Women's Studies 30
common side effects - benefits - genetic based studies - conclusion
Margaret Sanger had envisioned a birth control pill since she opened her first clinic in 1916. However, she was not able to fund the project for years. In 1951, Sanger teamed with Katherine McCormick to provide enough funding to finally accomplish her dream. They contacted Gregory Pincus, who was the head of the Worcester Foundation for Experimental Biology. Until then, Pincus had worked on test tube fertilization. In 1952, Pincus notified Dr. John Rock, a gynecologist who was especially interested in studying progesterone. Rock had many patients who could test the new pill.
Concurrently, Carl Djerassi, working for Syntex, had just learned how to produce a synthetic oral form of progesterone. It was just like the natural form of the hormone except the orientation was wrong at positions 14 and 17. It was named 14-iso-17-iso-19noreprogesterone1. Two different chemical companies, Searle and Syntex, started testing their similar forms of progesterone in 1953. Each company was backed by different companies, such as Parke-Davis, and Johnson & Johnson. Both groups were in a race to be the first pharmaceutical company to obtain FDA approval so that they could mass produce their synthetic hormone and produce an effective pill. Searle entered the market first, but Syntex quickly gained control of the market. The first pill was available in 1960 and contained 100-175 micrograms of estrogen and 10 milligrams of progesterone2. Within just two years, 1.2 million American women were using the pill2. It was popular because women suddenly felt that they were in control of their sexual lives.
After the pill had been in use for a few years, there were reports of some side effects. The pill manufacturers decided to lower the amount of hormones in the hope that side effects would decrease. In 1970, the pill was comprised of 50 mcg of estrogen and 2 mg of progesterone2. While representing a significant decrease in the level of hormones, the amount was still large. The pill used by millions of women around the world today contains only 30 mcg of estrogen and 1 mg of progesterone2.
HOW IT WORKS
The birth control pill contains estrogen and progesterone, which are two common hormones found in a woman's body. Taking the pill simulates the increase in their hormones which occurs in the body during pregnancy. An increase in estrogen inhibits ovulation by suppressing follicle stimulating hormone (FSH) and luteinizing hormone (LH) and inadvertedly tricks the pituitary gland into thinking that the body is pregnant. An increase in progesterone inhibits ovulation by suppressing LH and also hampers the transportation of sperm, which impedes implantation of the egg. However, even if an egg manages to implant, it will be shed since the lining of the uterus is extremely thin. Some people view this effect as an abortion, since it is similar to using the morning after pill. However, since women don't know if the egg ever actually implants, they never emotionally feel as though they had an abortion3.
HOW TO TAKE
A woman should begin taking the birth control pills the Sunday after her period begins. It is imperative to take the pill every day at the same time. Skipped doses can lead to uncertain results. A woman will take three weeks of active hormone pills followed by one week of placebos. The woman will menstruate during the week of placebo pills. A pap smear and a pelvic examination are given every three to six months while the woman is on the pill. When discontinuing use of the pill, a different method of contraception should be used for two to three months to ensure that a pregnancy does not occur.
Women taking the birth control pill face problems with their insurance companies. Only about 15% of insurance companies pay for the pill4. Comparing that to the 90% of insurers that pay for sterilization4 explains why in the 1980s, 30% of American women opted for sterilization1. In Europe, only about 5% of women use sterilization for birth control, which can be explained by the fact that their health care system is funded by the government and reimburses all medical expenses1. It is estimated that without contraception, a woman can expect to have as many as 15 24 pregnancies in her lifetime4. It seems ridiculous that a method as simple as the birth control pill would not be covered by insurance, but abortions would. Moreover, reimbursement seems to be in the insurers' best financial interest since the cost associated with reimbursement of birth control pills is a small fraction of the lifelong medical costs which insurers would incur for children born because their mothers could not afford the pill. Recently, more controversy has arisen with the introduction of Viagra. Most insurance companies pay for Viagra, yet they don't pay for the birth control pill. This disparity seems like blatant sexism. In July, 1998, the United States Congress reviewed a bill which would require any health plan for federal employees to pay for prescription contraceptives. However, this bill is still being discussed in subcommittees4.
