Birth control is safer than pregnancy: Day 1 at AAAS 2012

It's that time again. Maggie is back at the largest science convention in the Western Hemisphere for four days of wall-to-wall awesomeness. Each day, she'll tell you about some of the cool things she learned watching scientists from all over the world talk about their work. Check the bottom of each post to find links to earlier posts in this series!

Each year, the American Association for the Advancement of Science holds a conference. Scientists from every discipline you can think of attend. They come from all over the world bearing fascinating studies they're dying to talk about, and Power Point presentations they'd probably rather I didn't critique. The result: The worst part about this conference (besides the aforementioned poorly done Power Points) is trying to choose which session you want to see. There's often as many as a dozen occupying the same time slot. Usually, three or four of those will strike me as something I MUST find out more about.

Friday morning, I picked a session that I hoped would provide some background and context on issues you and I are already talking about. Birth control—and, specifically, who should have access to it—has become a major issue in the current presidential campaign. Along with that has come a lot of confusion and misinformation about how birth control works, how effective it is, and what we know about its potential side effects. My first session of the day: Fifty Years of the Pill: Risk Reduction and Discovery of Benefits Beyond Contraception.

The first thing I learned: If you're taking an oral contraceptive, there's a good chance that you're doing it wrong.

Only 50% of the women who use the pill actually use it correctly—never missing a day and taking the pill at the same time of day every day. In fact, in 1998, University of Michigan nursing professor Deborah Oakley did a study with a small group of nursing students that found that even women who think they use the pill consistently, often don't. Before the study, Oakley asked the women how often they missed their birth control pills. They told her one out of every 10. Then, she gave them electronic packs that recorded actual usage. "The reality: Their pill missage rate was 2-3x what they thought it was," says Ronald Burkman, professor of obstetrics and gynecology at the Tufts School of Medicine.

Burkman was one of the speakers on the panel, and he told me that inconsistent usage affects both how well birth control works and how well we can study its side effects. That's because "inconsistent usage" doesn't just refer to forgetting to take pills or not taking them at the right time. Those are the things that can lead to unwanted pregnancies, but there's a bigger picture as well. Women don't use birth control in a monolithic way. For instance, in my own life, I've used 3-4 different kinds of hormonal birth control—all with different formulations and dosages. And even though I used the pill for the first time when I was 18, I've not been on a hormonal birth control consistently since then. For various reasons, women go on and off of this medication. And that makes it difficult to study the side effects of birth control in a really granular way.

In general, we know that birth control is pretty safe. Even the scary-sounding side effects, like heart attack, are incredibly rare. What's more, pregnancy is more dangerous. For example, even though birth control slightly increases the risk of heart attack, pregnancy (and particularly the period immediately following pregnancy) increases your risk far more. Burkman said that studies show somewhere between 2 and 14 cardiac events per 10,000 woman-years of birth control use. Meanwhile, for every 10,000 pregnancies, 20-50 women will have some kind of a cardiac event. (That's true for all the big risks of birth control, Burkman said. The absolute increase in risk is tiny, and you're safer with birth control than you are with pregnancy.)

We know this because of two different kinds of studies. One type of study compiles the medical information of thousands of women who use birth control, aggregating the amount of time they each used it. That's what is meant by "10,000 woman-years of use". There might be 200,000 women in the study, and between them, they've used the pill for 10,000 years.

The other type of study follows individual pill users over the course of their lives and records what happens to them. At this point, we have data following pill users over 39 years. Those studies actually show some interesting benefits to birth control use. Compared to women who never took the pill, the pill users had increased bone mass, fewer cases of endometriosis—when uterine cells start growing outside the uterus and cause a lot of pain—and fewer cases of pelvic inflammatory syndrome, bacterial infections in the reproductive system that can lead to scarring and infertility.

But, at the same time, there's really not much data that breaks out the risk analysis by type of birth control user. If one woman takes birth control for 2 years, and another takes it for 20, we don't really know much about how their relative risks differ. That's because 2 years of use (or 20 years of use) doesn't mean the same thing for one woman that it means for another. How do you know who has been using the pill consistently during that time and who hasn't? How do you compare women who've used two completely different types of pills? Different chemical formulations have different effects on the body.

During the Q&A portion of the session, a woman told the panel that she was concerned about what happened to women who used birth control for 15 years straight, starting in their mid-teens. "It can't be safe," she said. "I've personally known too many people with fertility problems and blood clots."*

The truth is that we have enough data to say she's wrong. We can look at the aggregate studies and see that birth control is safe, that it's safer than pregnancy. We can look at the longitudinal studies (the ones that follow women over the course of their lives) and see that birth control doesn't cause fertility problems. But, frustratingly, we can't give that woman the exact kind of data that she's looking for. We can't point to a study of 30-year-old women who have been on birth control since they were 15 and tell you what happened to them.

There's a possibility that that could be easier in the future, as more women use forms of birth control that are harder to use inconsistently—things like the monthly ring, the three-year implant, or the 5-10 year hormonal IUD. But these still aren't easy studies to set up, and you still can't compare a ring user to an implant user, and expect that to say something about women who use the pill. The data we have today is good—but it's not granular. We can speak about women who use the pill in general. But we can't tell you much about particular women.

