testing of the pill was then <a href="https://www.washingtonpost.com/news/retropolis/wp/2017/05/09/guinea-pigs-or-pioneers-how-puerto-rican-women-were-used-to-test-the-birth-control-pill/?utm_term=.176a06003786">relocated to Puerto Rico</a>, where it was tested on hundreds of women. </p>
<p>Representing a darker side of the pill’s history, these women were not informed that they were participating in an experimental trial. They also did not receive information on the possible risks. </p>
<p>During the trial, two women died and almost 20% of women <a href="https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf">reported side effects</a> such as headaches, weight gain, nausea, and dizziness. These side effects were caused by the very high levels of hormones contained in the pill. Some women also experienced <a href="https://www.ncbi.nlm.nih.gov/books/NBK236579/">ongoing health issues</a> as a consequence of the treatments they received.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-wont-have-a-male-contraceptive-until-we-change-our-understanding-of-risk-68375">We won't have a male contraceptive until we change our understanding of risk</a>
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</em>
</p>
<hr>
<p>Despite the raft of side effects, only one of the women in Puerto Rico became pregnant and the trial was considered a success. </p>
<p>The pill was approved in the United States for the treatment of “menstrual disturbance” in 1957, and finally as a contraceptive in 1960. A year later, in 1961, it was approved in <a href="http://www.nma.gov.au/online_features/defining_moments/featured/the_pill">Australia</a>, <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj13/review-new-zealands-contraceptive-revolution.html">New Zealand</a> and the <a href="https://peopleshistorynhs.org/encyclopaedia/birth-control-on-the-nhs/">United Kingdom</a>.</p>
<h2>Response</h2>
<p>Although the pill’s release was met with opposition from the <a href="http://www.nytimes.com/2008/07/27/opinion/27allen.html">Catholic Church</a> and even <a href="https://www.theguardian.com/society/2010/jun/06/rachel-cooke-fifty-years-the-pill-oral-contraceptive">some feminists</a>, the response in general was overwhelmingly positive. Women celebrated the new control they had over their fertility. The pill has <a href="https://theconversation.com/the-contraceptive-pill-was-a-revolution-for-women-and-men-37193">has even been linked to</a> improved educational and social outcomes for women.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217442/original/file-20180503-153884-1x384y1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women today continue to enjoy the advantages of the contraceptive pill.</span>
<span class="attribution"><span class="source">Priscilla Du Preez/unsplash</span></span>
</figcaption>
</figure>
<p>This newfound freedom did come with a price: side effects were common, and some women experienced more serious complications such as stroke, heart attack, blood clots, and depression. Through her 1969 book The Doctors’ Case Against the Pill, writer and activist Barbara Seaman exposed these risks. This resulted in a <a href="https://www.womenshealthspecialists.org/about/the-womens-movement/barbara-seaman/">mandate</a> being introduced in 1970 requiring all pills to include patient safety information.</p>
<p>In 1988, high-dose pills were finally removed from sale. These were replaced by new low-dose formulations, which have a better safety profile, and fewer side effects.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-we-really-need-prescriptions-for-the-contraceptive-pill-20823">Do we really need prescriptions for the contraceptive pill?</a>
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</em>
</p>
<hr>
<p>Today, more than a century has passed since Margaret Sanger announced her seemingly impossible plans for a safe, effective oral contraceptive. The pill remains the mainstay of hormone-based contraception. However, it is no longer the only option. Research in this area is rapidly evolving, and we watch with interest to see what advances the next 100 years will bring.</p><img src="https://counter.theconversation.com/content/92282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bryony McNeill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Before the pill, contraceptive options were extremely limited and generally required the cooperation of the male partner. Almost 60 years later, the pill remains the mainstay of contraception.Bryony McNeill, Lecturer in Reproductive and Developmental Biology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923782018-04-12T12:10:06Z2018-04-12T12:10:06ZMenstruation is not a taboo in women’s sport, period<figure><img src="https://images.theconversation.com/files/214246/original/file-20180411-543-99vy5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via shutterstock.com</a></span></figcaption></figure><p>Menstruation is often <a href="https://www.telegraph.co.uk/sport/2018/03/07/menstruation-last-great-taboo-womens-sport/">called</a> the “last great taboo” in women’s sport. But periods are the media’s taboo, not sportswomen’s. Our new <a href="https://doi.org/10.1123/ijspp.2017-0330">research</a> showed that elite athletes are not afraid to talk about their menstrual cycle and how it affects them. We also found that half of the 430 athletes we interviewed are using some kind of hormonal contraceptive, which affected their menstrual cycle.</p>
<p>The menstrual cycle is a repeating pattern of hormones, designed to allow pregnancy to occur. Each phase produces different concentrations of the hormones oestrogen and progesterone. On the other hand, hormonal contraceptives aim to prevent pregnancy by removing the menstrual cycle and creating a new hormonal environment, with low levels of oestrogen and progesterone almost all of the time. </p>
<p>These hormonal differences, between women with and without a menstrual cycle, mean that not all female athletes are the same. As oestrogen and progesterone have the potential to affect many aspects of health and sports performance, it’s important to know the hormonal profile of each athlete, so that training and performance can be optimised. </p>
<p>Up until now, it was unknown how many elite sportswomen in the UK used hormonal contraceptives, such as the oral contraceptive pill, the contraceptive injection, a patch or implant. My colleagues and I <a href="https://doi.org/10.1123/ijspp.2017-0330">surveyed</a> 430 elite athletes, from 24 different sports including hockey, football and rowing, to determine how many used a hormonal contraceptive or not. </p>
<p>As contraceptives can have other roles outside of preventing pregnancy, we asked them about any other effects they experienced as a result of taking them – such as easing painful periods, heaving bleeding and acne. We also asked the athletes who didn’t use a hormonal contraceptive to tell us about their experiences with the menstrual cycle. This meant that we could compare those athletes who had a menstrual cycle – with variable hormone concentrations – versus those who used hormonal contraceptives and had a more stable hormonal profile.</p>
<h2>Managing periods with contraceptives</h2>
<p>Out of 430 sportswomen, 213 (49.5%) used some type of contraceptive and 217 (50.5%) did not. The oral contraceptive pill was the most popular type of hormonal contraceptive – used by 78.4% of contraceptive users. Contraceptive users reported 19 negative side effects, with weight gain, irregular periods and poor skin being the most common. </p>
<p>In contrast to the negative side effects reported, 12.7% of contraceptive users told us they liked the regularity of the pill and knowing when they would experience their withdrawal bleed – not the same as a period – which happens during the seven pill-free days of an oral contraceptive pill cycle. In addition, 12.2% of the athletes using a hormonal contraceptive said they liked having a reduced number of bleeds per year, which can be achieved by skipping the pill-free days. Knowing when the withdrawal bleed would occur allows athletes to avoid bleeding during an important competition, such as the Olympics.</p>
<p>Athletes not using any type of hormonal contraceptive had menstrual cycles of different lengths, usually between 21 and 35 days. Just over three-quarters of these athletes reported negative side effects that usually occurred during the first day or two of the cycle, when they were having their period. The most common side effects were cramps, back pain, headaches and bloating. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214106/original/file-20180410-566-1s7ectm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heather Watson spoke about how period pain played a part in her 2015 Australian Open defeat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=dsMuazLG9NzAqqNomfLkIw-1-17">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>A healthy hormonal profile</h2>
<p>Although some of the athletes in our study reported a small number of perceived advantages to using a hormonal contraceptive, outside of the medical benefits, my colleagues and I aren’t suggesting that all athletes switch to contraceptive use. We don’t believe that convenient benefits, such as reducing the number of withdrawal bleeds, outweigh the likely undesirable health consequences of chronically low hormone levels caused by hormonal contraceptive use.</p>
<p>Having a menstrual cycle – and not using a hormonal contraceptive – which includes phases with high oestrogen concentrations <a href="https://doi.org/10.1007/s11914-017-0412-x">is associated</a> with good bone health and better fertility outcomes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214244/original/file-20180411-570-eccdvq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keep healthy as you compete.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/home">via shutterstock.com</a></span>
</figcaption>
</figure>
<p>The menstrual cycle is part of a much bigger health issue for female athletes. A concept called the “<a href="http://bjsm.bmj.com/content/48/4/289">female athlete triad</a>” describes the link between menstrual function, energy availability and bone health. If an athlete does not have a healthy menstrual cycle – which can be caused by low energy availability – then this can cause problems for her bone health. Another concept, known as “<a href="https://doi.org/10.1136/bjsports-2014-093502">relative energy deficiency in sport</a>” expands upon this by adding other aspects of health and performance. This research suggests that bone health may not be the only aspect of health or performance affected by poor menstrual function. </p>
<p>Taken together, these two concepts teach us that having a menstrual cycle is better than not having one. While some athletes told us that they experienced a small number of negative side effects during their period, the long-term benefits of having a period clearly beat the possible short-term issues. Athletes need to be supported with these issues, which can be achieved by athletes talking openly about their periods and menstrual cycles with their coaches and medical professionals. This way, we can ensure that their hormonal profile is the best it can be for their health and sporting performance.</p><img src="https://counter.theconversation.com/content/92378/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kirsty Elliott-Sale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research with elite sportswomen found half use hormonal contraceptives.Kirsty Elliott-Sale, Senior Lecturer, School of Science & Technology , Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/683752016-11-08T16:02:13Z2016-11-08T16:02:13ZWe won’t have a male contraceptive until we change our understanding of risk<figure><img src="https://images.theconversation.com/files/145025/original/image-20161108-16697-9loxg3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Worth the risk?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-409500925/stock-photo-extreme-closeup-man-face-taking-white-pill-mouth-view-swallowing-pills-and-smile.html?src=agw2dHDA8OJujvHxN263FQ-1-55">Shutterstock</a></span></figcaption></figure><p>A <a href="http://press.endocrine.org/doi/abs/10.1210/jc.2016-2141">recent paper</a> reported that an otherwise successful trial of a male contraceptive injection was halted early due to the concerns of a safety committee regarding adverse side effects, specifically acne, mood changes and depression. </p>
<p>There have been comments on social media and <a href="http://www.independent.co.uk/voices/male-contraceptive-injection-successful-trial-halted-a7384601.html">in the press</a> that female hormonal contraceptive methods often cause adverse side effects but are still considered suitable for use by healthy women. For example, another <a href="http://www.bbc.co.uk/news/health-37551855%E2%80%8B">recent study</a> showed increased rates of depression in women using both kinds of contraceptive pill, and mood changes are a common adverse effect reported by some women using hormonal methods. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"792878303958949888"}"></div></p>
<p>As one author in the The Conversation asked, would <a href="https://theconversation.com/why-the-male-pill-is-still-so-hard-to-swallow-68133">the female contraceptive pill ever be licensed today</a>? One has to wonder – is this apparent double standard of concern about side effects an example of sexism in plain sight?</p>
<p>It is <a href="http://www1.udel.edu/soc-bak/tammya/socDev/blum%20stracuzzi%20gender%20in%20prozac%20nation.pdf">sometimes argued</a> that the apparent lack of concern about female contraceptive side effects is due to a cultural belief that mood swings and depression are simply part and parcel of “femininity”, and of little note. Conversely, when they occur in men, they are viewed as illnesses or side effects, and are considered much less tolerable. There are some deep cultural truths in this view – but there is much more going on, too.</p>
<h2>Changing attitudes</h2>
<p>The female contraceptive pill was <a href="http://hansard.millbanksystems.com/commons/1961/dec/04/birth-control-pills#S5CV0650P0_19611204_HOC_160">first available in Britain in 1961</a> and the trials on it were carried out a few years before the 1964 <a href="http://www.wma.net/en/30publications/10policies/b3/">Declaration of Helsinki</a>, which set the basic ethical benchmark for drug trials. Since then, trial methodology has developed, making adverse effects more visible. Ethical sensitivity has also increased with the well-being of trial participants much more prominent in the research process. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=341&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=341&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=341&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=429&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=429&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145027/original/image-20161108-16733-j41kcw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=429&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not without its dangers.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-141490228/stock-photo-belly-of-pregnant-woman-monochrome-on-a-dark-background.html?src=AaUt-TVrj3ipXbdIK0ookw-1-45">Shutterstock</a></span>
</figcaption>
</figure>
<p>Added to these developments is the perception that end users of drug products are now more likely to sue manufacturers than they were 60 years ago. Everyone is now much more concerned than they were with ensuring the risks of a drug are outweighed considerably by the benefits.</p>
<p>Contraceptive products present particular difficulties when it comes to balancing risks and benefits. Unlike drugs to treat disease, contraceptive methods are used predominantly by healthy people. So any adverse effect might be viewed as tipping the balance towards unacceptable risk. </p>
<p>But of course women use contraception because they wish not to become pregnant. For this reason, taking into account the <a href="http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplications.htm">risks associated with pregnancy</a>, the risk-benefit balance, for a woman, is favourable for any contraceptive method whose risks to health are minor or rare. </p>
<p>This is because the risks of pregnancy to a woman’s health usually greatly outweigh the risks of hormonal contraceptive methods, providing the woman is healthy. But men do not bear the health risks of pregnancy. So in a purely biological sense, almost any risk associated with a male hormonal contraceptive method could be deemed unacceptable. </p>
<h2>Non-biological risks</h2>
<p>And therein lies the problem. Many men also wish fervently to avoid unwanted pregnancy. But for them the risk is social, relational, emotional and perhaps financial. While the balance of risks and benefits when applied to treatments for disease can be made on an individualist and biological basis, such reductionism is unhelpful in regards to male contraception. For in this context we are necessarily looking at a couple’s risk, and for men we must assess non-biological risks and benefits as well as clinical ones.</p>
<p>Ethical and risk-benefit calculations have not yet reached this degree of sophistication. There are sound ethical reasons to be wary of balancing risks for one person against benefits for another. After all, I could argue that the risk-benefit balance of you donating one of your kidneys to someone in renal failure is so obviously in favour of donation that it should be commonplace. Perhaps even a moral obligation. But that would be an ethically worrying conclusion.</p>
<p>Nonetheless, in the area of male contraception, where studies have shown both <a href="http://www.sciencedirect.com/science/article/pii/S0002937804001395">efficacy</a> and <a href="http://humrep.oxfordjournals.org/content/21/8/2033.full.pdf">acceptability</a>, it is necessary to move beyond an individualised, biological calculation of risk. This requires courage on behalf of researchers, regulators and safety committees. It requires common sense from manufacturers, lawyers and the legal system. But most of all it involves an open public conversation about risk, how it is measured and what the figures mean to an individual user or couple. If this is not undertaken, research into male contraception will remain stopped in its tracks.</p><img src="https://counter.theconversation.com/content/68375/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has previously received funding from Bayer for research into female intrauterine contraceptive methods. </span></em></p>Why research into male contraception keeps hitting the buffers.Susan Walker, Senior Research Fellow/ Senior Lecturer in Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681332016-11-05T12:31:22Z2016-11-05T12:31:22ZWhy the male ‘pill’ is still so hard to swallow<figure><img src="https://images.theconversation.com/files/144437/original/image-20161103-25329-1g8fa8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Okay for women, but what about men?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=HdRlUOkWprnSWU_oY-gDMA-1-6&id=160288271&size=medium_jpg">Shutterstock</a></span></figcaption></figure><p>A recent study looking at the effectiveness of a male contraceptive injection was abandoned after the men taking part reported <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">increased incidences</a> of acne (nearly half), mood disorders (over a fifth) and raised libido (over a third). In fact, there were 320 men in the study – and a total of 1,491 adverse events were reported. For those overseeing the trial these side effects were viewed as being more significant than the fact that the contraceptive injection appeared to work well in reducing the production of sperm – and the evidence does appear to support their concerns?</p>
<p>Nevertheless, many women will feel these side effects seem minor when compared with those of the female contraceptive pill – and they’d have a point, too. These include <a href="http://www.nhs.uk/conditions/contraception-guide/pages/combined-contraceptive-pill.aspx#Advantages%22%22">anxiety, weight gain, nausea, headaches, reduced libido and blood clots</a>. Which raises the question: why is it so hard to make a male contraceptive? And if the plug has been pulled on this one because of side effects, would the female contraceptive pill make it to market if it were released today? </p>
<p>On the face of it, regulating fertility in men should be the more obvious choice. Sperm are produced on a constant basis and not in cycles like eggs are in women. This means that, barring any underlying health problems, men are always fertile. In addition, as the biology of sperm production is <a href="http://www.open.edu/openlearn/body-mind/health/health-sciences/the-science-sperm">well-known</a>, the mechanisms of how to block it are also well-known. </p>
<p>Indeed, the current study was exploiting the well-established relationship between testosterone – the hormone that gives men their male characteristics – and sperm production. By giving men synthetic testosterone in combination with a hormone called progestogen – similar to the hormones usually found in the pill – sperm production in the testes is reduced dramatically. </p>
<p>Before the study was halted, the researchers from Martin Luther University, Germany, observed that pregnancy rates for the men on their trial fell to an equivalent of just <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">1.5 babies conceived per 100 couples</a>. Compare this with the pregnancy rate of nine babies per 100 couples for <a href="http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/failure-rates-table">women using the combined pill</a>, and the development of such a male contraceptive seems like a no-brainer.</p>
<h2>So what’s going on?</h2>
<p>Yet, here we are at the end of another study – without being any closer to the development of a viable male contraceptive. As such, women are left once again placed solely in charge of their fertility as well as bearing the brunt of the side effects. Many women may view the side effects as the lesser evil when compared with an unplanned pregnancy, and many <a href="https://www.theguardian.com/commentisfree/2016/oct/30/will-we-believe-a-man-who-says-he-is-on-the-pill">may also question</a> whether leaving the responsibility of contraception in the hands of men will work. </p>
<p>But the side effects of the male pill could actually have been an unlikely beneficial factor. With both partners actively taking contraceptives – and sharing an understanding of the side effects – a joint sense of responsibility for the couple’s fertility would be established. Also, if one partner needed to take a break from their contraceptive, the other could start taking theirs, sharing the impact of those side effects.</p>
<p>So why has it been so difficult to develop an effective male contraceptive when women have been taking the pill, and enduring the side effects, since the early 1960s? In fact, looking at the original trial results from 1956, it’s hard to see how the contraceptive pill ever actually made it to market.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144439/original/image-20161103-25322-71orgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Well, there’s always these.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-282513755/stock-photo-colorful-condom.html?src=jcARgUppDpmVvubnSo4Lkg-1-4">Shutterstock</a></span>
</figcaption>
</figure>
<p>The <a href="http://pdf.usaid.gov/pdf_docs/PNAAV359.pdf">first large-scale human trial</a> was conducted in Rio Piédras, a Puerto Rican housing project. The women taking part received little information about the product they were receiving, partly because there was little to give and partly, perhaps, because none of the people running the trial felt it necessary. Such were clinical trials in the 1950s. </p>
<p>While women even then reported side effects including headaches, dizziness, nausea and blood clots, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/pdf/058e757.pdf">these were largely dismissed</a>. Thankfully, since then, the pill has undergone constant refinement and modification, becoming a form of contraception now taken by an estimated <a href="http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf">225m women world-wide</a>. </p>
<p>The pill has unquestionably <a href="http://www.albertmohler.com/2010/04/26/the-pill-turns-50-time-considers-the-contraceptive-revolution/">changed female sexual freedom</a>, allowing women <a href="http://www.bbc.co.uk/news/uk-15984258">greater control over when to have children</a>. Indeed, in 2012, UK women voted the pill their favourite invention of the last century – ahead of leisure devices such as the <a href="http://www.thescottishsun.co.uk/scotsol/homepage/news/4239571/Women-say-the-Pill-is-their-favourite-invention.html">internet and the television</a>. </p>
<p>Consequently, it is strange that more resources haven’t been ploughed by big pharmaceutical into a male pill. Part of the problem appears to be the very success of female contraceptives. As many pharmaceutical companies make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464843/pdf/AJPH.2012.300706.pdf">big profits from female contraceptives</a>, there is little desire to take focus away from them. </p>
<p>It also appears that there isn’t a universal desire by men for such a form of contraception. Indeed, a <a href="http://humrep.oxfordjournals.org/content/20/2/549.full.pdf+html">2005 study</a> surveyed more than 9,000 men across nine countries about their willingness to take a male pill. While approximately 70% of men in Spain and Germany stated they would be happy to take it, less than 30% of men in Indonesia displayed a positive attitude towards it.</p>
<h2>Shared responsibility?</h2>
<p>In the meantime, it seems that until there’s more demand from men for a “pill” of their own, the responsibility will be left to women. This means that the need for such a powerful regulator of fertility as the female contraceptive pill is still needed today as much as ever. </p>
<p>It should be remembered that many women take the pill for its additional benefits such a relieving heavy menstrual bleeding and pain, reducing acne and helping with <a href="http://www.nhs.uk/Conditions/Premenstrual-syndrome/Pages/Symptoms.aspx">premenstrual dysphoric disorder</a>. With the development of new and improved contraceptive pills that contain lower hormone doses, the negative side effects of the pill also appear to be reducing.</p>
<p>Indeed, in light of the enormous benefits that the contraceptive pill has brought to women and their sexual health, it would be hard to imagine a world without it. But perhaps we should also be asking why, even in the 21st century, the idea of a man taking a contraceptive “pill” remains such a big deal.</p><img src="https://counter.theconversation.com/content/68133/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Side effects have led to the plug being pulled on the male contraceptive injection. But what about those experienced by women on the pill?Adam Watkins, Research fellow, Cell & Tissue Biomedicine, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/572612016-07-21T17:38:59Z2016-07-21T17:38:59ZThe search for answers to hormonal contraception’s role in HIV infection<figure><img src="https://images.theconversation.com/files/131412/original/image-20160721-32610-ftsewe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Injectable progestin contraceptives are particularly popular in sub-Saharan Africa.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>About 75% of HIV-infected people in sub-Saharan African between the ages of 15 and 24 <a href="http://science.sciencemag.org/content/sci/308/5728/1582.full.pdf">are women</a>. Many factors play a role in this gender imbalance. These include gender-based social disparity and a high prevalence of intergenerational sexual partnerships. </p>
<p>But research suggests certain types of hormonal contraceptives commonly used in this region could also play a role.</p>
