Informed Consent: The Pill
Informed Consent: The Pill
The oral contraceptive pill is still the most common contraceptive used in the US, with over 11 million people using it each day. Not only are people who menstruate using it to prevent pregnancy, they are also prescribed it for a number of off-label uses. The benefits of the pill are well marketed, but this leaves out the importance of discussing the serious and potentially life-altering risks of using this medication.
Combined Oral Contraceptives
What it is: A daily pill taken orally that contains ethinyl-estradiol, and a progestin.
How it prevents pregnancy: The progestin prevents gonadotropin release by the hypothalamus. Without gonadotropin release, the brain does not get the signal to release follicle stimulating hormone, which matures the egg, or luteinizing hormone, which releases the egg. Essentially, the connection between the brain and ovaries is severed, and ovulation is suppressed. Without ovulation, pregnancy is impossible.
Failure rate: Typical use: 7% (or 93% effective) Perfect use: 1% (or 99% effective)
Ovulation preserved?: No, the mechanism of action is ovulatory suppression.
Side effects: Combined oral contraceptives have common side effects as well as more serious health risks. Side effects may include loss of sex drive, pain during sex, and increased inability to orgasm, inflammation, chronic UTI's, weight gain, cystic acne, nausea, irregular bleeding or spotting, headaches, breast tenderness, changes in breast size and nipple shape, and clitoral and ovarian shrinkage. Clitoral shrinkage was observed in all participants of one study, with an average of 20% reduction in size. Other symptoms of estrogen excess may surface.
Mental health effects: There are also well documented mental side effects including mood swings, depression, anxiety, worry, doom, self-doubt, and social anxiety. The most serious outcome of these mental health effects is an increased risk of suicide. Depression risk varies depending on the progestin used, somewhere between 10%-50% for adults, and between 20%-120% increased risk for teens. All mental health risks are increased if you start using contraceptives as a teen.
Serious physical health risks include micronutrient and mineral deficiencies, especially folate (which may help the body protect itself against sexually transmitted disease such as HPV), hypothyroidism (caused by ethinyl estradiol which leads to increased levels of Thyroxine Binding Globulin, that binds thyroid hormone. More circulating TGB leads to lower levels of free thyroid hormone available for use by our body), bone loss (leading to an increased risk of osteoporosis later in life), premature ovarian failure (menopause), a decrease in insulin sensitivity (pre-diabetes), and increased risk of auto-immune disease (high cortisol levels can lead to gut permeability and result in an increased risk for interstitial cystitis, lupus, and there is a documented 51% increased risk of Crohn's disease for pill users). Risk of hypertension is increased due to depletion of nitric oxide which is critical for vascular and brain health. Risk of deep vein thrombosis and pulmonary embolism, stroke, heart attack is increased 3x-6x. If at any point while using the pill you have aching in your legs, shortness of breath, or dizziness, stop the pill right away, and get it checked out immediately. Breast cancer (39% increased risk if used for more than 10 years) and cervical cancer (50% increase if used for more than 5 years) risk is also increased. There is also a risk of idiopathic intercranial hypertension which may cause headache, ringing of the ears, and temporary blindness.
Body systems that may be impacted: 11/11 systems. Cardiovascular system, digestive system, endocrine system, exocrine system, immune system, muscular system, nervous system, reproductive system, skeletal system, renal system, respiratory system.
How long it should be used for: In order to mitigate serious health risks, the pill should be used for less than 5 years, though it is commonly used for upwards of 10-20 reproductive age years.
Progestin Only Pills
What it is: A daily pill taken orally that contains a progestin.
How it prevents pregnancy: Progestin only pills work through multiple mechanisms. The first is that it thickens cervical mucus, preventing sperm entry into the uterus. They also thin the lining of the uterus. Lastly, they stop ovulation, but less consistently than combined oral contraceptives.
Failure rate: Typical use: 7% (or 93% effective) Perfect use: 1% (or 99% effective)
Ovulation Preserved?: Questionable, but most likely not.
Side effects: See above. The only exception is hypothyroidism, that appears to be linked directly to the use of ethinyl-estradiol, which progestin pills do not contain.
Body systems that may be impacted: 9/11 systems. Cardiovascular system, digestive system, endocrine system, exocrine system, immune system, muscular system, nervous system, reproductive system, skeletal system.
How long it should be used for: In order to mitigate serious health risks, the pill should be used for less than 5 years, though it is commonly used for upwards of 10-20 reproductive age years.
Progestin Generations and Risk
The newest drugs on the market are not necessarily the safest. Pharmaceutical companies can only hold patents for so long on their medications before generic versions can be produced. In order to continue to profit, they produce newer "generations" of contraceptive drugs with different forms of progestins. So far there have been 4 generations of contraceptives. Different generations have different risk factors, which are significant enough to note.
First Generation Pills - The first generation contraceptive pill had a higher concentration of the both oestrogen and progestin. The progestins found in the first generation pills included norethynodrel, norethindrone, lynestrenol and ethynodiol diacetate.
The first generation pill was linked to blood clots and other cardiovascular issues.
Second Generation Pills - The next generation of pills came into use in the 1970s, and had a much lower daily dosage of drugs. They contain progestins such as levonorgestrel and norethisterone. These are considered the safest in regards to venous thrombosis.
Third Generation Pills - Third generation pills were generated in the 80s. This group of pills uses progestins such as norgestimate, desogestrel, gestodene and cyproterone acetate. These pills increase your risk of venous thrombosis from 3x more likely to 6x more likely.
Fourth Generation Pills - The most recent type of combined oral contraceptives contain progestins such as drospirenone, nomegestrol acetate or dienogest. Fourth generation pills also increase your risk of venous thrombosis from 3x more likely to 6x more likely