*Personal observation of a friend group shouldn't be taken as a signal of what actual risks look like. Here's a good example of why: I'm about the same age as this woman was, roughly 30. Like her, most of my female friends have been on hormonal birth control of some sort at one time or another since their mid-to-late teens. I know nobody who's had a blood clot. Or any side-effects more serious than unpleasant emotional yuckiness. I know a small handful of women who have had fertility problems, but all of them also had irregular periods as teenagers, something that is often a sign of underlying, natural fertility problems.



  1. While I wish the medical community good luck in their studies and research on the long term effects, I’d like to see a study on the emotional changes that can occur on hormonal birth control.  Especially if there is a long term partner involved that can give an outside opinion of the patient.

    Sometimes it’s not fun to come home to your girlfriend who appears to be having a meltdown because of a trivial problem…

    1. Sometimes it’s not fun to come home to your girlfriend who appears to be having a meltdown because of a trivial problem…

      Maybe grown-up relationships are not the right lifestyle choice for you.

      1.  Uncontrollable crying and sadness over something like spilling a glass of water is a little extreme in my opinion…
        It’s a good thing she thought it was too, other wise we wouldn’t have been married for the last 8 years and counting.

        1. As someone who has struggled with clinical depression, I can say that while the proximate causes of disrepair and other negative emotions may seem trivial, the root causes (body/brain chemistry) are not trivial at all.

      2.  I think his post came off in the wrong light. I was in a long term relationship with someone who was subject to inconsolable crying for two weeks out of four. I thought it might be something to do with the HBC pills she was on for menstrual cramps, based on what another female friend had told me about her experience, and so I put it to her and promised to help with any of the problems she might encounter going off them. She got off the pills, used some cramp-specific medication (and I helped out with treats,  massages and, uh, other relief)  instead and was a completely changed person. The pill’s emotional side-effects on some users really aren’t a small matter but they are not widely publicised.

    2. I’m sure it’s fun for her…  but I suppose the impact of her mood swings on you is more important?

      Some people react badly to one or another HBC formulation.  Some react badly to all of them and just can’t take artificial hormones without severe mood effects.  Most have reduced hormonal mood swings on birth control.  If she’s miserable on the pill she’s on, she should try a different type of pill or a different method entirely – but much of the time, changing brands is enough.

      Personally if anyone’s evaluating my moods I would like it to be me.

      1.  That was the second she was on, and she knew well before that incident that it wasn’t working out.  In total she has been on four different ones.  The one she is on now is fine, but having lived with her for 10+ years there are subtleties that no one else would notice.

        In reality she enjoys the lighter periods and PMS symptoms over any of the tiny mood changes.

    3.  re: “Sometimes it’s not fun to come home to your girlfriend who appears to be having a meltdown because of a trivial problem…”

      You don’t need to be on birth control to have this happen.

    4. Your girlfriend might have the same intolerance to synthetic progestins (contained in BC’s) that I and many other women do.  Can cause symptoms like emotional lability (eg: bursting into tears or ripping somebody’s head off at the drop of a hat), increased headaches (especially if the person suffers from migraines), anxiety, depression, insomnia…I tried 3 different BC’s; they all made me crazy.  After that, non-hormonal birth control for me, thanks!

      If discontinuing the BC’s doesn’t eliminate the symptoms, she should have her progesterone levels tested, and consider supplementation with actual progesterone (Prometrium, Progest cream, etc.) vs. synthetic progestins.  If her progesterone levels are low compared to her estrogens, symptoms like PMS, anxiety/depression, and that emotional lability again may be evident…long term, low prog can lead to symptoms such as weight gain, and increased incidence of estrogenic cell-proliferative disorders (endometriosis, fibroids, cysts, maybe cancer).

    5. If anything, I  have seen  BC to be very helpful with any PMS symptoms in my friends who take it.

      Also, women go through hormonal changes by just having sex with another person even without birth control.  This is something I have heard from a few therapists and nurses. This is something that diminishes over time. So her going off the birth control might not even be the contributing factor to resolving the issue.

      So it may be that your girlfriend is especially sensitive to hormonal changes (that can occur naturally, without BC), Or that there is some underlying issue at hand (depression, anxiety problems or abundant stress, for example, can cause such meltdowns).

    6. An interesting piece of advice I was given by a specialist: skip the placebo pills & go straight to the next pack. According to what I’ve read, the placebos weren’t added to the cycle for any reason other than giving women using the pill peace of mind that they hadn’t become pregnant (!!!!!!), and IME it smoothes things right out.

    7. “Sometimes it’s not fun to come home to your girlfriend who appears to be having a meltdown because of a trivial problem…”

      How about being more concerned with how she is feeling and what she’s going through, instead of clearly being more concerned with how it makes you feel?

      1. I don’t get this terror of human emotion. As far as I can tell, it’s pretty normal to burst into tears for no particularly reason about once a day.   Not doing it seems to be mostly a Northern European and its cultural sequels thing.

  2. It would be interesting to see if the benefits listed from being on long-term birth control are also present in women who have had multiple pregnancies.

  3. Interpreting long-term safety data also points to the pitfalls of observational studies, such as they’re not randomized. So there may be unanticipated traits in the control group that weren’t corrected for.

