BIRTH CONTROL PILLS (ORAL CONTRACEPTIVES)-SIDE EFFECTS OF THE PILL
The most common bothersome side effects of the pill mimic those encountered in pregnancy: nausea, constipation, breast tenderness, minor elevations in blood pressure, edema (swelling), and skin rashes (including brown spots on the face called chloasma). Other relatively minor side effects include weight gain or loss, an increased amount of vaginal secretions, and an increased susceptibility to vaginal infections.
Less common but more troublesome side effects caused by the pill include high blood pressure (4 percent of users), diabetes (1 percent of users), migraine headaches and/or eye problems (0.5 percent of users), and, rarely, jaundice or liver tumors. Because the pill causes alterations in liver function, women with hepatitis or other forms of liver disease should avoid it. If taken during pregnancy, the pill may cause birth defects, but if used before pregnancy, the pill does not have this effect. Some reports have linked the pill to depression, while others have not.
The most serious risks to women using birth control pills are disorders of the circulatory system: the overall death rate from circulatory diseases is approximately four times higher in users than non-users. However, to put this finding in perspective, only one in 27,000 women using the pill annually dies from this cause.
There are three different types of circulatory problems involved. The most common, affecting about one in 1,000 users each year, is the formation of a blood clot in a vein (usually in the legs). Most often this clot results in only minor discomfort caused by inflammation and swelling, but there is a risk that a piece of the clot may break off and cause serious damage in the lungs or brain. These problems, called thromboembolic diseases, are two to four times more common among pill users than non-users but account for only two or three extra deaths per 100,000 users annually. Birth control pills also increase the risk of heart attacks, but the excess risk is almost entirely found in users who smoke and/or users older than thirty-five. Women in their thirties who smoke and use the pill are about seven times more likely to have a heart attack than users who do not smoke, but pill users who do not smoke are less at risk than smokers who do not use the pill. Finally, an association between pill use and strokes has also been found, but even with an increased risk, stroke is a rare disorder in women under forty-five.
A few final words about the safety of oral contraceptives are in order. Safety is a relative matter, not just a statistical equation. For example, a woman who has intercourse frequently receives more contraceptive protection from the pill than one who does not. While other contraceptive methods may seem "safer," she may choose to risk certain health problems to be more certain of not becoming pregnant. Another example applies to women in developing countries, where maternal death rates during pregnancy and childbirth are much higher than in countries with advanced medical care systems. In this situation, oral contraceptives are far safer than no birth control even over age thirty-five. The safety of birth control pills should also be looked at in comparison to risks of everyday living such as auto accidents or sports injuries. In this case the figures may seem somewhat different: only one pill-related death occurred in 46,000 women under thirty-five who were non-smokers in 200,000 woman-years (one
woman-year is equivalent to a woman using a particular contraceptive method for 12 calendar months) of use of the pill. By contrast, nine deaths from auto accidents would be expected in a group of this size over this period of time. Confirming this view, the largest prospective American study of pill users found that overall, the risks of oral contraceptive use appear to be minimal.
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