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Why is avoiding pregnancy such a hard pill to swallow?

Vue recounts society’s complicated history of making love without making babies

From 17th century French methods of brandy-soaked sponges, to early 20th
century olive-oil-soaked sponges and cocoa butter/boric acid recipes for
which women paid $50, to the giant breakthrough pill of the 1960s, to the
modern mini pill and the possibility of a male pill, we’ve come a long
way. One thing is clear—women have been trying to control conception
for a very long time, and have overcome more than a little resistance along
the way.

Birth control clinics in the 1930s distributed foams, diaphragms and condoms
only to women who were married with a minimum of two children, and drug store
owners in 1960 could still be fined for distributing condoms. And though the
pill became available in the early ’60s, contraception wasn’t
legalized until 1969. Doctors, however, had by then been prescribing it for
close to a decade, though ostensibly only for menstrual irregularities and
severe cramping.
The first pill, Enovid, with its built-in overdose, caused thousands of blood
clots and strokes before we figured out we only needed a fraction of the dose
it delivered for effective contraception. Modern pills, which deliver about a
tenth the level of hormones, are considered safe by most, though not by
all.

One thing almost everyone agrees on is that the pill and its cousins are an
effective form of contraception—anywhere from 92 to 99 per cent
effective. But whether we’re talking about the combo pill or the mini
pill, the Patch, Depo Provera shots, the Nuvoring or the newly-approved
Seasonale, we’re talking about tampering with a woman’s natural
hormonal state, which comes with some risk. And we’re also still
talking about opposition, though the loudest opposition now comes from new
quarters, from people anything but anti-sexual freedom or anti-feminist.

Most opposition to birth control has historically been based primarily on
philosophy, the argument being that effective birth control promotes immoral
and liberal attitudes toward sex. But the idea of hormonal contraception, now
both widely accepted and even pushed by mainstream medicine and
pharmaceutical companies, is now being opposed by women
themselves—women tired of being expected to artificially override their
natural hormone states, and women sick of both the immediate effects and the
long-term risks associated with doing so.
“Women are so ready for options in birth control,” said Megan
Lalonde, a holistic reproductive health practitioner with Justisse
Healthworks here in Edmonton.

“We work with a physician who supports choice for women, and see women
of all ages, women in their late teens to those in perimenopause,” she
explained. “Some have never been on the pill and prefer not to take
oral contraceptives, others can’t be on it because of familial health
histories, and many just don’t like how being on the pill makes them
feel.”
For many years women have routinely been told by their doctors that the pill
is the only truly reliable option for birth control. And though things are
changing, Megan pointed out that “women are still too often being
shamed by their doctors for going off oral contraception because of its
side-effects.”
Most doctors and pharmacists insist the chemicals found in the pill are very
similar to the hormones produced by our own bodies and are very safe, though
the pharmacist at my local drug store couldn’t explain to me why we so
readily consider the pill safe when the hormone levels delivered by even
low-dose pills are actually higher than those delivered by standard hormone
replacement therapy—the risks of which have received much attention in
recent years.
But not all health professionals are comfortable with the idea of synthetic
hormones. “Their chemical structure is different from the hormones
produced by our bodies, and so is their action in our bodies,” said
local alternative health practitioner Cathy Weigle. “What they do is
override our own sensitively balanced endocrine systems, which can have
far-reaching effects.”
Pharmacists who provide bio-identical hormones for menopausal women agree
that in order for a hormone to fully replicate the function of our own, the
chemical structure must match exactly—and synthetics don’t.
Combination pills work by suppressing our bodies’ own hormone
production and feedback cycle, and by artificially controlling hormones at
levels high enough to suppress ovulation. Estrogen/progestin combination
methods include varying doses of daily pills, the Orthoevra patch, the
Nuvoring and Seasonale. The well-marketed Orthoevra patch delivers the
convenience of once-a-week changes over daily pill-popping but delivers more
estrogen than low-dose combo pills. The Nuvoring delivers estrogen internally
over a period of three weeks, and the controversial new kid on the block,
Seasonale, which does require daily pill-popping, comes with the promise of
only four periods a year.
The advantages of estrogen/progestin combinations generally cited are
alleviation of severe menstrual symptoms or acne and regular cycles. (And
with Seasonale, only four per year; with the 365-day pill Lybrel now on the
horizon, none at all). Combo pills can also help prevent bone loss and come
with a slight decrease in risk of ovarian and uterine cancer. But they also
come with a daunting list of disadvantages.