    But yeah; I learned in pharmacy college 28 years ago that the pill was safer than pregnancy. Nothing new there, but it often needs revalidating and restating to battle the misinformation perpetuated by the religious right.

  4. In this current climate in America  of food fear and GMO labeling fear and organic food obsession I can’t believe that you are promoting  drugs over pregnancy by saying it is safer.

    Really? WTF?

    So GMO food, which has not been proven harmful,but food being necessary for human survival, is BAD, and artificial drugs produced by BIG PHARMA so you can have sex without worrying about pregnancy is good?

    1. It’s not an ethical issue.  Either the science says that there is more risk to a woman in having a baby than in taking birth control.  Or not. 

      With food the comparison is GM food versus non-GM food.  It seems like a completely seperate issue to me…

    2. Keep in mind that some of the complaints about genetically-modified foods are not about the scientific issues, but rather the legal issues that arise when a wealthy and aggressive company owns the genome of a popular plant. 

    3.  If you are in a position to afford all the organic/locally raised food that you need and have enough resources to be able to have kids and maintain your lifestyle then more power to you.  That is the beauty of America.  Other people may choose to use birth control to plan a pregnancy, or may simply not have the financial resources to have children at this point.  (Not that finances seems to stop a lot of people from having kids anyway.)

      And your argument seems more cyclical than anything.  If GMO crops are bad, and big pharma making drugs so women don’t get pregnant is bad, that leads to less food (per unit of land) and more people (because I’m pretty sure people will continue to have sex regardless if the pill exists or not.)  In the end we are even more over populated and starving.  Sounds like a win/win to me.

    4. There actually are environmental effects of the pill, like raised estrogen levels in the water, that affect fish reproduction.  This could be solved at the wastewater treatment plants though, and the “safer” was for individual women.

      1. or just lack of science and history for GMO.  where there is not a relative lack of science and history for HBC

    1. This is one of those areas where I wish we had some of that 23rd+ century technology like Star Trek (or insert your favorite sci-fi show here).  I’ll agree that my wife is more even on the pill, but she also has a lowered sex drive and isn’t as spontaneous.  I dated her 4 years before she went on any type of birth control, and in my situation I am willing to tolerate a few days a month of anger bitchfest for the plus side of things.

      -I’m guessing if doctors/scientist studied things like this they probably wouldn’t find any or much direct reason as to why one birth control pill affects a certain women in a specific way and not others.  The number of factors to take into account seem very very high. 

  5. if it werent for birth control i would be spending more on abortions than all my bills combined, so stop complaining religious zealots

    1.  They’re complaining because they want you to have more babies. It’s 1000 BC, the Middle East is vastly underpopulated. That’s why God wants us to multiply. Get to work!

  6. I am not trying to be silly, but there should be an app for that (cue the bazookas). Has no one created drug timing apps that work?

    When I went through chemotherapy in the late 1990s, my oncologist said that he was absolutely rigid about trying to keep my body in order so that I could get the chemo doses on schedule without any delays. He said he felt the literature showed that consistent timing of doses had an effect on outcome. To that end, I receive white-cell stimulating shots and so forth. We stayed right on schedule. I don’t know how well that’s been studied in the last 15 years.

    1. I don’t use my phone as a pill reminder because I can’t always hear it. E.g. sometimes it’s in the other room charging, or I left it on buzz and it’s too quiet.

      My watch beeps every evening at 6PM. The problem is that if I am distracted – e.g. in a busy checkout line – I turn off the alarm, tell myself I’ll take my pill in a few minutes, and then hopefully I actually remember to do that. Can you make me a cheap, nice looking watch with a snooze button?

      1. I used to take my pill at 6pm too because it was the time I was mostly likely to be both home and awake.  Both my partner and I used to keep our watch alarms set for it, and he would come find me or call to make sure I’d taken it whenever possible.  Snooze button on a watch would be great for this.

        I was very angry at the planned parent hood lady for trying to slow walk me into deciding to take it in the morning when I brushed my teeth.  It was a slow painful walk b/c i don’t jump out of bed and brush my teeth right away, if I’m not about to leave the house I don’t always do it right away. She kept asking me frustrating questions about my morning routine until I finally said “brush my teeth” then jumped all over that.  I tried to explain to her that my class schedule varied a great deal day to day, I had one 8 o’clock class and never got up that early any other day, and I would sleep in a good bit on the weekends, and my schedule would get way out of whack during vacation when thrown off my insomnia or migraines.

        She told me I wasn’t responsible enough to be on the pill.  Yeah.. I was the most paranoid meticulous birth control user I’ve known.  I would use condoms for a week whenever I threw up just in case I’d lost some of my dose (unless it was placebo week of course), even though the clinic said “don’t worry about it.”  I did take my pill late a few times but never by a whole day, and not often.  Granted she creeped me out a lot in general, I really felt like she thought that 19 was somehow way to young to be having sex.  When I told her I was in a monogamous relationship she said “I should hope so” as if anything else was unthinkable.

        I also got really mad at my dentist when he didn’t warn me about antibiotics when I has my wisdom teeth out, when I brought it up he said it wasn’t really a problem.  I used condoms anyway because I am not stupid but it was really irresponsible for him to say.  I know some antibiotics are not as bad for birth control but that’s not what he said, he just dismissed the whole idea.