RISK GROUPS AND COMMON SIDE EFFECTS
During the 1960s and 1970s, many women taking oral contraceptives experienced side effects. Some people quickly blamed birth control pills and decided that no one should be using them. After the evidence was examined more carefully, it was found that only women in certain risk groups actually did experience side effects. All the other women have only a slight chance of experiencing problems. The women who are part of the risk groups include women over 35, women who are obese, and women who smoke. Also, women with a history of health problems such as heart attack, stroke, cancer, diabetes, and migraines are increasing their chances of encountering medical problems by taking birth control pills.
When a woman decides to take the pill, her doctor will give her a pamphlet which describes the possible signals which are cause for contacting the doctor. These difficulties include abdominal pain, chest pain, headaches, eye or speech problems, and severe leg pains. If a woman taking oral contraceptives experiences any of these symptoms, she should immediately contact her doctor because it could be the sign of a deeper, underlying problem.
The most common, serious problems associated with the birth control pill are blood clots, heart attacks, stroke, cancer, nausea, emotional disorders, and increased appetite. Obviously the women in the risk groups, who are predisposed to have health problems, are more likely to have side effects. However, since the amount of hormones in the pills was so large in the 1960s and 1970s, many women experienced problems. There were also problems with the early medical literature, which did not make it clear that the pill did not protect against sexually transmitted diseases. During the 1960s and 1970s, 70% of the women using the pill stopped because they experienced side effects5. 17% of the women stopped taking the pill because they were afraid of side effects5. The number of women taking the pill decreased steadily until 1980 because people were afraid. In 1980, about 8.4 million women used the pill2. Once tests proved that most women were not at risk with the new phasic pills which slowly released hormones throughout the menstrual cycle, women started taking the pill again. In the 1990s, only 24% of women stopped taking the pill because they either experienced side effects or were afraid of experiencing them6. In 1992, it was estimated that 16 million women took the birth control pill1.
Recently, noncontraceptive benefits associated with taking the birth control pill have been discovered. Currently, one third of all prescriptions for oral contraception are for noncontraceptive reasons7. The pill has been found to prevent cancer of the ovaries and of the endometrium (lining of the uterus). It also prevents women from having heavy menstrual bleeding, which can help with anemia and menopause. Birth control pills have been found to minimize benign lumps and help maintain bone density. The most interesting benefit is that it prevents acne. Many dermatologists are turning to certain birth control pills for their patients with acute acne.
GENETIC BASED STUDIES
In 1995, Claus Wedekind did a study which was meant to test the mating preferences of women. It was a biological test which aimed to use products of the MHC (major histocompatibility complex). These products are instrumental in immune recognition because they bind onto foreign peptides and present them to T-lymphocytes. The MHC contains genetic material in its antigens, which can be characterized into HLA-A, -B, and -DR. The DR antigens were further broken down into subtypes. The forty nine females and forty four males being used for the experiment were genetically typed into a certain category.
The men in the study were told to wear a new tee-shirt for two days straight. They were not allowed to use perfumes or deodorants or eat spicy foods. The next day, the women were asked to rate the odors of six shirts. Three of the shirts they rated had been worn by men who had dissimilar MHC antigen type to them. The other three shirts had been worn by men who were of similar genetic make-up to them. Each woman had to rate the shirt for pleasantness and sexiness. All of the women rated the shirts the second week after menstruation in order to standardize the data. There were some women who were on the birth control pill and Wedekind decided to compare their results separately.
