The Pill

The Pill

It's Changed, and So Have You

Remember when you and your girlfriends first sat around drinking coffee and talking about the Pill? Telling them you were on it made you feel adult and mature. It meant that you were sexually active, that you had a boyfriend, that you were having passionate, romping sex whenever you wanted to.

Now, years later, you once again find yourself talking to your girlfriends over coffee about the Pill. Only now the conversations make you feel like you're growing old. You talk less about the sex and more about what impact the Pill might have on your long-term health. While you once blessed the Pill for its ability to prevent pregnancy (by ceasing ovulation), now you're concerned about what it doesn't protect you from--namely, the threat of sexually transmitted diseases. You're also worried about the possible risks that have been associated with the Pill's long-term use, such as heart disease, cancer and fertility problems.

If nothing else, the conversation alone is showing your age. You find yourself talking about cervical cancer, high cholesterol and AIDS instead of multiple orgasms and foreplay. Yes, you're older now, but you're smarter, too--about your body. Your questions and concerns about the Pill no longer have to do with its ability to prevent pregnancy. It's now a question of health.

Sometime around their mid-thirties, women begin to question their doctors about the wisdom of being on the Pill, says Edward Linn, M.D., chairman of obstetrics and gynecology at Lutheran General Hospital in Park Ridge, Illinois.

And the good news is that there doesn't appear to be as much bad news about the Pill as there used to be. In fact, there may be more benefits than risks. Many experts believe that for women in their thirties and forties, the pros outweigh the cons--if they are healthy and don't smoke.

Matters of the Heart

When it comes to aging and the Pill, smokers face the greatest risks. Smokers in general are at greater risk for heart attacks, and taking the Pill boosts that risk dramatically. Statistics show that women over age 30 who smoke between 1 and 24 cigarettes a day are three times more likely to have heart attacks if they take the Pill than if they don't. And women over 30 who smoke 25 or more cigarettes a day increase their risk of heart attack ten times by taking the Pill.

The Pill and cigarettes are also a bad combination when it comes to your risk for a stroke. The figures are similar to those for heart attack: Women over age 30 who take the Pill and smoke between 1 and 24 cigarettes a day increase their risk for stroke three times, and women who smoke 25 or more cigarettes a day increase their risk for stroke by almost ten times.

But if you don't smoke and you're otherwise healthy, you can consider the Pill relatively safe. Studies show that the Pill of the 1990s poses little threat to your overall health.

This message is dramatically different from the one women received in the early days of the Pill, which made its debut in the 1960s. That's because synthetic estrogen, the ingredient that gives the Pill its protective action, is lower in content than ever. Researchers have discovered that it takes only a small percentage of the hormone levels used in earlier days to make the Pill effective. And this small dosage has been found to have positive effects.

At these lower levels, estrogen appears to decrease the levels of LDL (low-density lipoprotein) cholesterol, the bad cholesterol that contributes to clogging up the arteries. Estrogen also appears to increase levels of HDL (high-density lipoprotein) cholesterol, the good cholesterol that helps prevent clogged arteries by transporting bad cholesterol away from vessel walls. And even when bad cholesterol is present, studies show that estrogen may act on the vessel wall in a beneficial way that can help prevent plaque buildup.

The Era of STDs

It's a relief to know that the Pill is no longer the health threat that it used to be. And it's also comforting to know that when it's used correctly, the Pill offers virtually certain protection against what it was originally intended for: pregnancy. But back in the 1960s, AIDS and sexually transmitted diseases (STDs) weren't the major concern to women that they are today.

When used alone, with no condom or other barrier method, the Pill offers no protection against the human immunodeficiency virus, which causes AIDS, or against sexually transmitted diseases such as chlamydia, gonorrhea and human papillomavirus (HPV), or vaginal warts. For women between the ages of 25 and 44, AIDS is the fourth leading cause of death in the United States overall, and in certain areas of the country, it is the number-one cause. The disease is spreading four times faster among women than among men.

Each year, sexually transmitted diseases are thought to be the cause of an estimated 150,000 cases of infertility in women and 45,000 life-threatening ectopic pregnancies, in which the egg is fertilized in the fallopian tubes instead of the womb. Certain strains of HPV, or vaginal warts, have been associated with cervical cancer, which kills more than 4,500 women a year. So by using the Pill with no other protection, a woman can jeopardize her life and her health.