        1. I’m not surprised.  I’ve worked with some seriously misinformed or uneducated dentists.  Their cont ed requirements aren’t as strict as they should be, I’ve heard a lot of the older ones complain about what a hassle it is, and how when they pay for courses they often don’t bother showing up, because they don’t require the certificates as proof of attendance.  Research findings change all the time, but if someone hasn’t bothered to keep up with new literature, and they graduated 30 years ago, you can’t expect much.  The older ones seem worse, over all, and have some seriously dumb ideas about hygiene and prevention of oral diseases.  As far as I know dentists don’t spend much time in school learning about dental hygiene, their job is not to prevent, but to fix problems once they have already happened.  Do not ever have a dentist clean your teeth, find a dental hygiene clinic or a dental clinic which employs hygienists; not all hygienists are great either, but chances are far better of actually getting a cleaning with a hygienist, especially if it’s a hygiene clinic.  This one fairly newly graduated dentist I worked with, was asked what antibiotics a certain patient needed renewed as prophylaxis prior to some dental work, and his response was “it doesn’t matter, they all do the same”.  As soon as he said that, I said “allergies”, never mind that there is a significant diff between ABs.  That wasn’t/ isn’t even my job.  He looked at me, and ran after the receptionist.  Also, some of the new grads, which work with older dentists who have bad habits, unfortunately learn the wrong things.  Having gingivitis or perio or pockets between your gums and teeth is not normal with age, but you have no idea how many times I’ve heard dentists tell patients that, or how they themselves don’t floss.  Majority of dental clinics I’ve dealt with don’t care much about patient specific care, they only pay attention to the patients’ insurance plans and what they can bill for.  Having said that I have worked with 3 dentists in private practice, who were great at their jobs and didn’t over bill, there were also those from public health, who do amazing work for the community, but you know if a dentist chooses public health s/he isn’t in it for the money.  Any clinic you go to, look around and see how clean it is.  By clean, I don’t mean how flashy it is, because chances are that if a clinic is all spiffed out in flat screens and marble, their actual tools are outdated, and they are over billing to pay for all the renos.  Ask how they disinfect and sterilize the tools and extras, such as counter tops, the safety glasses – which you should be offered, your head rest, etc.  You’d be surprised how filthy some dental clinics are.  Don’t feel weird about asking either, it is your health after all.  Another thing is, some dentists will want HIV soiled tools sterilized twice, but that should not be necessary with the Universal Infection Control Precautions, which basically says that everything should be sterilized the same, because infection control should always have high standards, not just when you’re aware that a patient is HIV or Hep infected.  You never know who has what, and often times, the patients themselves don’t know.  I wish more people took the time to get informed about things, just so they can ask the right questions, but already have educated answers, and if they get told otherwise, be able to question the options offered.  Don’t think of your health care provider as someone who knows it all and makes no mistakes, or that they even care about what’s best for you, because that is often not the case. 

          1.  I liked this. I would have liked it even better with paragraph breaks. I wouldn’t say that to someone who hadn’t written a really good, really informative comment. I’d like to see you get read and listened to more.

        2. Your pharmacist is the one who knows best about drug interactions; it’s our business.  Always have them check for drug interactions and detail the side effects with any new prescription…and try to get all your meds at the same pharmacy, so their computer can catch drug interactions more easily.  If a pharmacy tries to brush off your questions on a new prescription…find yourself a new pharmacist!

    2. There are apps for that, and timers, and really:  life isn’t that regular or routine for most people.  It’s one thing if you’re in cancer treatment, another if you’re talking about a pill you’re supposed to take every single day for multiple years.  Do you want to go ahead and predict exactly what time of day you’ll be awake, and near your pills, every day?

      When I was on the stuff, I took it in the morning, whenever I got up.  That was as close as I got to a regular dosing schedule (and it was close enough; the combined pill isn’t that picky about exact timing).  But it’s really easy to crash at someone else’s place and not have your pill-pack, for example.

  7. Not only is birth control safer than pregnancy, but it is a whole lot more fun to get pregnant when you actually want to do so.  Better for the kids too.

    That said, the best birth control is the vasectomy.  Quick, relatively painless and drug free.  And it works pretty much 100% (1 in 3000 failure rate, significantly better than all other forms of birth control).

    Of course, fellas are a bit fussy about their bits.

    1. If it were easily reversible I’d have it done in an instant. Your comparison is to tubal ligation – not exactly a great way to have kids when you want them.

      1. I thought vasectomy reversal rates were actually quite good?  I’ve seen 99% success rates quoted, although the rates do go down as time passes.

        It’s easier to reverse than a tubal ligation.  The function of the vas deferens is a bit simpler than that of the fallopian tubes.  Plus it’s easier to get to.

        I’m still waiting for a hormonal or other medical method to make men temporarily infertile.  It’s ridiculous that the responsibility of preventing pregnancy is still largely on women…  I know plenty of straight guys who would gladly wear a contraceptive implant because they don’t want to be fathers.  

        Instead, men get a couple of choices:  sterilization surgery and barrier methods.  They can also participate in withdrawal and fertility awareness methods, which are kind of everyone involved’s responsibility.  