The results of the study were very interesting. Those women who did not take oral contraceptives perceived the odors of men with dissimilar MHC as more pleasant. However, women who were taking oral contraceptives perceived the odors of the men with similar MHC as more pleasant. In order to draw a firm conclusion, the study would have to be conducted again with a large sample, however, the results of this study suggest some notable hypotheses. The birth control pill seems to interfere with natural mate choice. This result could be explained because the body believes that it is pregnant. When a woman is pregnant, she does not search for a new mate. Instead, she looks for friendly help and a form of communal nesting. These results also suggest the causes of problems in some relationships. If two people are together, and the woman decides to start taking the pill, the relationship could sour. Likewise, if a woman stops taking the pill after she has a partner, the relationship could change for the worse. Cases like these have been found, but it is too early to draw a firm conclusion. Scientists are also currently investigating the effect of oral contraceptives on conception. It is much more difficult to conceive a child with someone who has similar genetics. There is a natural aversion to inbreeding. If a woman is attracted to a man with similar genetics, this could result in fertility problems. Experiments are still being done to try to determine to what degree these results can be verified.
Another interesting study was conducted in 1994 by Krug, Stamm, Pietrowsky, Fehm, and Born. It tested the effects of the menstrual cycle on creativity. Seventeen women, not taking oral contraceptives, were tested at three stages throughout their menstrual cycle. Another seventeen women, taking oral contraceptives, were also tested three times throughout their cycle. The women in the two groups were paired with similar characteristics, such as age. Creativity was measured by six tests which tested divergent thinking. The tests included such things as thinking up consequences to hypothetical situations, transforming familiar drawings into various objects, and free association tasks. The sample size used for this study was small, but a trend can be noted. Overall, creativity did not differ between women taking oral contraceptives and women not taking oral contraceptives. However, during the preovulatory phase, creativity was substantially increased in the women not taking oral contraceptives. The women taking oral contraceptives had an unchanging level of creativity throughout their cycle. These results are probably due to the increase in estrogen in a woman's body when taking the pill. Once again, further studies should be done to make any firm conclusions, but the evidence thus far seems promising.
Ronald D. Nadler performed many studies which investigated the effects of oral contraceptives on chimpanzees. In 1993, he did a study which tested copulation in chimpanzees taking oral contraceptives. The female chimp was in one cage and the male chimp was in an adjoining cage. Some of the chimps had free access and some had restricted access. The chimps that had restricted access allowed the female to press a lever to let the male in. The chimps were separated into four comparable groups. Accessibility and taking oral contraceptive were the two variables that were being tested. It was found that during the midcycle phase, chimps are more likely to copulate. Chimps or humans taking oral contraceptives do not experience different phases in their menstrual cycle. Their worlds are much more static. Therefore, chimps taking oral contraceptives would want to copulate less. The clearest reduction in sexual activity occurred with the free access chimps who were taking oral contraceptives. The experimenters had hypothesized that there would be a greater decrease in copulation in chimps on oral contraceptives with a restricted access. However, the restricted access chimps avoided copulation during the natural cycle so there was not a large decrease in the amount of copulation of the chimps on oral contraceptives. Nadler did warn not to take the results of the study too seriously because there are other factors that affect copulation. Chimps who had a good relationship copulated the same amount regardless of accessibility and oral contraceptive intake. Likewise, chimps in abusive relationships copulated the same amount because the female chimps felt threatened. The data from the chimps who had mediocre relationships supported the conclusion as well. Nadler speculates that since the physiology and behavior of chimps and humans are extremely similar, the results of a study done with humans would produce the same results. In upcoming years, similar studies might be conducted to see if the effects of oral contraceptives on sexual behavior is similar in humans.
The birth control pill was an extremely important invention for women. It was just one of the many technologies for women that was made in the 20th century. The three current genetic studies examined provide evidence of some of the problems associated with oral contraceptives. By increasing the hormones in the body, the body chemistry is changed and the woman is not the same. However, the birth control pill is extremely safe. Unless further studies focusing on these genetic changes indicate negative effects, women should not be alarmed. Women all over the world have adjusted to popping the pill once a day. Interestingly, only 73% of women have used condoms, yet 80% of women have used the pill6. The pill has liberated women and allowed them to be much more spontaneous and carefree.
[added 16 March 2005 by E. Carr Everbach at the request of Karon Shmon:]
With the risk of HIV and AIDS, doctors also recommend a condom or barrier also be used, even for those taking the pill.
ENDNOTES AND REFERENCES
Send message to Swarthmore College Women's Studies
last updated 12/8/98webmaster