The combined contraceptive pill (the Pill) has attracted more than its share of adverse publicity since it was introduced in the early Sixties. But despite being linked over the years to conditions ranging from stroke to breast cancer, it remains the contraceptive of choice for millions of women in the UK.
So how much does the average Pill user really understand about the effects of the hormones she is taking? Here are ten questions that I am often asked.
How likely am I to get a blood clot?
The Pill contains two hormones — oestrogen and progestogen — as opposed to the mini-pill, which only contains progestogen. The latter doesn’t alter a woman’s risk of developing a blood clot (deep vein thrombosis or DVT), but women on the Pill are around five times more likely to get one. The absolute risk is small (less than 1 in 1,000), but as it is a potentially fatal condition, it’s important to report any pain or swelling of the calf (where most DVTs occur).
Recent research from the Netherlands and Denmark has suggested that some brands of Pill are much more likely to cause DVTs than others. Microgynon 30 (very widely used in the UK) was found to be one of the safest, while more modern brands such as Marvelon, Yasmin and Femodene were among the worst.
The Pill also increases the risk of heart attack and stroke — both unusual in women of childbearing age, but still a threat that has to be considered in those who are already at higher risk because they are overweight, smoke or have high cholesterol or blood pressure.
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What about breast cancer?
The link with breast cancer and cancer of the cervix is a difficult one to explain, not least because different studies have turned up different results. My take on the situation is that there is a small increase in risk of cancer of the breast and cervix in Pill-takers, but that any additional risk is very small, and more than outweighed by a protective effect against cancers of the bowel, ovary and womb. Indeed recent research suggests that, overall, women taking the Pill are less likely to die from cancer than those who don’t use oral contraceptives.
Are some types of Pill less likely to cause weight gain than others?
Fears about putting on weight put a lot of women off the Pill, but studies suggest that its reputation for piling on the pounds is undeserved. Research shows that 70 per cent of women who start the Pill are the same weight after a year, 15 per cent are lighter and 15 per cent are heavier — and that may not be down to the Pill. There is no particular brand that is significantly better than others.
Is it wise to take a break every few years?
There is no medical benefit from to be gained from taking a few months off the Pill, despite the widely held belief to the contrary. In my experience, the only result of such breaks is an unplanned pregnancy.
How long can I take it for?
Contraceptive methods should be tailored to the needs of the woman or couple. The Pill is the first choice for all age groups: it is now recognised that an otherwise healthy woman can take the oral contraceptive right up until she reaches the menopause (average age 51) if she wants to. Smokers and women with other risk factors (such as obesity) are generally advised to stop taking the Pill at 35 (many switch to the mini-pill which is much safer, albeit not always as effective).
Is it OK to miss the occasional period by running packs back-to-back?
The monthly withdrawal bleed associated with the pill-free week at the end of every packet is not a proper period and only there because the team who developed the Pill thought that women would find a monthly bleed reassuring. It is now widely regarded as perfectly safe to avoid periods by running some packets back-to-back without a break. Indeed the latest variants of the Pill are designed from the outset to give fewer periods.
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How quickly will my fertility return to normal after stopping the Pill?
Taking the Pill has no effect on long-term fertility, although in a minority of women it can take a few months for normal cycles and ovulation to resume. I generally advise stopping the Pill and using condoms for a month before trying to conceive so that a woman has at least one normal period before she falls pregnant, but there is little scientific basis for this.
Is the Pill still the most effective contraceptive?
It has never been the most effective contraceptive — sterilisation and long-acting reversible methods (LARCs) such as implants have that honour — but it is one of the most convenient. Clinical trials suggest a failure rate of less than 0.1 per cent, but in the real world, where women forget to take their pills, it can be a hundred times higher at closer to 5 per cent. Or to put it another way, if 20 women take the Pill for a year, one of them could fall pregnant. That is still a lot better than condoms, which have a real world failure rate of 1 in 7.
What are the latest alternatives?
Worrying failure rates in some Pill-takers — particularly younger women — have meant that doctors are now much keener on prescribing LARCs such as implants, intra-uterine devices and injections. They tend to have fewer serious side effects, can’t be forgotten and are much more effective contraceptives. The mini-pill is another popular option in older women, who aren’t quite as fertile and tend to take their pills properly — but there is far less margin for error than with the Pill. Sterilisation is a very popular option in couples who have completed their families. Visit www.fpa.org.uk for the pros and cons of all the available methods.
Who shouldn’t take the Pill?
This should always be assessed on an individual basis, but I would not prescribe the Pill to women with a past history of blood clots, breast cancer, severe migraine, stroke or heart disease, or anyone who is very obese, has high blood pressure or who continues to smoke over the age of 35.