        Compare this to the hormonal and non-hormonal methods for women:  all of the above plus progestin or progestrogen only pills, combined oral contraceptives, an implant, IM injections, copper IUD, hormonal IUD, vaginal ring.  Oh, and my least favorite:  spermicides, used with or without a barrier like a sponge or diaphragm.  Even the barriers vary more.

        I’m not saying “oh no poor men, they have fewer choices.”  I’m saying “why the hell, when in general a member of each sex is part of creating a kid, are members of one particular sex expected to make sure it doesn’t happen?”

        1. “Why the hell, when in general a member of each sex is part of creating a kid, are members of one particular sex expected to make sure it doesn’t happen?”

          The short answer as to why there’s not male hormonal birth control is that it’s a lot more difficult than female HBC, for pretty obvious biological reasons: men become fertile and don’t stop being fertile, for the most part, until they die. Women, by contrast, are only fertile some of the time, and “some of the time” is quite easily measured in hormone levels. I’m not a scientist, but that’s the basic gist of it.

          I, being male, would love if there was a pill I could take or a reversible, safe procedure. I would love to have more of the “responsibility of preventing pregnancy”. But those options don’t exist at present, because male bodies simply aren’t designed to stop being fertile.

          1. I’m not saying there are no challenges.  There’s also not much pressure to make it happen.  You’re in the minority here.

            I’m gonna go out on a limb and say if we can make IUDs we can make a device to kill sperm on the way out…  

    2.  I *did* know one couple who had their second child when she was on the pill… so he got a vasectomy. After their third child she got a tubal. After their FOURTH child he became a total meth-head and she dumped him. That seems to have worked, although it might not be ideal for everyone.

  8. I’m also interested in the emotional effects. Severe side effects are one thing, but often it’s the non-severe side effects, not the heart attacks but the uncontrollable drooling or diskinesia or  mood swings that cause people to stop taking drugs. We’ve all observed that hormonal cycles can have a powerful effect on mood. It’s my personal observation that the interaction between hormonal birth control and mood can go either way – some folks get better, some get worse, some lose their sex drive, some ramp it up. Was there any discussion of changes in mood like this in these aggregate studies?

  9. Because birth control lowers risk of heart attacks does not mean it is safer than pregnancy. That is an psudo-scientific assumption and a misleading statement that is unfortunately too common when science is being covered in the media. I expected more from boingboing.

    Though the science is well documented and studied, it is still premature to calculate the lasting effects on women. If an external process is adding hormones not naturally produced by the body or consumed in foods, chances are that there will be an addictive type of response to lack of the hormone or an atypical response, i.e. hormonal instability, and perhaps increased risk of heart attacks once it has been discontinued.

     Though not a drug, hormones therapy could cause the body to react the same way as if a person who has been taking a histamine blocker all their life all of a sudden stops. Their reaction will be worse than that of a person that has the same allergic reactions  who has build a tolerance by never have had taken one. Or it could be similar to what happens to a person on an SSRI or MAOI  who can never stop taking them because their response will be worse than the symptoms that got them prescribed it in the first place. The thing is we do not have enough data.

    Couple this with the fact that estrogenic compounds from birth control is now found in most waterways in the world and the  effect is having on people inadvertently exposed to unregulated amounts and we realize we have tons more research to do.

    1. I don’t think comparing the dangers of birth control to the perils of pregnancy counts as “pseudo-science” on any level. You seem to have carefully overlooked that Maggie herself said that we cannot predict the risks for any particular person, and that the long-term risks and benefits are still being evaluated. She explained that rather well, I thought, and I’d recommend reading it over again. But back to your reductive reasoning: do you think heart problems are the only risks that are being evaluated, and that they are somehow the lynchpin of Maggie’s entry? They’re not. Guess what– women die in childbirth for all kinds of reasons. Women suffer lasting physical trauma from childbirth, also for a whole host of reasons. My good ol’ pappy is a working OB/GYN, and I heard all kinds of horror stories around the dinner table as I was growing up–told in a matter-of-fact tone, of course, as this was Dad’s daily grind– of dangerous miscarriages, grisly births, gruesome deaths, cracked pelvic bones, PTSD, etc. He even had a great one of a woman undergoing a C-Section without anesthesia, since the baby’s heartbeat was fading and they didn’t have time to wait for the meds to kick in (this was before his hospital required all deliveries to happen in Surgery. The baby died anyway, if you care to know). I understand that pregnancy is fairly safe, statistically speaking, but as Maggie has illustrated so well, birth control is far safer. 

    2. When the negative effect of something can barely be distinguished above background noise, you can be fairly certain it’s as harmless as anything else we take for granted as being safe. That cheeseburger you just ate is doing more to hurt you.

    3. Of course birth control is safer than pregnancy…  seriously.  Are you even aware of the risks of pregnancy?  

    4. Oh, I can’t let that last para slide. Firstly, the major sources of estrogenic compounds in the environment are plastics manufacturing and agricultural waste, not the pill. Secondly, isn’t it funny how no-one complains about, say, viagra metabolites entering the water supply?

      1. Yes and no.  True, estrogen mimicking BPA from plastics are a major concern too, however norgestimate and ethinyl estradiol are clearly identified as contaminates in water. 