<p>Injectable progestin contraceptives, like Depo-Provera, are particularly popular in <a href="http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(14)71052-7.pdf">sub-Saharan Africa</a>. They are effective and convenient. Instead of taking a daily pill, women can receive Depo-Provera injections every three months. </p>
<p>But studies suggest that women using this specific type of contraceptive are more susceptible to HIV. Most recently <a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70247-X/abstract">a large-scale study</a> conducted in Africa found women using injectable progestins were twice as likely to acquire HIV than women using no hormonal contraceptive. </p>
<p>This type of study cannot <em>prove</em> a particular type of contraceptive actually makes women more susceptible to infection, as it is just looking for an association between the two.</p>
<p>To really find out if contraceptives make women more susceptible to infection, you need to see how these drugs actually affect the systems that protect the body from infection. Such studies are more difficult to do in humans, so my colleagues and I decided to explore mouse models.</p>
<h2>What we learnt from mice</h2>
<p>We used mice to learn if Depo-Provera or levonorgestrel (LNG), a progestin used in hormonal intrauterine devices, affect the genital mucosal barrier. This barrier serves as a blockade to prevents virus and bacteria from infecting body tissues. In other words, it is a first line of defense against infection.</p>
<p>Epithelial cells on the surface of genital tract tissues are a vital part of this barrier. They are held tightly together by adhesion molecules that make it difficult for pathogens to penetrate tissue and establish infection. </p>
<p>But <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">we found</a> that mice treated with Depo-Provera or LNG have lower levels of several of these adhesion molecules. This means that genital epithelial cells aren’t held together as tightly, tissue becomes more permeable and virus more easily invades. </p>
<p>Our research shows these contraceptives increase mouse susceptibility to infection. But do similar changes in permeability also occur in women? </p>
<p>To find this out, we obtained cervical tissue from US women before and after they started using Depo-Provera. This showed Depo-Provera causes changes to adhesion molecules and tissue permeability <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">similar to those seen in mice</a>. </p>
<h2>Where do we go from here?</h2>
<p>Sexually transmitted infection and unplanned pregnancy are interconnected public health problems. Countries with a larger burden of infection typically also have higher infant and maternal mortality rates and a great need for <a href="http://www.ncbi.nlm.nih.gov/pubmed/23871397">effective contraception</a>. </p>
<p>Since Depo-Provera and LNG provide women with effective contraception, we wanted to learn if there are ways to counteract their ability to weaken the mucosal barrier. With this in mind, we also performed studies in which mice were treated with both Depo-Provera and oestrogen.</p>
<p>This combination strengthened the genital mucosal barrier and made mice <a href="http://www.ncbi.nlm.nih.gov/pubmed/27007679">less susceptible to virus infection</a>. It also suggests a scenario in which women would receive Depo-Provera and a vaginal ring that releases oestrogen and an antiviral microbicide. </p>
<p>Before this can happen, research is needed to determine if Depo-Provera and an oestrogen-releasing vaginal ring protect non-human primates from viral infection. If positive results are seen, the next logical step would be clinical trials that explore if similar approaches also reduce a woman’s risk of acquiring HIV.</p><img src="https://counter.theconversation.com/content/57261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas L. Cherpes receives funding from the NICHD. </span></em></p>Studies have suggested that women using a particular kind of injectable contraceptive are more susceptible to HIV infection. Research in mice offers new insights.Thomas L. Cherpes, Associate Professor in the College of Medicine, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575462016-04-27T10:07:15Z2016-04-27T10:07:15ZHow limiting women’s access to birth control and abortions hurts the economy<p>Reproductive health isn’t <a href="https://www.guttmacher.org/united-states/abortion/demographics">just about abortions</a>, despite all the attention they get. It’s also about access to family planning services, contraception, sex education and much else.</p>
<p>Such access lets women control the timing and size of their families so they have children when they are financially secure and emotionally ready and can finish their education and advance in the workplace. After all, <a href="http://www.nwlc.org/sites/default/files/pdfs/reproductive_health_is_part_of_the_economic_health_of_women_5.29.15pdf.pdf">having children is expensive</a>, costing US$9,000 to $25,000 a year. </p>
<p>And that’s why providing women with a full range of reproductive health options is good for the economy at the same time as being essential to the financial security of women and their families. Doing the opposite threatens not only the physical health of women but their economic well-being too.</p>
<p>The Supreme Court <a href="https://www.oyez.org/cases/1991/91-744">acknowledged</a> as much in 1992, stating in Planned Parenthood of Southeastern Pennsylvania v. Casey:</p>
<blockquote>
<p>The ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives.</p>
</blockquote>
<p>However, it seems that state and federal legislators, certain politicians running for president as well as some conservative Supreme Court justices have forgotten the meaning of this sweeping language.</p>
<p>As a consequence, the right to control their reproductive health has become <a href="http://thinkprogress.org/health/2013/05/08/1979831/women-struggle-afford-abortion/">increasingly illusory</a> for many women, particularly the poor.</p>
<h2>The economics of contraception</h2>
<p>With some conservative politicians dead set on limiting access to abortion, you’d assume that they would be for policies that help women avoid unintended pregnancies. But <a href="http://www.motherjones.com/politics/2012/02/republican-war-birth-control-contraception'">conservative attacks on birth control</a> are escalating, even though <a href="http://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf">99 percent of sexually active women</a> have used <a href="https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states">some form such as an intrauterine device (IUD), patch or pill</a> at least once. </p>
<p>In addition to its widely recognized health and autonomy benefits for women, contraception <a href="http://www.theatlantic.com/health/archive/2014/07/the-broader-benefits-of-contraception/373856">directly boosts the economy</a>. In fact, research shows access to the pill <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684076/">is responsible</a> for a third of women’s wage gains since the 1960s. </p>
<p>And this benefit extends to their kids. Children born to mothers with access to family planning <a href="http://www.nber.org/papers/w19493.pdf">benefit from a 20 to 30 percent increase</a> in their own incomes over their lifetimes, as well as boosting college completion rates. </p>
<p>Not surprisingly, in a survey, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23021011">77 percent of women</a> who used birth control reported that it allowed them to better care for themselves and their families, while large majorities also reported that birth control allowed them to support themselves financially (71 percent), stay in school (64 percent) and help them get and keep a job (64 percent). </p>
<p>Still, there is a class divide in contraception access, as evidenced by disparities in the 2011 rate of unintended pregnancies. While the <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1506575">overall rate</a> fell to 45 percent (from 51 percent in 2008), the figure for women living at or below the poverty line was <a href="https://www.guttmacher.org/sites/default/files/pdfs/pubs/FB-Unintended-Pregnancy-US.pdf">five times that of women</a> at the highest income level (although also decreasing).</p>
<p>One reason for this disparity is the <a href="http://www.thenation.com/article/why-does-best-birth-control-cost-entire-months-wages/">cost of birth control</a>, particularly for the most effective, long-lasting forms. For instance, it typically costs over $1,000 for an IUD and the procedure to insert it, amounting to <a href="http://www.jahonline.org/article/S1054-139X(13)00054-2/pdf">one month’s full-time pay</a> for a minimum wage worker. </p>
<p>These costs are significant, given that the <a href="https://www.guttmacher.org/sites/default/files/pdfs/pubs/fulfill.pdf">average American woman wants</a> two children and will thus need contraception for at least three decades of her life. Unfortunately, <a href="http://rooseveltinstitute.org/wp-content/uploads/2015/11/Breaking-the-Cycle-of-Poverty-Expanding-Access-to-Family-Planning.pdf">publicly funded family planning</a> meets only 54 percent of the need, and these funding streams are under constant attack by conservatives.</p>
<p>Not surprisingly, <a href="http://www.scotusblog.com/2015/12/symposium-womens-compelling-need-for-contraception-met-by-insurers-not-objecting-employers/">health insurance makes a difference</a>, and women with coverage are much more likely to use contraceptive care. The <a href="http://nwlc.org/resources/zubik-v-burwell-non-profit-objecting-employers-should-not-be-allowed-to-make-it-harder-for-women-to-access-critical-birth-control-coverage/">Affordable Care Act is responsible</a> for part of the drop in unintended pregnancies – it expanded contraception coverage to around 55 million women with private insurance coverage. </p>
<p>Yet this coverage is also at risk for millions of employees and their dependents who work for employers claiming a religious objection. In Burwell v. Hobby Lobby, the <a href="http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf">Supreme Court concluded</a> that a for-profit company cannot only profess religious beliefs but also impose those beliefs on their employees by denying them certain forms of contraception. The <a href="http://kff.org/womens-health-policy/issue-brief/round-2-on-the-legal-challenges-to-contraceptive-coverage-are-nonprofits-substantially-burdened-by-the-accommodation/">Obama administration has issued regulations</a> allowing religious employers to opt out of offering contraceptive coverage. Affected employees are then covered directly by their insurers.</p>
<p>This is not enough for some. In March, the Supreme Court heard oral arguments in the case of <a href="http://www.scotusblog.com/case-files/cases/zubik-v-burwell">Zubik v. Burwell</a>, in which several religious <a href="http://kff.org/womens-health-policy/issue-brief/contraceptive-coverage-at-the-supreme-court-zubik-v-burwell-does-the-law-accommodate-or-burden-nonprofits-religious-beliefs/">nonprofits assert</a> that even the act of seeking an accommodation from the law burdens their religious consciences. </p>
<p>These religious groups argue in part that women can get their birth control from other sources, such as federally funded family planning centers. Yet at the same time, <a href="http://time.com/4264955/contraceptive-coverage/">conservatives are on a mission to slash that funding</a>, particularly for Planned Parenthood, which provides sexual and reproductive health care to almost five million people a year.</p>
<p>This makes no economic sense. Publicly funded family planning programs <a href="https://www.guttmacher.org/news-release/2015/publicly-funded-family-planning-yields-numerous-positive-health-outcomes-while">help women avoid about two million unintended pregnancies</a> a year and save the government billions of dollars in health care costs. The net savings to government are $13.6 billion. For every $1 invested in these services, the government saves $7.09.</p>
<h2>Sex education and the economic ladder</h2>
<p>Another key to reproductive health – and one that isn’t discussed enough – is sexual education for teenagers. </p>
<p>For years, the public has spent over $2 billion on abstinence-only programs, which not only <a href="http://www.jahonline.org/article/S1054-139X(05)00467-2/fulltext?mobileUi=0">fail to reduce teen birth rates</a> but also reinforce gender stereotypes and are rife with misinformation. Low-income minority teens <a href="http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=1084&context=bjalp">are particularly subject</a> to these programs.</p>
<p>Teens without knowledge about their sexual health <a href="http://www.advocatesforyouth.org/publications/publications-a-z/597-abstinence-only-until-marriage-programs-ineffective-unethical-and-poor-public-health">are more likely</a> to get pregnant and less likely to work, spiraling them to the bottom of the economic ladder. </p>
<p>President Obama’s <a href="http://www.siecus.org/index.cfm?fuseaction=Feature.showFeature&FeatureID=2438">proposed 2017 budget would eliminate federal funding</a> for abstinence-only sex education and instead fund only comprehensive sexual education, which is age-appropriate and medically accurate. However, <a href="http://www.motherjones.com/mojo/2016/02/state-of-teen-sex-america-chart-abstinence">Congress has rejected</a> the president’s prior proposed cuts and the same result is likely for 2017. </p>
<h2>Access to abortion</h2>
<p>Then there’s the issue of abortion. Let’s start with the cost.</p>
<p><a href="http://www.nwlc.org/sites/default/files/pdfs/reproductive_health_is_part_of_the_economic_health_of_women_5.29.15pdf.pdf">Half of women who obtain an abortion</a> pay more than one-third of their monthly income for the procedure.</p>
<p>Costs rise significantly the longer a woman must wait, either because state law requires it or she needs to save up the money – or both. Studies show that women <a href="http://www.nytimes.com/2013/06/16/magazine/study-women-denied-abortions.html?_r=0">who cannot access abortion</a> are <a href="http://rhtp.org/abortion/documents/TwoSidesSameCoinReport.pdf">three times more likely</a> to fall into poverty than women who obtained abortions.</p>
