A hard Pill to swallow

Are oral contraceptives a risky proposition for some women?


Carol Lloyd
November 8, 2007 8:41PM (UTC)

Word about a new Belgian study on the risk of atherosclerosis associated with long-term use of the Pill raised my perennial fears about the brave new world of Internet health research and the difficulties of navigating the waves of information that wash over us daily. The population-based study of 1,301 women ages 35-55 looked for the relationship between oral contraceptive use and levels of arterial plaque -- a risk factor for heart disease. The Belgian researchers found that for every decade of use, oral contraceptives may increase arterial atherosclerosis by 20-30 percent.

Say what? Now the Pill causes arterial plaque? Isn't this the same miracle drug that has been hailed as a cure for everything from acne to painful menstruation and possible preventive measures against gynecological cancer, osteoporosis, ovarian cysts and rheumatoid arthritis?

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Presented at the American Heart Association meeting this week in Orlando, Fla., the study has yet to be published in a peer-reviewed journal, so it will be interesting to see the research community's response. The authors are not suggesting that women discontinue use of the Pill because of the possible risk but that they manage any risks through lifestyle changes. So it's not as if this study is going to rewrite the medical history of the Pill, a drug whose health benefits and risks have been studied and debated since its introduction in 1960. (For an FDA article discussing the history of the risks and benefits up to 1990, click here.)

In response to various health risks, the Pill has evolved over the decades with increasingly lower doses of estrogen and progestin. Back in 2004, another study found that it may have a protective effect against heart disease. A couple of months ago a large-scale study, published in the British Medical Journal, found that the Pill protects against many cancers -- including endometrial, bowel and ovarian. (It has long been known that it raises the risk of breast cancer during use and for about five years subsequent to use.)

Not surprisingly, some of the Pill's Cassandras have pro-life axes to grind: "Noted endocrinologist" Maria Kraw was recently quoted on LifeSite warning that the Pill causes an array of serious diseases and side effects. But the new Belgian study reminds us that even with a drug as widely researched as the Pill, as the dosages and usage patterns change so too may the risks. Once the Pill wasn't recommended for women over 40, but now it's prescribed until menopause. The researchers of the new study told Medpage Today that the long-term effects have not been as thoroughly studied as hormone replacement therapy, a regimen in which estrogen has been associated with serious health risks.

Should we question our culture's infatuation with medical treatments for nonmedical problems? Before you brand me an anti-science Luddite who gave birth in the woods, let me just say that this double-C-sectioned mother has pretty much sided with conventional science over the alternatives throughout my life. Still, the details about this study once again reminded me that drugs -- even ones as well researched, safe and ultimately liberating as the Pill -- are more of a work in progress than many would like to admit.


Carol Lloyd

Carol Lloyd is currently at work on a book about the gentrification wars in San Francisco's Mission District.

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