        I do agree about viagra, and the same can be said for heart meds and anti psyches/ anti depressants. I just stuck to birth control because that was the topic at hand.

    5. You’ve misread. Birth control does not lower the risk of heart attacks. Birth control has a lesser chance of causing a heart attack than pregnancy and is therefore safer than pregnancy in that way.

      Sorry, can’t let that third paragraph slide. People on SSRIs and MAOIs can stop taking them. This does not mean that their response to getting off of the medication will be worse than the symptomsthat got then put on the med in the first place. Both SSRIs and MAOIs are antidepressants and antidepressants can be used short-term.

      Personally I think birth control has some really great things to offer and that the benefits far outweigh the risks.

    6. In addition to everyone else’s points…the number one cause of death in pregnancy is murder by a “loved one”.  Pregnancy is actually a very dangerous and vulnerable condition to be in.

  10. This is kind of unrelated… but reading this intelligent, well-articulated summary of what was probably a lot of science lingo, has made me realise how much I love Boing Boing. Not to mention how long I’ve loved it for. (I’ve been reading it since I was 17-year-old girl and I’m now 25.) With love, a happy mutant. <3 

  11. When I was on an oral contraceptive, I did take it quite regularly and as they advised. Definitely set my phone alarm for 6pm everyday since this was typically a time that I would usually be at home. This went on for about 9 months until I found out that I had multiple blood clots in both lungs. So while pregnancy does increase some health risks, those scary side effects that usually don’t occur are very, very real.

    It turns out that I have a protein deficiency that could have been easily diagnosed if there was a greater emphasis on testing before prescribing. Now I’m completely not allowed to take any type of hormonal birth control and all those medications that you can’t take if you’ve had a history of clots. Yeah, it pretty much sucks.

    So those 6pm alarms? I kept them for about 6 additional months to take my Coumadin. I guess those 9 months made me disciplined enough to remember the more important pill, eh?

    Totally not trying to be a downer, but I would recommend that you get tested for conditions before going on the pill, etc. 

    1. the editor of the british journal of medicine was on george strombolopolous’ ‘the hour’ a couple of years ago, talking about his efforts to draw attention to the complete co-opting of the medical review process by pharmaceutical companies, one of the points he made was that no-where was this more evident than with studies around pharmaceutical contraception.

  12. I want to know what is up with the copper IUDs.  I have an IUD and I really like how foolproof it is, but I really want to get off hormonal birth control.   I feel like my whole life I’ve heard that copper IUDs are dangerous and can make you infertile.  Maybe because my best friend growing up was adopted because her mom couldn’t conceive naturally because of some sort of horrible side effect of her copper IUD.

    1. The damaging IUD design is from 40 years ago and the issue wasn’t the copper it was the string providing bacteria a medium to infect the uterus.

      1. What Adela said. Copper IUDs in use today are not dangerous. There was one particular brand of IUD that was available in the 1970s (and I believe it was plastic, not copper) that had a tendency to allow bacteria to invade the uterus and cause serious illness. It’s not been on the market since the early 1980s. The flaws in the design of that IUD don’t apply to the IUDs for sale today. 

        It’s like early diesel engine cars. One really bum product has scared people off of an entire category of products for decades. 

  13. Since Republicans (forced birthers) do not even want to allow abortion even in case of rape or incest, all women not actively trying to get pregnant need to be on birth control. Otherwise the forced birthers will make the woman bear the “god’s gift” of the rapist. So the Republican not exception policy is the main reason women should insist insurance cover birth control.

  14. The BCP is female specific.  I have friends who have no issues with pills, but I tried about 5 different kinds over a bit more than 4 years and wasn’t happy with any of them.  They all made me more moody, and some made me break out.  I went off pills, for health reasons, I hated what they were doing to me.  When I went off the pill all together, I was a complete mess.  I’d cry a lot and for no reason, felt depressed, and got angry easily.  As much as there has been research done, it’s inconclusive.  I’ve heard many more negative stories about the IUDs tahn the BCPs, with women gaining massive weight, become super depressed, etc.  I never tried those, because the idea of it doesn’t appeal to me, but I have a friend who tried it and had to go off after a short period of time.  There was a website with women discussing IUDs, mainly their negative experiences.  It wasn’t anti-contraceptives, it was there for women with similar negative experiences to discuss and help one another. 
    Someone above mentioned why there isn’t more choice of BC for men.  I’ve always wondered that myself.  I will never go on BCPs again, but they should be available to anyone who wants to take them, and that’s including guys, once those pills hit the market.  I’ve relied on rubbers and timing for about a decade now, and so far so good.  I’m atheist, pro-choice, and don’t want kids.

  15. I took birth control pills for about 15 years. Never had any significant health problems from them. The information packet always included a chart showing mortality rates for women based on what birth control method they used.  I can’t remember the exact breakdown, but I do recall that the pill was the second safest option. The safest option was using simple barrier methods (condom, diaphragm), and then having an abortion when you get pregnant — and you are significantly more likely to get pregnant using those methods than you are on the pill. The group of women with the highest mortality rate were those that had pregnancies and childbirth. 

    The pill does cause problems for some women. But these large population studies show again, and again, that with proper screening (which you should have for any prescription) it’s an excellent option.