<p>In addition to the financial burden, <a href="https://www.guttmacher.org/state-policy/explore/overview-abortion-laws">many states are enacting laws</a> designed to limit abortion access. These laws hit low-income women particularly hard. From 2011 to 2015, <a href="https://www.guttmacher.org/article/2016/01/2015-year-end-state-policy-roundup">31 states have enacted</a> 288 such laws, including waiting periods and mandatory counseling sessions. </p>
<p>Moreover, <a href="https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_TRAP.pdf">24 states have enacted so-called TRAP laws</a> (targeted regulation of abortion providers), which medical experts say go far beyond what is needed for patient safety and impose needless requirements on doctors and abortion facilities, <a href="http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/ACOG-and-AMA-File-Amicus-Brief">such as requiring facilities</a> to have the same hallway dimensions as a hospital. </p>
<p>In March, the Supreme Court heard arguments in a case <a href="http://www.scotusblog.com/case-files/cases/whole-womans-health-v-cole/">challenging a Texas TRAP law</a>, <a href="http://www.reproductiverights.org/case/whole-womans-health-v-hellerstedt">Whole Women’s Health v. Hellerstedt</a>. If the court upholds the law, the entire state of Texas will be left with only 10 abortion providers.</p>
<p>A <a href="http://www.scotusblog.com/wp-content/uploads/2015/09/14-50928-CV0.pdf">lower federal appeals court stated</a> in the Texas case that travel distances of more than 150 miles one way are not an “undue burden” and are thus constitutional. This, I would argue, shows a <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2446644">complete lack of understanding</a> regarding the difficulties that poverty – especially rural poverty – imposes. Traveling long distances adds additional costs to an already expensive medical procedure. </p>
<p>The court’s decision is expected in June. <a href="http://www.slate.com/articles/news_and_politics/supreme_court_dispatches/2016/03/in_oral_arguments_for_the_texas_abortion_case_the_three_female_justices.html">Observers fear</a> that the court could split 4-4, which would leave the Texas law intact. </p>
<h2>The Hyde Amendment</h2>
<p>Another way in which U.S. policy on abortions <a href="https://www.americanprogress.org/issues/women/news/2013/05/10/62875/how-the-hyde-amendment-discriminates-against-poor-women-and-women-of-color">exacerbates economic inequality, especially for women of color</a>, is through the ban on federal funding – which some aspiring politicians <a href="http://www.motherjones.com/mojo/2016/02/donald-trump-really-doesnt-understand-how-federal-funding-works-planned-parenthood-0">seem to have forgotten</a> is still in place.</p>
<p>It has been so since the <a href="http://billmoyers.com/content/five-facts-you-should-know-about-the-hyde-amendment/">1976 enactment of the Hyde Amendment</a>, which prevents federal Medicaid funds from being used for abortions except in cases of rape, incest or when the life of the mother is at risk. The Affordable Care Act does many wonderful things for women’s health, but it also <a href="http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/">extends the Hyde Amendment</a> through its expansion of Medicaid, and it allows states to ban abortion coverage in their private exchanges. </p>
<p>Denying poor women coverage under Medicaid contributes to the unintended birth rates that are <a href="https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states">seven times higher</a> for poor women than high-income women. </p>
<h2>Economic and reproductive health</h2>
<p>Politicians cannot promise to grow the economy and simultaneously limit access to abortion, birth control and sexual education. Our nation’s economic health and women’s reproductive health are linked.</p>
<p>And as Hillary Clinton <a href="http://www.politifact.com/truth-o-meter/statements/2016/apr/15/hillary-clinton/hillary-clinton-says-democratic-debate-moderators-/">correctly noted</a> recently, it’s an issue that deserves more attention in the presidential campaign – and hasn’t received enough.</p><img src="https://counter.theconversation.com/content/57546/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michele Gilman is affiliated with the ACLU of Maryland and the Women's Law Center of Maryland.</span></em></p>Providing women with a range of reproductive health options – from abortions to IUDs – is not only essential for their financial security but good for the economy as well.Michele Gilman, Venable Professor of Law, University of BaltimoreLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/448962015-09-27T19:21:30Z2015-09-27T19:21:30ZFew Australian women use long-acting contraceptives, despite their advantages<figure><img src="https://images.theconversation.com/files/95115/original/image-20150917-32615-chxckk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long-acting reversible contraception such as intrauterine devices don't require women who use them to do anything else to prevent pregnancy. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mirkmirk/16670919389/">Sarah Mirk/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Few Australian women use long-acting reversible contraception, despite its advantages over other methods. These contraceptives offer women long-term, cost-effective, “fit-and-forget” contraception.</p>
<p>Long-acting reversible contraception (LARC) includes intrauterine devices (IUDs) and implants that are usually inserted in the upper arm. In contrast to other commonly used contraceptives, such as the pill and condoms, LARC don’t require women who use them to do something to prevent pregnancy daily or every time they have sex. </p>
<p>Intervention is required only when a decision is made to stop their use, and <a href="http://dx.doi.org/10.1016/j.contraception.2006.09.010">fertility is restored</a> when the contraception is removed.</p>
<h2>Good but under-used</h2>
<p>This type of contraception is highly effective for between three and ten years. Women using these methods have <a href="http://www.ranzcog.edu.au/documents/doc_download/2050-long-acting-reversible-contraception-c-gyn-34.html">less chance of unintended pregnancy</a> compared to women using other contraceptives. </p>
<p>In fact, along with sterilisation, these are <a href="http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#How-effective-are-birth-control-methods">the most effective means of contraception</a>. This is because unlike other methods – such as the oral contraceptive pill, diaphragm, rings and condoms – whose effectiveness depends on correct and consistent use, compliance isn’t an issue.</p>
<p>Long-acting contraception is <a href="http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.19_eng.pdf.">suitable for most women</a> including the young, those who’ve never given birth, are breastfeeding or have recently given birth, and those with chronic health conditions. It’s also suitable for use just before menopause, and <a href="http://austinpublishinggroup.com/obstetrics-gynecology/fulltext/ajog-v1-id1027.php">appropriate</a> for women who should avoid oestrogen. </p>
<p>Despite these apparent benefits, <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">our research</a> shows Australian women don’t use these contraceptive methods very much when compared to women in other high-income countries.</p>
<p>Even though most of the 1,131 Australian women <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">we surveyed</a> had heard of IUD and implants, only 4% to 8% reported using these methods compared with <a href="http://onlinelibrary.wiley.com.ezproxy.lib.monash.edu.au/doi/10.1363/46e1914/epdf">10% to 32% in Europe and 10% in the United States</a>. </p>
<p>On the whole, our respondents thought these contraceptive methods were unreliable and said they were unlikely to consider using them. The findings of <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">our study</a> suggest women in Australia may not be using LARC due to misperceptions about side effects, suitability and cost. </p>
<h2>Possible misunderstandings</h2>
<p>Concerns about the side effects and safety of LARC may reflect <a href="http://dx.doi.org/10.5694/mja12.11832">women’s understanding of the risks of infection and infertility</a> associated with older intrauterine devices. But modern long-acting contraception has been developed to overcome these early problems. They’re <a href="http://dx.doi.org/10.1097%2FAOG.0b013e31828b63a0">safe</a> and US studies show they have <a href="http://dx.doi.org/10.1097%2FAOG.0b013e31821188ad">higher rates of continuation and satisfaction</a> than other contraceptive methods. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95117/original/image-20150917-32615-ikky4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The effectiveness of long-acting contraceptive methods doesn’t depend on correct and consistent use.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hey__paul/6980584656/">Hey Paul Studios/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Religious beliefs may also influence choice of contraception away from long-acting options. <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">We found</a> women who said religion was important in their fertility choices were less likely to consider long-acting contraceptive methods as reliable. And they were less likely to consider using them. </p>
<p>What’s more, UK research also shows doctors may not comply with patient requests for certain methods of contraception because of <a href="http://jfprhc.bmj.com/content/34/1/47.long">their own personal religious beliefs</a>.</p>
<p>Interestingly, <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">our research team</a>, along with others in <a href="http://dx.doi.org/10.5694/mja14.00011">Australia</a> and the <a href="http://dx.doi.org/10.1097%2FAOG.0b013e31821188ad">United States</a>, found women who’ve had a pregnancy or an abortion are more likely to think long-acting contraception is reliable and consider using it. </p>
<p>It’s likely that women who have experienced a pregnancy or, especially, an abortion are more motivated to obtain more effective contraception and avoid further unintended pregnancies. And doctors are likely to pay greater attention to these women’s contraceptive needs. </p>
<h2>Myriad barriers</h2>
<p><a href="http://dx.doi.org/10.3109/13625187.2015.1052394">We’ve also found</a> that <a href="http://dx.doi.org/10.1016/j.ajog.2012.02.014">men tend to have</a> less knowledge of these contraceptive methods and to perceive them as being <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">less reliable</a>. This is likely due to the fact that women are the primary users of LARC and that men may receive little contraception education. Still, the <a href="http://dx.doi.org/10.1016/j.contraception.2011.04.018">attitudes of male partners</a> are important predictors of contraceptive use. </p>
<p><a href="http://www.fpv.org.au/assets/LARCstatementSHFPAFINAL.pdf">The cost</a> of long-acting contraception could be a barrier for some Australian women. <a href="http://dx.doi.org/10.3109/13625187.2015.1052394">We found</a> women who lived in socioeconomically advantaged areas were more likely to think of these contraceptive methods as reliable and consider using them than women who lived in disadvantaged areas. </p>
<p>It may be that the former have better health and access to health services and products, as well as money to spend on contraception. While implants and IUDs are subsidised by the Pharmaceutical Benefits Scheme, there are high costs – paid by the patient – for the insertion procedure. But despite their high initial cost, long-acting contraceptives <a href="http://dx.doi.org/10.1016/j.contraception.2008.08.003">are not expensive over the longer term</a>. They cost about the same as the oral contraceptive pill over equivalent periods of use. </p>
<p><a href="http://dx.doi.org/10.1016/j.whi.2010.07.005">Doctors</a> may be reluctant to prescribe these types of contraceptives because of uncertainty about their suitability. And they may have not received training on insertion. Indeed, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23992177">a 2013 Australian study</a> concluded doctors’ beliefs were the most important barrier to women using these contraceptive methods. </p>
<p>To help women make the right contraceptive choice for their needs, we need to provide accurate, up-to-date information to them, their male partners and their doctors. And we need to ensure that cost doesn’t prevent a woman from using the contraceptive method best suited to her.</p><img src="https://counter.theconversation.com/content/44896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors, including Sara Holton, are investigators on the 'Understanding fertility management in contemporary Australia' study which was supported by an Australian Research Council Linkage Project Grant (LP100200432) with funding and in-kind contributions from Family Planning Victoria, Melbourne IVF, The Royal Women’s Hospital, and the Victorian Department of Health</span></em></p><p class="fine-print"><em><span>Heather Rowe receives funding from the National Health and Medical Research Council, the Australian Government, the Australian Research Council, Australian Rotary Health, not-for profit organisations and philanthropic trusts. </span></em></p><p class="fine-print"><em><span>Jane Fisher currently receives funding from the National Health and Medical Research Council, the Australian Research Council, the Australian Department of Social Services, the Australian Department of Health, the Victorian Department of Health and Human Services, Jean Hailes for Women's Health, Family Planning Victoria, Women's Health Victoria, Monash Health, the Australian Federation of Medical Women, the Parenting Research Center, Melbourne IVF, Grand Challenges Canada, Australian Rotary Health; the L and H Hecht Trust, the Jack Brockhoff Foundation and the Prostate Cancer Foundation of Australia .