The Pill does offer some protection against one sexually transmitted disease, however. Research indicates that the Pill may actually reduce the risk of pelvic inflammatory disease, or PID, a disease in which sexually transmitted organisms infect a woman's fallopian tubes and uterus and can cause infertility. By some means that researchers don't completely understand yet, the Pill may help prevent lower genital tract infections such as chlamydia and gonorrhea from ascending to the upper genital tract and causing PID.

Questions about Cancer

You may be asking more questions than you used to about the Pill and cancer. You've heard that breast cancer is the cancer most prevalent in women, and you want to know what role, if any, the Pill can play in its development.

Unfortunately, some questions about breast cancer and the Pill are still unanswered. Several studies, including the cancer and steroid hormone, or CASH, study conducted by the Centers for Disease Control and Prevention in Atlanta, do provide some clues.

The CASH study looked at the effect of Pill use on cancer in 10,000 American women. The results indicated that women 35 years of age or younger were 1.4 times more likely to develop breast cancer if they took the Pill than women of the same age who never used oral contraceptives. Women 35 to 44 who took the Pill were 1.1 times more likely to develop breast cancer than women who didn't take it. And women over 45 were actually at slightly lower risk--they were 0.9 times as likely to develop breast cancer as women their age who never used the Pill. In other words, taking the Pill may increase the risk of breast cancer slightly.

While the jury is still out on the breast cancer/Pill connection, the verdict is in on the Pill's culpability in other female cancers--namely, ovarian and uterine. The verdict: not guilty.

In fact, the Pill is believed to actually help protect against these cancers. Studies show that after a woman has been on the Pill for one year, her risk for both forms of cancer decreases by about 50 percent, says Herbert Peterson, M.D., chief of the Women's Health and Fertility Branch of the Centers for Disease Control and Prevention. And the protective effect extends well after a woman stops taking the Pill, he says.

Is Fertility Affected?

Another concern for women in their thirties and forties is whether taking the Pill will affect their fertility. "Fertility declines naturally as a woman ages, regardless of whether she's on the Pill," says Dr. Linn. But oral contraceptives have not been shown to increase infertility, he says.

Several studies indicate that oral contraceptive use may slightly delay a woman's ability to conceive, but the delay is generally a matter of a couple of months.

In a study in Oxford, England, women who used oral contraceptives experienced conception delays of about two months. The older women were when they discontinued the Pill or any other method--say, age 35 compared with 30--the longer it took them to get pregnant, though often it took only a month or two, says Carolyn Westhoff, M.D., associate professor at Columbia University in New York City and one of the researchers on the British study. But, she said, the delay may be more a matter of age than taking the Pill.

Another study conducted at Yale University in New Haven, Connecticut, also reported delays in conception in women who took the Pill. Again, the delay was only a matter of a couple of months. Women who used other methods of contraception took nearly four months to conceive, while those who used the Pill generally took closer to six months.

Your Best Protection

If you are on the Pill or plan to start, here's what you need to know.

See your doctor annually. Your decision to start, stay with or get off the Pill should be based on your own health history. So you should see your doctor on an annual basis. Don't hesitate to ask questions and get her opinion. Don't be afraid to seek a second opinion. Remember that a lot of doctors feel that the benefits generally outweigh the risks for healthy, nonsmoking women.

Know your family history. If anyone in your family has had heart disease, breast cancer, high blood pressure, ovarian cancer or uterine cancer, discuss it with your doctor. These factors should be taken into consideration, but they won't immediately prohibit you from taking the Pill, says Dr. Linn.

Protect yourself. The Pill may protect you from pregnancy, but it won't protect you from sexually transmitted diseases or AIDS. One answer is condoms. Latex condoms containing the spermicide nonoxynol-9 are most effective against sexually transmitted diseases, experts say.

Practice prevention. Performing a monthly breast self-examination is always important, but if you're on the Pill, make certain you do it routinely. Doctors also recommend that you have your first mammogram between the ages of 35 and 40, then one every two years during your forties and one every year thereafter.