  16. I used BCPs for 15 yrs, and it was a life saver.  I had major uterine pain during menstruation and sever mood swings, without them.  If it wasn’t for the pill I couldn’t have lead a normal life. (Least not when my period was going on.) 

    When I got married the first time, my Dr. suggested the Deproprovera?(3 month Birth control shot).   Dangerous Allergic Reactions aside, it made me infertile for 18 months. 3 solid weeks of a Migraine that if it hadn’t of stopped on the day I said it needed to, I would have committed suicide due to the pain. I could not work, I couldn’t get out of BED. No lights, No sound, and barely was able to keep food / water down during that time as well.  3 Weeks of my life spent in a dark, silent room screaming. I wouldn’t recommend that shot to anyone!

    The Dr. put me on a different combo of pills on my 18th month without a period, and with in 2 weeks of starting that pill, I was 1 pregnant and 2 had 2 blood clots in my legs. Apparently I didn’t need a period to get pregnant. Odd that, but as I said, I was an odd patient too.  I can’t take BCPs now, I can’t even LOOK at progesterone for per-menapausal symptoms.

    I ended up getting a Tubal, and my mood swings and depression not withstanding, I still wouldn’t recommend this either. It’s painful, it doesn’t relieve any of my period symptoms. Although I know I won’t have any more kids, it doesn’t help the pain, or the nausea, the crying jags, or any of my severe symptoms.  I want my pre-pregnacy  BCP back.  I can’t do or schedule anything during my period. I can’t even drive due to my heavy emotional termoil.  Makes living life very difficult and I can’t wait til I stop my periods all together.

  17. While BC’s are definitely safer statistically, some women do not tolerate them well.  Women on BC’s should familiarize themselves with the possible side effects…and if any negative symptom shows up, check to see if BC’s could be causing it.  A significant percentage of women endure side effects such as increased anxiety, depression, emotional lability, and headaches without realizing the BC’s could be causing or exacerbating those symptoms. 

    In my case, it was not only necessary for me to avoid BC’s, but to supplement with progesterone (NOT just any progestin, but specifically progesterone itself) to overcome my estrogen dominance symptoms…which had the effect of controlling my anxiety-depression, calming my emotional responses, and shrinking my fibroids.  Huzzah!

    1. While BC’s are definitely safer statistically, some women do not tolerate them well.

      Agreed. Though it’s also worth noting that different pills and types of hormonal birth control use different dosages and formulations and that can have a huge impact on how well an individual tolerates the drug. 

      I didn’t tolerate ortho-tricyclin AT ALL. It made me depressed and crazy. 

      But the Nuva-Ring and I have a long, happy, and healthy relationship. If I have side effects at all from Nuva-Ring, I barely notice them. 

      So people might not have to forego hormonal birth control altogether. They might just need to try a different kind. 

  18. I don’t get the comparison – pill vs. pregnancy.  I don’t see the benefit of this type of risk assessment. Who would decide against birth control and for pregnancy based on minor differences in the risk of a cardiac event?  Or given the results cited above, shouldn’t we stop getting babies and start taking oral contraceptives to reduce the risk of cardiac events?

    A much more relevant question is, do oral contraceptives increase the risk of certain adverse events in comparison to alternative methods of birth control? If yes, are the practical benefits that oral contraceptives may offer over their alternatives worth taking those risks?

    1. The comparison is really about putting the increased risk into perspective. Percentages and numbers are often very abstract and don’t mean much to most people. Say the pill slightly increases your risk of heart attack and people freak out unnecessarily, unless you put that into context. 

      This is a lot like talking about the safety of airplane flights by talking about how much safer it is in comparison to driving a car. You’re not saying nobody should every drive again, you’re just putting the airplane risks (which sound big and scary) into perspective with the risks of something similar that we feel more comfortable with. 

      And hormonal contraceptives are A LOT more effective than any other form of birth control available (with the exception of IUDs and sterilization), especially when you start talking about things like the ring and the patch that are easier to use correctly. So, for most people, the miniscule increase in risk is going to be worth the huge benefit in reliability. 

      1. Comparing oral contraceptives to pregnancy and birth is not like comparing driving to flying. The latter compares two modes of transportation, so the fitting analogy is comparing oral contraceptives to condoms.
        Where I have a problem with this sort of comparison is that pregnancy is probably one of the most risky health condition that a young woman may routinely experience. Therefore it is only natural to provide the means such that taking that risk becomes a voluntary act. However, if you want to put a dimension on the risk of oral contraceptives comparing them to a relatively risky condition seems problematic. For those who try to decide for a type of birth control the risk of birth will be equally abstract than the risk of taking this pill every day for a long time.

    2.  The comparison is because those who try to limit access to birth control are pushing those who cannot get it towards pregnancy. Pregnancy is quite natural and we’ve been doing it for millennia, but it comes with risks, and statistically the risks of a woman using pretty much any type of birth control available are much lower than a woman who chooses to get pregnant. So those who try to keep people off birth control are raising the chance that a woman will have the unwanted pregnancy, and the health risks that go with it. (Or an abortion, but those who are anti-birth control are usually way anti-abortion.)

      I work in an adolescent gynecology clinic, and birth control pills are widely prescribed- not just for contraception but because they are one of the best ways to control menstrual problems- from those who simply have bad cramps to those who would literally die from menstrual bleeding without medical intervention. (Blood transfusions save their life in the short-term, and birth control pills or IUDs control their bleeding in the long term.) Birth control pills with estrogen also can be used for women who have Polycystic Ovarian Syndrome (PCOS), a quite common disorder that involves hormone imbalances. Long-term use of birth control pills has been shown to lower the risks of ovarian and uterine cancer.

      As for alternative methods of birth control, it really depends, as there are so many. For example, the Mirena IUD is quite effective and has very few long-term complications, but many people who haven’t had a baby are leery of the insertion process (which isn’t that bad, really.) Depo-Provera can cause bone loss if used for over 2 years, and also is famous for causing weight gain. Implanon has the common side effect of on-and-off spotting, which some women don’t want. Natural Family Planning can be effective if used properly, but not as effective as other methods, and if people can’t even take birth control pills correctly, most people can’t handle the complexity of it. Condoms are great for preventing STDs but not so great for preventing pregnancy, although they’re certainly better than nothing. When comparing birth control methods, there are pros and cons for each method, and really every woman should have access to a trained health care professional who can help her sort through them and decide what’s best for her, and then have cheap and safe access to that method.

      I went off on a tangent there. Oh well.

  19. There are modern scientific ways for women to chart their fertility that are much better than the old “rhythm method” and let women take control of their fertility to either avoid or facilitate pregnancy. Women report feeling very empowered when they have a good understanding of what is going on inside their bodies and the mystery of human estrous is no longer a mystery. The medical establishment makes more money off selling pills that you have to re-buy every month instead of the very understandable books that are available for purchase that remove the mystery. If  you check any online bookseller with user reviews you will find many satisfied women who use these modern scientific methods of chemical-free empowerment to control their fertility.

    1. anharmyenone, are you really suggesting that a woman make a decision about birth control based on book reviews posted on websites?
      Unless one has access to safe, inexpensive abortion, and feels comfortable emotionally with having one, choosing contraception is a decision made with very careful consideration of failure rates. If you can manage to take a pill a day (or even if you can’t, quite, but get close) you are about 99.9% guaranteed not to get pregnant. And getting pregnant is a very big deal.  

      1.  Any forum comments people make are not medical advice. It is the responsibility of the reader to do her/his due dilligence. I’ve eaten at a kosher deli, even though I ‘m not Jewish. I’ve meditated, even though I’m not Buddhist. I’ve prayed at Shinto shrines, Buddhist temples, Christian churches, and one of these days I’ll get around to praying at a mosque and a synagogue. Sometimes we overlook valid choices just because they are associated with somebody else’s beliefs. The point is we have many choices. Sometimes “the road not taken” is the best one for you, sometimes, not.

      2. Just so ya know, people who leave book reviews online are probably not doctors or scientists, and even if a few are, you can’t verify that.  Just sayin’.

    2. ” If  you check any online bookseller with user reviews you will find many satisfied women who use these modern scientific methods of chemical-free empowerment to control their fertility.”

      Are you serious?  For reals?  Wow.

  20. There’s also the whole mathematical scale challenge – one egg or so a month versus millions upon millions of sperm at the ready.

    (sigh, this was supposed to be in response to tessuraea way up there. Thanks, commenting software…)

  21. Hello, I am the person who was at the meeting who made the comment mentioned above during the Q&A. I want to clarify, maybe I let my personal feelings come across too strongly because I was upset when Dr.  Burkamn said the cost of doing tests to see if a woman is at risk of blood clots due to a preexisting condition was not cost effect to save one life, when that life is your best friend then it sure as hell is. Especially when, like most people that get blood clots, she had the most common genetic defect and it would have taken one blood test to figure that out. Also, I did not say “It can’t be safe.”  I said that given that there are no long term studies of women that have been on the pill consistently (for the reasons mentioned above) and that, at least in my acquaintance, there seems to be an unusual number of women with reproductive issues, I found it hard to believe that there wasn’t a connection. Of course that is my small group of friends and not scientific at all, I know this. Conferences of that type are a good place to voice those sorts of observations and get feedback from professionals. I am just curious to the long term effects.
    Also, I think that the argument that women go on it and then have trouble getting pregnant later is most likely due to a preexisting fertility issue. Again, I am talking about young women (15-16 years old) who start taking it before their cycles have even become all that regular. I think that if a teen went to the gynecologist with irregular periods the doctor would say not to worry because it’s normal (you might not become reliably regular till your late teens) and then put them on BCP to improve their lifestyle. I don’t think you can know for sure that the girl would have grown up to have fertility issues if she wasn’t on the pill. I was trying to point out the possible, and in my opinion likely, connection that taking exogenous hormones for 15+ of your sexually maturing/childbearing years might have unexpected side effects on your body. Not that women should not be using it, that it is more dangerous than any other drug (or driving a car everyday, mentioned as an example by one of the speakers). I was trying to bring up the point that I don’t think we are ready to be completely nonchalant about it either. I take BCPs and will continue to take them and I hope when I am ready to have children that I wont have any issues, but we will have to wait and see. 

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