Protracted periods of elevated hormone levels bring an increased risk of
cervical abnormalities and, according to the Canadian Cancer Society, an
increased risk of breast, cervical and liver cancer, though Planned
Parenthood says a link to cancer has not been shown.
Combination pills also come with an increased risk of blood clots, heart
attack and stroke, especially in those who smoke, though Planned Parenthood
says this risk is limited to smokers only and primarily to higher-dose
estrogen formulas such as the patch. Combo pills also come with the fairly
common side effects of depression, nausea, headaches and reduced libido, and
with the fairly rare (though I’ve seen it in a friend) effect of
darkened skin on the upper lip and under the eyes, which can be
permanent.

Hormonal birth control has also been shown to cause a number of key
nutritional deficiencies, which can have far-reaching health effects. And
there is little disagreement that synthetic estrogen in the pill is less
easily metabolized than other hormones, which puts significant stress on our
livers.

Research published in the Journal of Sexual Medicine last year showed reduced
bio-available testosterone in women while on the pill, and persisting well
after stopping the pill—which just may explain the not-so-little irony
of decreased sexual desire many women experience with oral
contraception.

Progestin-only options include the mini pill, Depo-Provera and Norplant,
which work mainly by making things difficult for sperm rather than by
preventing ovulation. The mini pill is tolerated well by some who don’t
tolerate combination pills, but both the quarterly injection Depo-Provera,
which has already been embroiled in a class-action lawsuit, and Norplant, a
set of capsules surgically implanted under the skin of the upper arm and
replaced every five years, seem to come with more trouble than benefit.

The mini pill comes with a slightly higher failure rate than combo pills,
mostly due to its time sensitivity—a pill missed by three hours can
cancel protection, which is a problem for travellers and partying types with
irregular schedules. And all progestin-only options come with the very real
risk of osteoporosis, as well as the short-term side effects of intermittent
and unpredictable bleeding, headaches, acne, weight gain and irritability.
(Men have been known to quip that the main reason progestin-only options work
lies in their ability to make women irritable.)
Despite its list of problems, the pill is still popular with many women, but
especially with the doctors who encourage its use—and with men. One
young man, in summing up the attitude of his peers, said, “There are
two kinds of women, those on the pill and those not.” It’s not
hard to guess what they prefer; based on what I hear from the young women I
know, the pressure to be on it is significant.

The pill’s popularity with doctors lies in its reliability, though
there is yet another energy driving it. Not all options in birth control are
patentable, and those who profit from hormonal contraception have more than a
little influence. When sales of hormone replacement drugs for menopausal
women dropped because women began turning to pharmacists willing to compound
bio-identical hormones for them, the drug company Wyeth filed complaints
against the compounding pharmacies.

I asked Weigle if she’d recommend the pill for her daughter. Her answer
was a pretty quick and definite no.
“There are other safe and effective options out there,” she said,
“and fertility awareness education will empower women much more than
the pill has.”

The tension between pharmaceutically oriented doctors and women becoming
aware of the consequences of disturbing their very finely tuned hormonal
systems may well just be beginning. But more and more women are paying
attention to their intuition and insisting on information and choice, even
digging in their heels in the face of pressure. One thing is sure: as women
have fought for choices in how they give birth, they are now also fighting
for non-invasive and non-chemical options in birth control.
V

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