A Hard Pill To Swallow?

Photo by Reproductive Health Supplies Coalition

Ms P, a new thirty year old patient came into my office last week, interested in talking about contraception. In taking her reproductive history, I learned she had been on ‘the pill’ for the past nine years, and was having some issues with it. I asked, “Would you be interested in switching to a different pill? Or a different method of contraception?” She thought for a moment, and then said, “Aren’t all the pills about the same?”

BING!

It was as if an alarm went off in my head. I took her comment as an invitation to launch into my favorite ‘let’s talk about birth control pills’ discussion. The big benefit of owning my own private practice is that I get to decide how much time I spend with each patient; I am an educator at heart and feel uncomfortable if I cannot at least offer a bit of reproductive history and education to my patients. What might have been labelled in our Monday afternoon schedule as a ‘15- minute contraceptive consult’ was about to be so much more. She seemed interested. I got out my flip chart.

The first birth control clinic opened in the United States around 1915. This clinic would eventually become Planned Parenthood, and it took until the 1950’s to really start searching for the perfect oral contraceptive. The first birth control pills were created based on the hormone Progesterone, which they were extracting from yams. Most of the early clinical trials on the combined birth control pill (Estrogen and Progesterone) took place on the island of Puerto Rico, with participants who were in good health, under 40 years old, and who had already had children. (I of course have an issue with the whole lack of true informed consent that probably accompanied this, but I hope that these women did willingly choose to try the pill for these studies.)

In 1957, the FDA approved the use of the pill to regulate menstruation, and by 1959, a half million women were using it for this; the warning label on the bottle stated that “impaired fertility” would almost certainly be a side effect. I have a feeling that most women were okay with that. By 1967, 13 million women were using the pill and by 1984, up to 80 million. The oral contraceptive remains the most popular method of contraception today, for many reasons. Among them: