“The Pill”: Long-Term Impact

By Harleen

The contraceptive pill catalysed a sexual revolution. Women in the 1960s were granted newfound sexual liberty by effectively making pregnancy a woman’s choice and taking away the fear of unwanted or unplanned pregnancy. This colossal shift in sexual practice and family planning triggered a religious, scientific and political backlash. However, women continued to ask for and take “the pill”; and it is now used by over 100 million women worldwide. Whilst there is a reasonable pool of information about its immediate and short-term side effects, there is considerable concern about its long term effect on fertility and other risks it may pose to health.

Does “The Pill” permanently affect fertility?
As the contraceptive pill is used to induce temporary infertility, there is understandably a concern that it may have a long-term effect on fertility. Fortunately, the pill has been around for long enough enabling large and long-term studies to have taken place. These studies refute the anecdotal accounts of delayed return to fertility, after stopping oral contraceptive use. In fact, a large European study which followed 60,000 women after stopping (combined or progestin-only) oral contraceptives, found that 20% of women were able to become pregnant in their first cycle after pill cessation. 80% of all women were able to become pregnant in the first year after pill cessation. Whilst women will be older when they stop taking an oral contraceptive, as compared to when they started taking it, and age is known to have a major impact on fertility; this study found that the data on pregnancy rates was comparable to women who had never taken an oral contraceptive. In other words, the rates of pregnancy are heavily impacted by age, irrespective of the use of oral contraception.

What about the C-word?
Cancer is another, reasonable concern – and the pill has been implicated as a risk factor for certain types of cancer. However, it is also thought to be protective against other forms of cancer.

Are there any other life-threatening conditions?
Simply put, yes. The combined oral contraceptive pill contains oestrogen, which has been recognised a major risk factor for developing venous thrombo-embolism (i.e. blood clots which can travel around the body). These clots can cause myocardial infarction (i.e. heart attacks) when they occur in the coronary arteries, and they can cause cerebrovascular accidents (i.e. strokes) when they occur in the cerebral arteries. This risk is thought to increase with higher doses of oestrogen, and it continues throughout the duration of oral contraceptive use. A Cochrane review recommended that the combined oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed—that is, 30 μg ethinylestradiol with levonorgestrel – as this has the lowest risk of leading to blood clots.

What happens if I take the pill back-to-back?
The Faculty of Sexual and Reproductive Healthcare suggested that whilst this may be associated with symptoms such as breakthrough bleeding and bloating, there are no concerns about the safety profile of running pill packs back-to-back. “Tricycling” (i.e. taking the pill for 9-weeks, followed by a 1-week break) has been practised for decades and is preferable for some women, although others feel more comfortable with a monthly bleed. Studies have found that the metabolic, hormonal and endometrial effects of continuous pill use, are similar to those who use the pill in cycles.

A final note
No drug is perfect. The contraceptive pill is often used in the treatment of various health conditions, such as endometriosis, polycystic ovary syndrome and acne. Whether you take it by choice or out of necessity, it would not be prescribed unless the net benefit was thought to be greater than the overall risk. Non-hormonal contraceptive methods are not without inconvenience or risk either, so it ultimately comes down to what is most acceptable to you.

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