Jane Fisher is President-elect of the International Marce Society for Perinatal Mental Health, she chairs the Psychosocial and Epidemiological Research in Reproduction Group for the Royal Women’s Hospital and Melbourne IVF and sits on the Royal Women’s Hospital Research Committee (2003 -), the Epworth Healthcare Human Research Ethics Committee (2009-) and the Masada Private Hospital Patient Care Review Committee (2003-). She is a member of the NHMRC Mental Health and Parenting Expert Advisory Group (2014-) and of the International Board of Advisors, Research and Training Centre for Community Development Hanoi, Vietnam. She has been an invited temporary technical adviser to WHO Departments of Reproductive Health and Research, Mental Health and Substance Use and Maternal, Newborn, Child and Adolescent Health and Development since 2005.</span></em></p><p class="fine-print"><em><span>Maggie Kirkman receives funding from the Australian Research Council, the National Health and Medical Research Council, Jean Hailes for Women's Health, Family Planning Victoria, Women's Health Victoria, Monash Health, and the Australian Federation of Medical Women.</span></em></p>Few Australian women use long-acting reversible contraception, despite its advantages over other methods. These contraceptives offer women long-term, cost-effective, “fit-and-forget” contraception.Sara Holton, Research Fellow - Women's Health, Monash UniversityHeather Rowe, Senior Research Fellow, Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash UniversityJane Fisher, Professor & Director, Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash UniversityMaggie Kirkman, Senior Research Fellow, Jean Hailes, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/418772015-06-01T05:59:54Z2015-06-01T05:59:54ZFor women, even a small co-pay for contraception can be a big deal<figure><img src="https://images.theconversation.com/files/83451/original/image-20150530-15228-1hsvted.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For contraception, choice and access are critical. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-155865605/stock-photo-chinese-doctor-talking-with-female-patient-in-doctors-office.html?src=7Ho0NXhkAXxi9G4eFtufuw-1-96">Doctor and patient via www.shutterstock.com.</a></span></figcaption></figure><p>On May 11, the Obama administration released <a href="http://www.dol.gov/ebsa/faqs/faq-aca26.html">updated guidance</a> on insurance coverage of contraception. The announcement provides much-needed clarification for insurance plans regulated by the Affordable Care Act (ACA). </p>
<p>Before this announcement, the guidance for what insurers were supposed to do was <a href="http://www.dol.gov/ebsa/faqs/faq-aca12.html">vague</a>. </p>
<p>The ACA requires insurers to provide women access to the full range of FDA-approved contraceptive methods at no cost. But insurers could use “reasonable medical management” to introduce cost containment measures like providing generics at no cost, while requiring co-pays for a branded equivalent.</p>
<p>Some insurers used reasonable medical management to restrict access to some forms of contraception – often the more expensive but longer-lasting forms. And that led to variation among insurance plans about which contraceptives required a co-pay and which did not. </p>
<p>The new guidance specifies that at least one birth control method from each of <a href="http://www.fda.gov/downloads/forconsumers/byaudience/forwomen/freepublications/ucm356451.pdf">18 different categories</a> must be covered without cost-sharing in all eligible plans. Reasonable medical management and cost containment strategies can still be used, as long as methods in each category are offered. </p>
<p>So why does it matter than some insurers were restricting access to some forms of contraception?</p>
<p>About half of pregnancies in the US <a href="http://www.guttmacher.org/pubs/journals/ajph.2013.301416.pdf">are unintended</a> – and that has much to do with access and use of contraception. Unintended pregnancies lead to an <a href="http://www.contraceptionjournal.org/article/s0010-7824(06)00447-1/abstract">estimated US$5 billion in costs</a> for the US healthcare system per year, while birth control use provides cost savings of $19 billion each year. Even small improvements in contraceptive use could result in a meaningful reduction in the number of unintended pregnancies.</p>
<h2>Why are co-pays such an important issue?</h2>
<p>Relative to other forms of healthcare, the low cost of so many contraceptive methods may make the individual out-of-pocket expense seem unimportant. But to many women, these costs are real. Cost is a big factor in choosing to use one form of contraception over another, using it consistently or even the likelihood of using contraception at all. </p>
<p>Notably, the most effective methods [such as long-acting reversible contraceptives, like intrauterine devices (IUDs) or hormone implants] have the highest up-front cost. And if women must share the cost, that discourages them from using these highly effective methods. </p>
<p>We <a href="http://journals.lww.com/lww-medicalcare/Abstract/2013/11000/The_Impact_of_Out_of_Pocket_Costs_on_the_Use_of.2.aspx">studied</a> the relationship between out-of-pocket costs and contraception use among almost 1.7 million women enrolled in the types of plans regulated by the ACA rules between January 1 and December 31 2011. Women in plans with the highest level of cost-sharing were 35% less likely to have an IUD placed than women with the lowest level of cost-sharing – suggesting that even higher-income women are sensitive to the price of contraceptives.</p>
<p>The <a href="http://www.ajog.org/article/s0002-9378(10)00430-8/abstract">Contraceptive Choice study</a>, which offered almost 10,000 women free birth control, demonstrated that low-income and uninsured women will select the most effective (and most expensive) birth control methods at high rates when cost is not a factor.</p>
<p>This is why the new White House guidelines are so important. The broader menu of options available will increase women’s access to their preferred method, which may in turn improve contraception use patterns and decrease unintended pregnancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83173/original/image-20150527-4820-1hl959p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s more to contraception than the birth control pill.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-161036582/stock-photo-colorful-oral-contraceptive-pill.html?src=eZQ2jA8NNZSN6pStrmVTKQ-1-3">Contraceptive pills via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>One contraceptive is not like another</h2>
<p>All contraceptives aim to prevent pregnancy, but there are a variety of ways they can do so. They aren’t interchangeable, and the method that may work best for one woman may not be suitable for another.</p>
<p>Under previous guidance, many insurers interpreted the law to mean they must cover at least one – but not all – option from each of five categories: hormonal contraception (like birth control pills, vaginal rings or patches), barrier methods (diaphragm), emergency contraception, implanted devices (like IUDs or hormone implants) and sterilization. </p>
<p>But this approach to grouping methods doesn’t reflect the clinical uses for each type of contraception. For instance, the contraceptive ring was considered a “hormonal” method, and since there is a generic pill containing the same hormones as the ring, insurers have often not covered it because they consider them equivalent. But the ring lasts for three weeks before needing to be replaced, while the pill needs to be taken every day. And this distinction is important for women who know that they will sometimes forget to take a pill every day. </p>
<p>Even methods that are similar – such as the copper IUD and the hormone-containing IUD – are not, in medical parlance, therapeutic equivalents. This means that they have different medical uses, health benefits or side effects. These products aren’t interchangeable – the best one for an individual woman will depend on her menstrual patterns, tolerance of side effects and prior birth control experience. Clinicians, therefore, use them in different situations.</p>
<p>When physicians helps a woman choose the “best” choice, we look at her medical history, lifestyle and a product’s unique characteristics. In contraception, it’s important to never underestimate the importance of side effects or ease of use, since they can drive how consistently a woman uses a particular method. If our goal is consistent, effective use, we must remove barriers to an individual’s choice of birth control method.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83172/original/image-20150527-4840-1bscxn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not the same.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174200045/stock-photo-birth-control.html?src=i8dESY1ZvyrXIt2-mxT2ZA-1-51">Pills and IUD via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>How much of a difference will the new guidelines make?</h2>
<p>In the months before the White House released the new guidelines, three different reports captured the coverage variations between insurance plans.</p>
<p>A report from the <a href="http://www.contraceptionjournal.org/article/s0010-7824(14)00687-8/pdf">Guttmacher Institute</a>, a nonprofit organization focused on reproductive health, in September 2014 found that women continued to report out-of-pocket costs, especially for the most effective methods, like the IUD. </p>
<p>In April, a report from the <a href="http://kff.org/private-insurance/report/coverage-of-contraceptive-services-a-review-of-health-insurance-plans-in-five-states/">Kaiser Family Foundation</a> looked at coverage for 12 contraceptive methods among 20 different insurance carriers in five states. The organization found significant variation in interpretation and coverage among the plans. They also found that methods such as the vaginal ring and patch (which don’t need to be taken daily), and the most effective methods like the implant and IUD, were less likely to be covered without cost-sharing. </p>
<p>Further gaps were identified by the <a href="http://www.nwlc.org/resource/state-birth-control-coverage-health-plan-violations-affordable-care-act">National Women’s Law Center</a> in an analysis of more than 100 insurance plans in 15 states. They concluded that 33 plans in 13 states did not comply with the ACA. These plans were not covering all FDA-approved methods. They imposed cost-sharing, only covered generic methods or were not covering associated services, such as counseling or administration visits. </p>
<p>If our nation wishes to reduce the high number of unintended pregnancies – and the costs and abortions that result from them – improving women’s access to the contraceptive methods they prefer, and that they will use consistently, is key. The updated guidelines from the White House mean that American women face fewer barriers to use the contraceptive method of their choice.</p><img src="https://counter.theconversation.com/content/41877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vanessa K Dalton is a paid expert witness for Bayer. She is also a contributing editor for the Medical Letter. She has also previously served on an expert panel for Johnson and Johnson.</span></em></p><p class="fine-print"><em><span>Lauren MacAfee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In May, the White House clarified the guidelines for contraceptive coverage, ending cost containment practices that made it hard for some women to access the method of their choice.Vanessa K Dalton, Associate Professor, University of MichiganLauren MacAfee, Fellow, Family Planning, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/423252015-05-27T04:38:03Z2015-05-27T04:38:03ZDon’t panic about the pill – it’s safer than driving to work<figure><img src="https://images.theconversation.com/files/83048/original/image-20150527-25055-pf2yqu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The risk of a woman dying from a road accident is approximately 25 times that of death from a pill-related clot.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/epsos/5591761716/">epSos .de/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="http://www.bmj.com/content/350/bmj.h2135">A study published in The BMJ today</a> suggests a link between newer contraceptive pills and higher risk of serious blood clots. The finding is not new, but it may be cause for a different kind of concern.</p>
<p>During their fertile years, between three and five women of every 10,000 who are not pregnant and not taking the pill are likely to develop blood clots every year. The research published today found older contraceptive pills double this “background” risk of blood clots, and the newer pills have roughly doubled the risk again. </p>
<p>Several studies published over the past 20 years show very similar findings. What this research brings to the table are larger numbers of women and more careful attention to factors in their medical history that could potentially skew the results. </p>
<p>It’s likely the media will pounce on this story; there will be testimonies from women who have experienced blood clots while taking the pill and a plethora of personal injury lawyers spruiking their business. Women across the world will be scared into stopping their contraception until it all blows over. I know this because I’ve seen it before, and I think that’s what we should be concerned about. </p>
<h2>Back and forth</h2>
<p>We’ve known the pill increases a woman’s risk of blood clots and stroke since it was first marketed. By the 1990s, concern had been tempered by the fact that this risk was greatly reduced by pills containing only a quarter of the oestrogen compared to the 1960s. The development of several newer progestogens in the 1980s had also increased the range of pills available, making it more likely that most women could find a combination that suited them. </p>
<p>But then, in 1995, <a href="http://www.ncbi.nlm.nih.gov/pubmed/7500751">three studies published in The Lancet</a> suggested <a href="http://www.ncbi.nlm.nih.gov/pubmed/7500750">pills containing these newer progestogens</a> posed twice the <a href="http://www.ncbi.nlm.nih.gov/pubmed/7500749">risk of blood clots as the older ones</a>, just as the study published today does. Frenzied media coverage of the finding led many women to simply discontinue their contraception. </p>
<p>As a result, 1995-96 saw a <a href="http://www.ncbi.nlm.nih.gov/pubmed/9455819">9% increase in abortion rates in Britain as well as a 25% increase in births</a>. And both pregnancy and birth hold significantly higher risks of blood clots than any contraceptive pill, with <a href="http://jfprhc.bmj.com/content/36/3/117.full.pdf+html?ijkey=4578acef138546c86e5531d71ef213bd19f64beb&keytype2=tf_ipsecsha">rates at least ten times higher</a>. </p>
<p>Within a few years, the controversy settled down somewhat when a number of epidemiologists pointed out that doubling an extremely small risk has no significant public health impact. But then, between 2007 and 2014, it all started again when a number of studies reached conflicting conclusions about whether there were any real differences in clotting rates between various pills. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83037/original/image-20150527-25055-15k024j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Every woman considering using the contraceptive pill should discuss the risks it poses to her health as well as available alternatives with her prescribing doctor.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/shimrit/426973819/">Annabelle Shemer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p><a href="https://www.deepdyve.com/lp/elsevier/the-safety-of-a-drospirenone-containing-oral-contraceptive-final-5pSl7I864J">Two very large studies</a> that kept track of women from the time they started various pills showed <a href="http://www.ncbi.nlm.nih.gov/pubmed/24576793">no difference in blood-clotting risk</a> between any of the pills the women were taking. But research like this is extremely expensive and only within the funding reach of either governments or pharmaceutical companies. In this case, it was the latter. Despite the fact that both studies were independently monitored, they were attacked as having commercial bias. </p>
<p><a href="http://www.bmj.com/content/339/bmj.b2921">Four out of six</a> of the <a href="http://www.bmj.com/content/339/bmj.b2890">remaining studies</a>, which used various <a href="http://www.ncbi.nlm.nih.gov/pubmed/21511805">databases to look back from a blood clot diagnosis</a> and capture the kind of pill the woman was taking, <a href="http://www.bmj.com/content/342/bmj.d2139">suggested the newer pills doubled risk</a>. But the inevitable lack of “real-time” information in this kind of research also leaves it open to many potential biases. </p>
<p>The <a href="http://www.bmj.com/content/350/bmj.h2135">just-published BMJ study</a> provides further evidence for research showing increased risk, and its publication will no doubt re-ignite the debate about the safety of newer contraceptive pills. It’s clearly time for an appraisal of the actual risks involved. </p>
<h2>Being cautious</h2>
<p>Even if we were to adopt the worst-case scenario from all the studies published to date, being on one of the older versions of the contraceptive pill increases the risk of blood clot from three and five per 10,000 women each year to somewhere between five and eight. Taking one of the newer ones raises it to between nine and 14. </p>
<p>So although a doubling of clotting risk sounds alarming, it <a href="http://www.ncbi.nlm.nih.gov/pubmed/23578274">actually translates to an additional four to six cases per 10,000 users</a> of the newer pills a year.</p>
<p>It’s also important to recognise that only one in 100 women who have a blood clot will die from it. That risk of death could be cancelled out statistically <a href="http://www.elsevierhealth.com.au/your-questions-answered/contraception-your-questions-answered-paperback/9780702046193/">by driving for two fewer hours each year</a>. Put another way, the risk of a woman dying from a road accident is <a href="http://humrep.oxfordjournals.org/content/12/12/2595.full.pdf">approximately 25 times that of death from a pill-related clot</a>. </p>
<p>This is not to say we should be blasé about the risks posed by the contraceptive pill. It is above all a medication, which means some of its benefits may be compromised by – potentially serious – side effects. Every woman considering using the contraceptive pill should discuss the risks it poses to her health as well as available alternatives with her prescribing doctor.</p>
<p>This study adds to what is known about blood clot risk on various oral contraceptive pills, but it doesn’t claim to provide the definitive answer. I hope that, as we again debate the risks posed by the pill, we don’t lose sight of the fact that, for most women, the benefits of combined contraceptives far outweigh risks.</p><img src="https://counter.theconversation.com/content/42325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terri Foran has been a member of a number of Advisory Committees for Merck Sharp and Dohme and Bayer – both of which market COCPs in Australia. She has developed educational material for sessions sponsored by Merck Sharp and Dohme and Bayer, and accepted an honorarium on these occasions as well as accepting sponsorship from a number of pharmaceutical companies to enable her to attend, and to present at, conferences relevant to her area of expertise.
