The Pill – Risks, Benefits And Choices

CLEAN teeth, wash face, take pill.

For many women, taking the pill is part of their daily ritual. It fits in among the myriad other things we do in a day and isn’t really something to which we devote much thought.

Microgynon, a second generation pill, and Marvelon, a third generation pill, are the most commonly prescribed oral contraceptives. 

For our mothers, the pill was something that represented liberation and control over their own body. The clunky, chunky condoms of yesteryear were hardly conducive to passion and the diaphragm was fiddly and time consuming, when all you wanted to do was leap into bed.

It’s hardly surprising more than half of couples were using the withdrawal method of contraception, even into the 1950s.

The pattering of tiny feet was just one drawback to this form of contraception which requires a lot of willpower – no getting lost in the moment here. The emancipation of women brought about by the pill caused seismic changes in society and we feel the benefits today, even though we may take them for granted. But not all aspects of the pill are as easy to swallow.

Since the introduction of oral contraceptives in the early 1960s, the benefits and side-effects have always been hotly debated.

The benefits are obvious – the ability to relax and enjoy sex without thoughts of romper suits and dirty nappies forcing their way into the equation, but the pill can also be a godsend for women with heavy, painful periods too.

The initial first-generation pills which contained a strong dose of oestrogen and progestogen - substances produced naturally in a woman’s body - can cause minor side-effects (speaking from a scientific perspective - they can feel pretty major when you’re suffering from them) such as migraines, sickness, mood swings and weight gain.

More worryingly, there are also a number of more serious issues. Whilst these risks are only small, increased occurrences of breast cancer or blood clots in the lungs (pulmonary embolism), in the legs (deep vein thrombosis) or arterial clots which can cause heart attacks and strokes, are no laughing matter.

The second-generation pill, which was introduced in the 1970s, managed to slightly reduce the side-effects although the risks remained.

Scientific progress marched on apace giving us the third and fourth generation pills in the 1990s. These contained synthetic compounds of progestogen. With each new development, you might expect to see improvements and to a certain extent, that is correct. The side-effects associated with the first-generation pills have been reduced still further, but the risks of blood clots have increased.

In France, Marion Larat, a young woman of 25 recently sued the German pharmaceutical giant Bayer after suffering a stroke. Now unable to use her right hand, suffering from memory and speech impairment and attacked by regular bouts of epilepsy, she holds the company responsible for her symptoms after taking the third generation pill, Méliane.

Larat believes it is her duty to warn other girls of the dangers: “Nobody, nobody, nobody, should take the third and fourth generation of pills. That is my crusade.”

The French health minister, Marisol Touraine, has declared that from now on, the third and fourth generation pills should only be prescribed to women for whom other types of contraception are unsuitable and that this should only be done by specialist doctors. She has also asked the European Medicines Agency, who are now reviewing the matter, to restrict the prescription of these pills in favour of second generation pills.

So far, so scare story.

However, Lynn Hearton from the Family Planning Association insists that the pill is “ultimately a very safe medicine to use.”

Whilst she acknowledges that taking the pill has always involved a risk of blood clots and thrombosis, the risks and statistics are often reported in ways that cause unnecessary alarm.

She said: “There is a risk of thrombosis for all women, taking the pill only increases it slightly. For third and fourth generation pills, there is a slight increase in risk but it is marginal - one or two cases per 100,000 women.

“What is not discussed is that women are more at risk if they stop taking the pill and become pregnant. There are 60 cases of thrombosis per 10,000 women who are pregnant compared to just six per 10,000 for women who are on the pill.”

In the UK, a third of women of reproductive age are on the pill. Despite the side-effects and risks, it is convenient, easy and above all very effective - at over 99 per cent effective and therefore more reliable than any other method - besides abstention, and that’s no fun.

Microgynon, a second generation pill, and Marvelon, a third generation pill, are the most commonly prescribed oral contraceptives. These pills have other positive outcomes as well as their contraceptive function. From lighter, shorter periods to preventing ovarian cysts and helping protect against ovarian cancer, a disease which is difficult to prevent and treat.

The pill is not suitable for everyone as there are potential risks but, ultimately, it is the responsibility of healthcare professionals to prescribe medicines appropriately. For women with a genetic history of thrombosis, for those who are obese, or for those who are in a wheelchair, oral contraceptives are not recommended. The risks and benefits need to be assessed on an individual basis. Therefore if you do have any worries, you should see your doctor.

Life is all about risk. About weighing up the pros and cons. If we avoided all risk, we’d never leave the house. The risk of thrombosis is tripled on long-haul flights, but I don’t see anyone cancelling their tickets to Barbados. I, for one, am going to keep taking the pill because on this issue of sexual roulette, it seems like the odds are heavily stacked in our favour.