She is a sub-investigator at the Women’s Health Research Institute of Australia (attached to the Royal Hospital for Women in Sydney) which conducts pharma-sponsored clinical trials.</span></em></p>Newer contraceptive pills pose a higher risk of serious blood clots, says a study published in the BMJ today. The finding isn’t new, but it may be cause for a different kind of concern.Terri Foran, Lecturer in the School of Women's and Children's Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/335072014-11-19T09:22:13Z2014-11-19T09:22:13ZHow to bring the teen pregnancy rate down<figure><img src="https://images.theconversation.com/files/64866/original/d8y3mz2j-1416323640.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Curbing teen pregnancy rates will take more than just access to contraception. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-150533705/stock-photo-pregnant-woman-sitting-on-a-bench-on-background-the-children-play-warm-weather.html?src=sYoTD53peXkCItIs091LlA-1-0">Image of pregnant women via Coffeemill/www.shutterstock.com</a></span></figcaption></figure><p>Teen pregnancy is a public health problem in the United States. According to 2010 estimates, girls aged 15-19 years accounted for 614,000 pregnancies in the US. An additional 11,000 pregnancies were recorded in girls younger than 14. This translates to a rate of <a href="http://www.guttmacher.org/pubs/USTPtrends10.pdf">126.6 pregnancies</a> per 1,000 sexually active teens. </p>
<p>As high as these numbers seem, they actually show a reduction in the teen pregnancy rate from previous years. But they also show that we still have substantial work to do to bring down the teen pregnancy rate in the US.</p>
<h2>The CHOICE project</h2>
<p>The Contraceptive CHOICE project at Washington University in St Louis, Missouri provided about 10,000 sexually active women aged 14-45 with reversible contraception – in other words everything but sterilization – at no cost for <a href="http://www.sciencedirect.com/science/article/pii/S0002937810004308">two to three years</a>. About 1,400 teenagers participated in the study. </p>
<p>Over the course of the project, we evaluated the impact of reducing barriers to long-acting reversible contraception (LARC) on pregnancy and abortion rates in St Louis. We set out to eliminate the most common barriers when it comes to LARC: education, access and cost. </p>
<p>Women were educated about all methods of reversible contraception, with LARC methods emphasized. LARC include IUDs and implants, like Implanon or Nexplanon. They are more effective than other popular forms of reversible contraception, like the birth control pill, because they do not rely on patients remembering to use them correctly. </p>
<p>The failure rate of IUDs and implants is less than 1%, compared with the pill, patch or vaginal ring, which range from <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1400506">4-9%</a>. Despite this, in the US they are not as widely used as other forms of reversible contraception.</p>
<h2>More LARC, fewer pregnancies</h2>
<p>The project’s findings were astonishing. About 72% of the 1,400 teens in the study chose a LARC method. This is especially significant as only 4.5% of the general teen population <a href="http://www.ncbi.nlm.nih.gov/pubmed/22795639">reports</a> using a LARC method. In fact, the teens in the study chose LARC methods at nearly the same rate as older women.</p>
<p>Among the teens in our study using a LARC method the annual pregnancy rate was 34.0 per 1000 and the birth rate was 19.4 per 1000, <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1400506">a dramatic reduction</a> compared to the national average of 126.6 pregnancies per 1000 sexually active teens. </p>
<p>This change can be attributed in large part to the high up take of LARC methods. How did the CHOICE project get so many teens to use LARC?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/64868/original/mm8rk3m5-1416323885.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s more to contraception than the pill.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-181677890/stock-photo-gynecology-consultation.html">Image of contraceptives via Image Point Fr/www.shutterstuck.com</a></span>
</figcaption>
</figure>
<h2>Education</h2>
<p>Comprehensive counseling about contraception takes time. We found that most women had <a href="http://www.sciencedirect.com/science/article/pii/S0002937812003900">never heard of</a> intrauterine devices or implants. And for those that had, the level of misinformation was enormous. Most women over-estimated the effectiveness of the pill, patch and ring, while under-estimating the effectiveness of LARC methods. </p>
<p>This misinformation can come from family and friends, but it can also come from clinicians. Some teens said they had been told by a clinician in the past that they could not have a LARC method. And some clinicians are biased towards other forms of contraception, like the birth control pill. There is a perception that teens are not good candidates for LARC despite the recommendations of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/10545568">American Academy of Pediatrics</a>, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/22996129">American College of Obstetricians and Gynecologist</a>, and the Centers for Disease Control (CDC) <a href="http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf">Medical Eligibility Criteria</a> for contraceptive methods. </p>
<p>This often stems from memories of the Dalkon Shield, a poorly designed IUD introduced in the 1970s that was associated with infection and infertility. Today’s IUDs have been in use for more than 20 years and studies have demonstrated a record of safety. </p>
<h2>Access</h2>
<p>There is also a perception that teens will not want these methods, or won’t be satisfied with them and ask to have them removed not long after they are inserted. These devices are an expensive upfront cost for clinics. And some clinicians have expressed concerns about “wasted resources” in a population that may ask have to their LARC removed after experiencing side-effects, like irregular bleeding. </p>
<p>But in our study, we found that continuation and satisfaction rates among the teen users were high: <a href="http://www.ncbi.nlm.nih.gov/pubmed/23168753">82% and 75% at 12 months</a>. This is similar to rates in older women using the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21508749">same methods</a>.</p>
<p>Additionally many clinicians express concerns with placing LARC on the same day it is requested. This fear is often rooted in the clinician’s comfort in reliably ruling out pregnancy on that day. </p>
<p>The CDC has guidelines to help clinicians <a href="http://www.cdc.gov/mmwr/pdf/rr/rr6205.pdf">rule out pregnancy</a> before placing a LARC. Same day insertion of LARC, just like prescribing quick start short-acting contraceptive practices, has been shown to increase the number of women who actually get the birth control option <a href="http://www.sciencedirect.com/science/article/pii/S0010782414000511">they want</a>. Requiring multiple visits poses a barrier for teens who are often reliant on others for transportation.</p>
<h2>Cost</h2>
<p>Despite the contraceptive mandate in the Affordable Care Act, women and teens in the United States still face <a href="http://www.sciencedirect.com/science/article/pii/S1054139X13000542">cost barriers</a> to accessing contraceptive services. Large numbers of women and teens remain uninsured, and provisions of the law mean that some women have to pay for some portion of their method <a href="http://plannedparenthood.tumblr.com/post/68942144701/why-isnt-my-birth-control-covered-for-free-under">out-of-pocket</a> or have no coverage for <a href="http://hsrc.himmelfarb.gwu.edu/sphhs_policy_facpubs/616/">certain methods</a>. </p>
<p>Privacy is another concern. For insured teens who can access contraceptive and family planning services without parental consent, as is true in about half the states, the potential for unintentional disclosure through an “explanation of benefits” remains a <a href="http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf">major concern and barrier</a>.</p>
<p>If clinicians don’t talk to teens about these contraceptives, this can severely limit access to what appears to be the best strategy thus far to prevent and reduce unintended pregnancies. Clinicians must address their own biases about teens and contraception.</p><img src="https://counter.theconversation.com/content/33507/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colleen McNicholas is a co-investigator for the Contracpetive CHOICE Project
She receives funding from an Anonymous donor, The William and Flora Hewlett Foundation, The American Cancer Society Institutional Research Grant, The Society of Family Planning, The Washington University Institute of Clinical and Translational Sciences, The National Institutes of Health- Loan Repayment Program</span></em></p>Teen pregnancy is a public health problem in the United States. According to 2010 estimates, girls aged 15-19 years accounted for 614,000 pregnancies in the US. An additional 11,000 pregnancies were recorded…Colleen McNicholas, Assistant Professor, Obstetrics and Gynecology, Washington University in St. LouisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/208232013-12-01T19:30:20Z2013-12-01T19:30:20ZDo we really need prescriptions for the contraceptive pill?<figure><img src="https://images.theconversation.com/files/36507/original/h2tmdbn9-1385699872.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Why should women not be in charge of their own contraception if it's safe for them to do so?</span> <span class="attribution"><span class="source">anoldent/Flickr</span></span></figcaption></figure><p>Women using <a href="http://www.fpnsw.org.au/713867_8.html">the contraceptive pill</a> currently require a prescription from a doctor and to return once a year to renew it. But recent research suggests the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837145/">relative safety</a> of this oral contraceptive means we should consider making it more freely available.</p>
<p>For <a href="http://www.biomedcentral.com/content/pdf/1478-4491-10-1.pdf">many women</a> the current model can involve a fair bit of effort – significant forward planning to get an appointment before the prescription runs out, an often lengthy wait to see the doctor and a hefty consultation fee – for a few minutes in the doctor’s surgery to have a prescription renewed.</p>
<p>A <a href="http://www.sciencedirect.com/science/article/pii/S0002937813020358">recent research article</a> has stimulated debate about the value of providing women with oral contraceptives, without having to go through all this.</p>
<p>While the position is <a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives">supported</a> by the American College of Obstetricians and Gynecologists, the Australian Medical Association <a href="http://www.medicalobserver.com.au/news/experts-back-ocp-on-prescription">has spoken out</a> against the suggestion, even for experienced pill users.</p>
<p>But why shouldn’t women be in charge of their own contraception if it’s safe for them to do so? Let’s consider some of the arguments for and against providing oral contraceptive pills over the counter.</p>
<h2>Why it’s a good idea – access</h2>
<p>The requirement to keep returning to the doctor for repeat prescriptions can be expensive, and time consuming. </p>
<p>For young women, those who are socioeconomically disadvantaged, and others who find it difficult to access the health system, these barriers can be considerable. Both <a href="http://fampra.oxfordjournals.org/content/20/1/11.short">doctors</a> and <a href="http://jfprhc.bmj.com/content/34/4/213.short">patients</a> can be embarrassed about discussing sexual matters.</p>
<p>Without easy access to effective hormonal contraception women may not use any birth control at all, or they may rely on less effective methods (such as condoms or the withdrawal method). </p>
<p>And anyway, the emergency contraceptive pill is already <a href="http://www.fpnsw.org.au/422437_8.html">available over the counter</a> at pharmacies in Australia, so why not include other oral contraceptives as well?</p>
<p>In the United States, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23664627">up to 30% of women</a> who don’t currently use contraception, or use a less effective method say they would probably start taking the pill if they could get it without a prescription. </p>
<p>For some women, the doctor’s visit is a significant barrier to using hormonal contraception, so making it available in pharmacies will lead to more, and more effective, contraceptive use, and fewer unintended pregnancies.</p>
<h2>Why it’s a bad idea – health risks</h2>
<p>Taking combined oral contraceptive pills has potentially serious health <a href="http://www.fpnsw.org.au/713867_8.html">consequences</a>. </p>
<p>The most dangerous of these is blood clots. Although rare, the sudden death of a healthy young woman because of a blood clot is <a href="http://www.cbc.ca/news/canada/british-columbia/yaz-yasmin-birth-control-pills-suspected-in-23-deaths-1.1302473">shocking</a>. Sadly this can happen even with the current requirement for a doctor’s prescription. </p>
<p>Although many doctors thoroughly screen women and inform them about oral contraceptive use, the quality of consultations is <a href="http://www.sciencedirect.com/science/article/pii/S0010782404002690">variable</a>. Reasons why a woman shouldn’t take the pill can be missed, or simply be unknown, particularly for young women.</p>
<p>Thorough <a href="http://www.racgp.org.au/afp/2012/october/contraception/">Medical Eligibility Criteria</a> have been developed to minimise the risk of serious adverse events from using oral contraceptives. Women with hypertension, migraines with aura, a history of venous thromboembolism, or smokers at age 35 years or older, for instance, are at higher risk of adverse events and should not take the combined oral contraceptive pill. </p>
<p>Without proper screening by a doctor, there’s a risk that factors that should stop women from taking the pill will be missed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Gnarls Monkey/Flickr</span></span>
</figcaption>
</figure>
<h2>Why it’s good – availability</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23664627">Many women wish</a> they could purchase their contraceptive pills over the counter. </p>
<p>In the United Kingdom, <a href="http://ocsotc.org/wp-content/uploads/2012/04/NHS-2012_Evaluation-of-pharmacy-provision-of-OCs-in-London-1-2012.pdf">a pilot program</a> evaluated the feasibility of community pharmacy providing combined oral contraceptives, <a href="http://www.fpnsw.org.au/936515_8.html">progesterone-only (“mini”) pills</a> as well as information on and referral to long-acting reversible contraception. </p>
<p>Women participating in the study said they valued the convenience, anonymity, drop-in system, long opening hours and lack of waiting time. </p>
<p>Appropriately trained health-care professionals, including <a href="http://rcnpublishing.com/doi/abs/10.7748/phc2013.07.23.6.16.e713">nurses</a> and <a href="http://ocsotc.org/wp-content/uploads/2012/04/NHS-2012_Evaluation-of-pharmacy-provision-of-OCs-in-London-1-2012.pdf">pharmacists</a>, could effectively assist women with contraception. And they could do this using current eligibility criteria, just as doctors do.</p>
<p>Could concern about maintaining professional territories be denying women better access to contraception?</p>
<p>There’s no reason why women couldn’t get advice about their contraceptive options from pharmacies or other community settings. This advice could include referral to see a doctor or specialist as required</p>
<h2>Why it’s bad - sexual health screening</h2>
<p>Doctors argue that having women visit them for a new pill prescription ensures they have a regular Pap test, breast examination and sexual health check. </p>
<p>While all these checks are undoubtedly important, there are many women who don’t take the oral contraceptive pill, so the logic of this argument is not entirely satisfying. It’s akin to the suggestion that condoms or aspirin should be provided by prescription so men visit a doctor for prostate examinations!</p>
<p>What’s more, in Australia, women are advised to have a Pap test every two years and those guidelines are currently under <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/ncsp-renewal">review</a> in light of the <a href="http://www.biomedcentral.com/1741-7015/11/227">effectiveness</a> of the HPV vaccination program on cervical abnormalities. And we have <a href="http://www.ncbi.nlm.nih.gov/pubmed/22520645">evidence</a> that rates of sexual health screening remain high among women who get oral contraceptive pills over the counter. </p>
<p>It’s also worth noting that the <a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives">American College of Obstetricians and Gynecologists</a> states screening for cervical cancer or sexually-transmitted infections is not medically required to provide hormonal contraception.</p>
<h2>There’s more</h2>
<p>The uptake of the very effective long-acting reversible contraceptives (such as IUDs and implants) is <a href="https://www.mja.com.au/journal/2011/194/6/intrauterine-contraception-why-are-so-few-australian-women-using-effective-method">low in Australia</a>. Evidence from the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21508749">CHOICE project</a> indicates women choose long-acting methods when offered good information and cost-effective access. </p>
<p>The low uptake in Australia may be an indicator that doctors are not able to spend time with women discussing all the contraceptive options available. </p>
<p>We need to provide easy access to contraception and contraceptive information, while balancing the potential risk for side effects and adverse events.</p>
<p>Perhaps the way forward is to trial providing the <a href="http://www.fpnsw.org.au/936515_8.html">progesterone only pill</a> over the counter for a start because most women can take it with <a href="http://www.ncbi.nlm.nih.gov/pubmed/22364816">little risk</a>.</p>
<p>What do you think?</p><img src="https://counter.theconversation.com/content/20823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayne Lucke receives funding from the Australian Research Council. She is Chief Investigator on an ARC Linkage Grant that involves cash and in-kind support from Family Planning New South Wales and Bayer Australia</span></em></p>Women using the contraceptive pill currently require a prescription from a doctor and to return once a year to renew it. But recent research suggests the relative safety of this oral contraceptive means…Jayne Lucke, Principal Research Fellow in Health Ethics and Policy, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/93312012-09-07T01:02:30Z2012-09-07T01:02:30ZPreventing pregnancy and STIs: the quest for the ultra contraceptive<figure><img src="https://images.theconversation.com/files/15146/original/dqpcjrzg-1346975029.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A vaginal ring could one day prevent pregnancy and STIs… but it's still a long way off.</span> <span class="attribution"><span class="source">Flickr/dhammza</span></span></figcaption></figure><p>By 2020, 1.2 billion people or 16% of the world’s population will be entering their childbearing years, with 90% of these in the developing world. Along with education, the availability of effective contraception is a <a href="https://theconversation.com/contraception-best-for-women-babies-and-the-planet-8283">major key</a> to overcoming the poverty trap.</p>
<p>Meanwhile, the rate of new HIV infections in women and girls is <a href="http://www.unfpa.org/hiv/women/report/chapter1.html">rapidly increasing</a> to match rates seen in men, making them the missing link in the success of many HIV/AIDS prevention programs. </p>
<p>A paper <a href="http://stm.sciencemag.org/content/4/150/150ra123">published this week in Science Translational Medicine</a> offers new hope. It outlines an early but significant step forward in the development of a dual contraceptive method offering protection from the transmission of HIV and other sexually transmitted infections (STIs) in conjunction with contraceptive action. More on that in a moment.</p>
<h2>Recent advances in female contraceptives</h2>
<p>Since the introduction of the pill in the 1960s, most new approaches to reversible contraception for women have focused on manipulation of the female hormones, estrogen and progesterone. These include <a href="http://www.fpq.com.au/publications/fsBrochures/Fs_Implanon.php">rods that are implanted below the skin</a> (Implanon®) and the <a href="http://www.patient.co.uk/health/Intrauterine-System.htm">intrauterine system</a> or IUS (Mirena), which slowly release progestins.</p>
<p>These progestin-only contraceptives have high efficacy, are fully reversible and provide protection against pregnancy for up to five years. But discontinuation rates are as high as 30%, mainly due to irregular bleeding patterns, which most women deem unacceptable. New forms of IUS that are easier to insert are under development. </p>
<p>Another popular device is the <a href="http://www.fpnsw.org.au/245483_8.html">vaginal ring</a> (NuvaRing), a bendable plastic ring which is inserted into the vagina. It offers monthly combined hormonal contraception, with three weeks of ring use and one ring-free week each month. The vaginal ring acts like the contraceptive pill but does not require daily action, thus facilitating compliance.</p>
<h2>So why do we need new contraceptives?</h2>
<p>The currently available contraceptives come with some major shortfalls. </p>
<p>Firstly, the use of many contraceptives including the oral contraceptive pill is associated with relatively high user-failure rates. Nearly <a href="http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf">40% of the 85 million unintended pregnancies</a> each year world-wide are due to failure of contraception.</p>
<p>Secondly, many couples discontinue using their chosen contraception after initiation because of method-related reasons, such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Contraception_choices_explained">side effects</a>, health concerns or inconvenience. </p>
<p>Finally, contraceptive use varies throughout the world. Usage continues to be very low in places such as Africa, due to limited access to services, logistic failures resulting in unavailability of products, and cultural, religious or personal reasons.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/15151/original/trr7jchb-1346975585.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The availability of effective contraception is a major key to overcoming the poverty trap.</span>
<span class="attribution"><span class="source">Gates Foundation</span></span>
</figcaption>
</figure>
<h2>Current research and development</h2>
<p>As progesterone is essential for establishment and maintenance of pregnancy, most current research and development is based on compounds known as anti-progestins. These work by inhibiting the synthesis or action of this vital hormone. </p>
<p>Administering these compounds through different means <a href="http://humupd.oxfordjournals.org/content/early/2012/06/13/humupd.dms021.abstract">may help improve</a> uptake and continuation of use. But many women don’t easily tolerate the manipulation of their hormones, or do not wish to use such contraceptives.</p>
<p>New contraceptive methods for women could include non-hormonal methods that will provide short-term protection when required and dual-acting methods that protect against both sexually-transmitted diseases and pregnancy. </p>
<p>Research is continuing world-wide to identify target molecules for the reproductive processes leading to pregnancy: egg production, fertilisation and implantation into the womb. A number of these have already been identified. But challenges remain, particularly around the development of small molecule inhibitors to block these targets at their sites of action: the ovary, the fallopian tubes and the uterine cavity. </p>
<p>A team of colleagues at Prince Henry’s Institute, headed by Associate Professor Guiying Nie, have identified one such molecule that may provide both contraceptive action – by blocking implantation – and protection against HIV infection. But while they now have an inhibitor of this molecule, they haven’t found the right vaginal delivery mechanism. </p>
<p>This is where the study in <a href="http://stm.sciencemag.org/content/4/150/150ra123">this week’s Science Translational Medicine</a> offers a new opportunity. Rachel Singer and her colleagues at the Population Council in New York have shown that new vaginal rings impregnated with an inhibitor of HIV transmission protected macaques from infection. In other words, the ring successfully delivered the inhibitor to the monkeys’ vaginal fluids and tissues. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/15134/original/3497bnqd-1346912562.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaginal ring.</span>
<span class="attribution"><span class="source">Journal of Translational Medicine</span></span>
</figcaption>
</figure>
<p>This is a significant finding because previous efforts to deliver HIV-preventing <a href="http://www.who.int/hiv/topics/microbicides/microbicides/en/">microbicides</a> in vaginal gels have proven ineffectual. </p>
<p>While the new study with vaginal rings has limitations, largely due to the high cost of studying macaques (one of few appropriate animal models for human contraception), it does provide important proof of concept.</p>
<p>So, how would it work?</p>
<p>A vaginal ring would be inserted monthly (as for NuvaRing), prior to or immediately following intercourse. The compound released would act within the vagina to prevent HIV. It would also reach the woman’s uterine cavity and give the womb a non-receptive surface, preventing embryo implantation. </p>
<p>Additional inhibitors could also be included to protect against sexually transmitted diseases.</p>
<p>It’s important to note that the research is still in its early stages – and timeline to get any new drug to market is long, due to the rigorous testing required to meet regulatory requirements. So it could be ten years or more before a duel contraceptive becomes available.</p>
<h2>Renewed hope for better contraception</h2>
<p>Pharmaceutical companies have traditionally been unwilling to support contraceptive development, preferring to focus on commercially successful drugs such as those for cancer or heart disease. Indeed, the need to provide contraceptives at very low cost to developing countries is a severe limitation for companies. </p>
<p>The advances in contraceptive research and development, along with the <a href="https://theconversation.com/contraception-best-for-women-babies-and-the-planet-8283">renewed international focus</a> to help women in the developing world access effective contraception, provide some hope for a future where women around the world have control of thier family planning and sexual health.</p><img src="https://counter.theconversation.com/content/9331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lois Salamonsen receives funding from NHMRC, and has previously received funding from CONRAD/CICCR, a US not-for-profit contraceptive agency, and from Bayer Schering AG. </span></em></p>By 2020, 1.2 billion people or 16% of the world’s population will be entering their childbearing years, with 90% of these in the developing world. Along with education, the availability of effective contraception…Lois Salamonsen, Professor at Prince Henry's Institute , Hudson InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/81502012-07-30T04:22:09Z2012-07-30T04:22:09ZMonday’s medical myth: the pill affects long-term fertility<figure><img src="https://images.theconversation.com/files/13164/original/ctqk3pvg-1342675610.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women question the long-term impact of the contraceptive pill on their fertility.</span> <span class="attribution"><span class="source">J. Stephen Conn</span></span></figcaption></figure><p>The combined oral contraceptive pill is the <a href="http://www.ncbi.nlm.nih.gov/pubmed/14696713?dopt=Abstract">most popular</a> form of contraception in Australia and is taken by an estimated 100 million women worldwide. </p>
<p>The pill’s most obvious use is to prevent pregnancy. But it’s also prescribed to treat acne, regulate periods, alleviate menstrual pain and reduce the symptoms of conditions such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Endometriosis">endometriosis</a> and <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Polycystic_ovarian_syndrome">polycystic ovarian syndrome</a>.</p>
<p>The average duration of pill use is estimated to be about <a href="http://www.ncbi.nlm.nih.gov/pubmed/21915124">three to five years</a>, but varies widely by country. </p>
<p>Research suggests that most women want to promptly return to their <a href="http://www.ncbi.nlm.nih.gov/pubmed/20818837">pre-pill fertility levels</a> when they stop taking the contraceptive. But some women have difficulty falling pregnant after ceasing the pill, leading them to question whether the contraception affected their long-term fertility. </p>
<p>This myth is so pervasive that researchers have identified fear of infertility as a key reason for <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016605/">women avoiding</a> this effective form of contraception.</p>
<h2>How does the pill work?</h2>
<p>The pill works by effectively switching off a woman’s natural production of ovarian oestrogen and progesterone and replacing this with a <a href="http://www.ncbi.nlm.nih.gov/pubmed/10561657">synthetic version</a> of both hormones. This sets off a number of mechanisms: inhibiting egg release (ovulation), changing the consistency or thickness of cervical mucus and altering the lining of the womb so that implantation of a fertilised egg is less likely.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/13163/original/n5z34znm-1342675276.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Variables in different pill formulations make it difficult to determine general effects of “the pill”.</span>
<span class="attribution"><span class="source">Alicakes</span></span>
</figcaption>
</figure>
<p>The early contraceptive pill used much higher doses of hormones than currently available pills, which also vary in their dose of hormones. Most pills contain the oestrogen ethinyl oestradiol and there are a number of different synthetic progesterone-like compounds in different pill formulations. </p>
<p>Women often try a number of pills throughout their reproductive lifetime and, unsurprisingly, find it difficult to recall the exact duration they’ve taken a particular pill. All these variables mean it’s difficult for researchers to make general conclusions about the effects of “the pill”: it’s not just one particular hormonal agent taken for a defined time in one particular group of women.</p>
<h2>Fertility</h2>
<p>A woman’s fertility declines with age, particularly <a href="http://journals.lww.com/clinicalobgyn/Abstract/2011/12000/Diminished_Ovarian_Reserve_and_Infertility.17.aspx">from 36 or 37 years</a> and this is, in part, genetically determined. </p>
<p>Fertility is also affected by general and gynaecological health, concurrent illness, weight, exercise levels, cigarette smoking and stress. Weight above and below the recommended range for height can have an <a href="http://www.ncbi.nlm.nih.gov/pubmed/17868286">impact on fertility</a>.</p>
<p>Health-based fertility problems are often signalled by irregular or absent menstrual cycles. This is one of the body’s natural “safety valves” to protect against pregnancy when the health of the foetus or mother may be at risk. </p>
<h2>Long-term effects of the pill</h2>
<p>It’s difficult to assess the effects of the pill on a woman’s fertility when so many other factors may be contributing. Some women will return to their normal levels of hormone secretion within a couple of days of ceasing the pill. Others may take up to six or 12 months. But the majority of women will return to normal within the first few months.</p>
<p>The very limited evidence we have suggests the pill has <a href="http://www.ncbi.nlm.nih.gov/pubmed/7766340">no overall effect</a> on long-term fertility. A review of studies comparing reversible forms of contraception found <a href="http://www.ncbi.nlm.nih.gov/pubmed/22018120">between 79% and 96% of women</a> were able to get pregnant in the 12 months after they stopped taking the pill. </p>
<p>Another study reported that pill users who ceased the pill in order to become pregnant had some <a href="http://www.ncbi.nlm.nih.gov/pubmed/19268187">delay in conceiving</a>. But this impairment of fertility was temporary and limited to the first few months after coming off the pill.</p>
<p>Overall, the pill - when taken as directed - is extremely effective at inhibiting fertility in the short term. With the evidence showing no long-term impact on fertility, this myth is no reason to avoid the pill. </p><img src="https://counter.theconversation.com/content/8150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonia Davison previously received NHMRC fellowship funding. Her current research funding is solely from Monash University. She has previously received pharmaceutical company funding to conduct clinical trials in women's health but this company is not involved in oral contraceptive pill manufacture or sale.</span></em></p>The combined oral contraceptive pill is the most popular form of contraception in Australia and is taken by an estimated 100 million women worldwide. The pill’s most obvious use is to prevent pregnancy…Sonia Davison, Endocrinologist, Jean Hailes & Senior Postdoctoral Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/46362011-12-08T03:32:40Z2011-12-08T03:32:40ZCatholic church urged to give nuns the pill to protect against cancer<figure><img src="https://images.theconversation.com/files/6288/original/yh5zv5bh-1323402489.jpg?ixlib=rb-1.1.0&rect=31%2C27%2C929%2C629&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A controversial article in Lancet suggests nuns should be prescribed the contraceptive pill to help reduce their high rates of cancer.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>The Catholic church should freely distribute the contraceptive pill to its almost 95,000 nuns in order to reduce their “greatly increased risk” of developing female-specific cancers, <a>a paper published today</a> in the Lancet says.</p>
<p>A comment-piece, “The Plight of nuns: hazards of nulliparity,” cites research directly linking the number of menstrual cycles a woman goes through to her risk of cancer, with younger arrival of periods or late onset of menopause being associated with higher cancer risk. Nuns, being childless, generally have no break from periods through their lives. The paper cites a study of US nuns showing that they suffer almost triple the rate of deaths from breast and uterine cancer as other women, and more than double the rate from uterine cancer.</p>
<p>Contraceptive pills have been shown to significantly reduce the incidence of ovarian and uterine cancer rates, the authors state, while forms of the pill are now available that suppress menstruation for months at a time or even altogether.</p>
<p>Professor John Hopper, a NHMRC Australia Fellow at the University of Melbourne, said that, if the paper’s recommendations were followed, it could put the church in an awkward position. “It’d be wonderfully ironic for the Catholics to say it’s OK to use the pill if you’re a nun, but not if you’re not.”</p>
<p>The paper quotes Italian <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446786/">Bernadino Ramazzini</a> physician noting in 1713 that nuns suffered from extremely high rates of breast cancer.</p>
<p>A nun from the Sisters of Mercy said that it was known amongst nuns that if cancer were to strike them, it was likely to be breast cancer. The sister, who wished to remain anonymous, also said that the church did not bar nuns from taking the pill or other appropriate medicines if they were required for health. </p>
<p>Professor Hopper said that while the early formulations of the pill were dangerous for women, the new lower dose versions had been finessed until they now appeared to be beneficial. “We’ll need to look at it over 20 years to be sure, but it certainly looks like it lowers the absolute risk of some cancers,” he said. Professor Hopper said advocating the pill might easier said than done for nuns in poor countries where money was extremely tight. </p>
<p>The decision was complex even in developed countries whether or not a woman is a nun, said Dr Louise Keogh, a Health Sociologist & Senior Lecturer, at Melbourne University’s Centre for Women’s Health, Gender and Society. “The decision to take the pill as a means of contraception is not a straight forward one for women in Australia. Women weigh up a range of risks and considerations – how their body feels when they take the pill, what it indicates about their relationship, and whether it is what their friends are doing. In addition, a significant group of women (16%) can’t take the pill for medical reasons,” Dr Keogh said.</p>
<p>“This decision would be even more complicated for nuns, who will not benefit from the contraceptive effect of the pill, and for whom there will undoubtedly be social, cultural and emotional factors to be considered. Further research is required to explore these wider implications, form the point of view of nuns, before we can be confident of the overall benefit of this proposal,” Dr Keogh said.</p>
<p>“The plight of nuns: hazards of nulliparity” was co-written by Kara Britt, a Research Fellow at the works in Monash University’s Faculty of Medicine, Nursing and Health Sciences, and Professor Roger Short, the Wexler Professorial Fellow at the University of Melbourne’s Department of Obstetrics & Gynaecology.</p><img src="https://counter.theconversation.com/content/4636/count.gif" alt="The Conversation" width="1" height="1" />
The Catholic church should freely distribute the contraceptive pill to its almost 95,000 nuns in order to reduce their “greatly increased risk” of developing female-specific cancers, a paper published…Matthew Thompson, EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/38072011-10-21T03:14:03Z2011-10-21T03:14:03ZWhy the contraceptive pill won’t stop you sniffing out your soulmate<figure><img src="https://images.theconversation.com/files/4442/original/402680205_367492b0ac_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The question of sexual attraction is far too complex to be explained pheromones alone.</span> <span class="attribution"><span class="source">hawk684/Flickr</span></span></figcaption></figure><p>Any mother collecting sweaty T-shirts left in a pile in the corner of their teenage son’s bedroom can attest to how unpleasant this task is. What might surprise them is that the experience may not be nearly so unpleasant for another woman. </p>
<p>The abundant pheromones in male sweat provide a potent clue to the owner’s major histocompatibility genes. While these genes play an important role in immune surveillance they also send powerful signals to any potential female mate. </p>
<p><a href="http://www.thestranger.com/images/blogimages/2009/10/07/1254931423-tree_final_proofs.pdf">Studies suggest</a> that the more different a man’s histocompatibility genes are from her own, the more attractive a woman finds him – thus the reason for teenage son’s pong. </p>
<p>Interestingly, women also have a heightened sense of smell at mid-cycle when oestrogen and fertility levels are at their highest. </p>
<p>This is how evolution ensures that genetic diversity is maintained and offspring are likely to be healthier and have a more robust immune system. </p>
<h2>Enter the hormone-based contraceptive pill</h2>
<p>For at least the last five years, there’s been speculation that the alteration of hormones in women taking the contraceptive pill affects their ability to choose the most suitable long-term mate. </p>
<p>A number of scientific papers published in 2008 suggested women on the pill were not only less able to pick up gene similarity than their naturally cycling sisters, but were also less likely to show a preference for more “masculine” males. </p>
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<img alt="" src="https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=867&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=867&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=867&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1090&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1090&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4666/original/True_Life_Romance_3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1090&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Grand Comic Database</span></span>
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<p>The theory goes that, if the pill does in fact alter a woman’s perception of male attractiveness, it might not only skew her choice of partner but have a long-term impact on her reproductive success. </p>
<p>In the worst case scenario, a woman stopping the pill might one day look at her partner and suddenly ask herself, “What was I thinking?”</p>
<p>But it’s not all doom, gloom and relationship breakdown. </p>
<p>When not under the influence of spiking oestrogen levels, women seem to find the alpha-male stereotype far less attractive. </p>
<p>Instead, <a href="http://scienceblogs.com/primatediaries/2009/10/does_taking_birth_control_alte.php">they prefer the caring/sharing type</a>: the type of man who makes a better long-term partner and father. </p>
<h2>New research</h2>
<p>Dr Craig Roberts is a psychologist from the University of Sterling in the United Kingdom, who first <a href="http://rspb.royalsocietypublishing.org/content/275/1652/2715.abstract">co-authored a paper on this topic in 2008</a>. </p>
<p>He and other researchers have explored these issues further in <a href="http://rspb.royalsocietypublishing.org/content/early/2011/10/10/rspb.2011.1647">a paper published last week</a> by the British Royal Society.</p>
<p>Their ongoing research indicates that women who met their partner when they were on the pill report less sexual satisfaction over time but also appear to be more satisfied with other aspects of their relationship. </p>
<p>To quote Dr Roberts, “Overall, women who met their partner on the pill had longer relationships – by two years on average – and were less likely to separate. So there is both good news and bad news for women who meet while on the pill. One effect seems to compensate for the other.” </p>
<p>The suggestion is that cautious women may like to consider a few months off hormonal contraception to reduce the risk of “pill-goggles” before making a strong commitment!</p>
<h2>More than meets the nose</h2>
<p>Most of those working in sexual medicine would contend the question of sexual attraction between couples is far too complex to be explained pheromones alone – and, of course, Dr Robert’s research makes no reference at all to same-sex couples. </p>
<p>The reality is that both men and women mask their natural “perfume” with decidedly unnatural ones and by bathing regularly. All this makes it much harder for any potential partner to read the underlying hormonal signals. </p>
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<img alt="" src="https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4667/original/Strangers_on_a_Train_-_Romance.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Successful bonding is also driven by social considerations. For most couples in long-term relationships, the mad frisson of passion experienced in the first few months mellows into something more substantial over time: commitment, respect and, with any luck, love. </p>
<p>Sex can still be great in a long-term relationship but it’s probably true that most couples have to work a little harder at it over time. </p>
<p>The alternative is a series of short-term relationships, churned as soon as the adrenaline dissipates. </p>
<p>Dr Robert’s research provides a fascinating insight into the primitive drivers that subconsciously shape our lives and our choices. </p>
<p>But while histocompatibility genes may indeed provide the spark in a new relationship, keeping that fire blazing is ultimately up to the couple.</p><img src="https://counter.theconversation.com/content/3807/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terri Foran acts as a expert consultant for a number of pharmaceutical companies which manufacture contraceptive preparations including the oral contraceptive pill. She is also an investigator for the WHIRIA research unit at the Royal Hospital for Women which has conducted trials on contraceptives.</span></em></p>Any mother collecting sweaty T-shirts left in a pile in the corner of their teenage son’s bedroom can attest to how unpleasant this task is. What might surprise them is that the experience may not be nearly…Terri Foran, Lecturer in the School of Women's and Children's Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.