OC - The Benefits and Risks

OCs are among the most thoroughly studied drugs in the world. The vast body of data collected on them indicates that although they do have certain side effects, few women are likely to experience them. Moreover, most of the information on side effects was collected from studies of higher dose pills than those generally in use today. And research done in the Pill's early years involved women who had not been screened to see if they were good candidates. Today, women with a personal or family history of heart disease or other illnesses linked to the Pill are usually steered towards another method of birth control. If you are healthy, you don't smoke more than 15 cigarettes a day, and no one in your family has suffered from cancer, a heart attack, or very high cholesterol, you may never experience any of the more serious side effects.

The Pill can produce both "nuisance" side effects and more serious health problems. Included among the more serious potential effects are increased risk of cervical and liver cancer (and possibly breast cancer—studies so far are inconclusive), heart and blood vessel disorders (clots and high cholesterol), high blood pressure, increased blood sugar levels, complications with the liver and gallbladder, cervical changes (increasing your risk for sexually transmitted diseases), eye problems, and delays in fertility once pills are discontinued. Some women at risk for these complications can continue taking OCs if they use them cautiously. Your doctor should be able to help you determine whether or not you should avoid the Pill.

Cancer: Women who have used OCs sometime in their lives are less likely to develop cancer by age 55 than women who have never taken the Pill. Oral contraceptives really do protect against certain kinds of cancer. If you use OCs for at least a year, your risk of developing endometrial cancer diminishes by 50 percent and it drops even more after three years of Pill use. The protection lasts up to 15 years after you stop using OCs.

Ovarian cancer, the most lethal of all female reproductive tract cancers, is also 40 percent less likely to develop in a woman who has used OCs. Even if you use OCs for as little as three months, you get some protection, but to get the full effect you need to take them for 5 to 10 years. If you use them for 10 years, your risk is reduced by 80 percent. The protection lasts for at least 10 to 15 years after discontinuation.

Endometrial and ovarian cancer are not the most common female cancers. Still, an estimated 2,000 cases of endometrial cancer and 1,700 cases of ovarian cancer were averted by Pill use in the 1980s.

OCs do not protect women from cervical cancer. In fact, the opposite may be true. Women who take the Pill for over a year appear to run an increased risk of developing this disease, the risk doubles when the medication is taken for 10 years. However, the most important risk factors for cervical cancer are not OCs, but rather the number of sexual partners a woman has had and how old she was when she first had sex. Exposure to human papillomavirus (HPV) and smoking also increase a woman's risk, while the use of barrier contraceptives, such as a diaphragm, condoms or spermicides protects against cervical cancer. It is difficult to determine the impact of these factors in women with cervical cancer who also used OCs, so research results have not been definitive. One study conducted by the Centers for Disease Control and Prevention (CDC) showed that women who used OCs didn't get cervical cancer more often than non-users. Instead, the higher rate of cancer diagnosed among these women was simply due to more careful screening, including more frequent Pap smears.

One woman in 9 will develop breast cancer during her lifetime, so it's not surprising that breast cancer is the main concern of anyone considering use of OCs. Unfortunately, despite a large body of scientific evidence showing no association between the two, a few studies have seemed to uncover an increased risk of breast cancer among those using OCs. Researchers aren't sure if these studies are important or if they are merely aberrations. It will probably take a decade or more before they reach a definitive conclusion. Many experts do agree that OC use is not associated with breast cancer after age 45. Some younger women, however, may be at higher risk. Several studies have shown that women who use OCs early in life, use them for longer than four years, and/or don't have a full term pregnancy early in life have a slightly increased risk for breast cancer. (However, other research concludes the opposite.)

OC use has been implicated in a rare form of liver cancer known as hepatocellular carcinoma. However, since so few people ever develop this cancer, it has been difficult for researchers to determine with accuracy whether OCs were actually the cause. The largest study to include data about hepatocellular carcinoma found no association with OC use. In addition, death rates from liver cancer in the United States haven't changed since the introduction of OCs to the marketplace in the 1960s.

Despite a suggestion that OC use might lead to skin cancer, follow-up studies indicate no difference in the risk for Pill users versus nonusers. There is also no proven relationship between OCs and kidney cancer, colon cancer, gallbladder cancer, or pituitary tumors.

See Your Doctor If... Here is an easy-to-remember acronym to help you determine whether to consult your doctor about what could be pill-related complications. Seek help if you experience jaundice, a breast lump, or any of the following warning signals: A - Abdominal pain (severe) C - Chest pain (severe), cough, shortness of breath H - Headache (severe), dizziness, weakness, or numbness E - Eye problems (vision loss or blurring), speech problems S - Severe leg pain (calf or thigh) Source: Contraceptive Technology. Ardent Media Inc., New York, NY, 1998.

Heart and blood vessel disorders: Although concerns about cancer are usually foremost in the minds of women using OCs, the Pill's effects on blood chemistry are actually a greater cause for worry. Both the hormones in combined OCs are responsible for these problems, but in different ways.

The progestin component of OCs can alter the level of lipids (such as cholesterol) in the blood. Although estrogen works against this effect by increasing beneficial high-density lipoproteins (HDL) and lowering harmful low-density lipoproteins (LDL), progestin opposes the estrogen and does the opposite. Because high levels of LDL and depressed levels of HDL can cause fatty plaque to build up in the arteries, progestins have been implicated as a risk factor for coronary heart disease.

The estrogen component has been linked to a different problem: an increase in abnormal blood clotting, which can block circulation. A blood clot can appear in any blood vessel, but it is especially serious if it occurs in the brain, heart, or lungs.

Clots or blockages to blood flow can lead to serious and sometimes fatal complications that are usually associated with the following risk factors:

• Family history of heart attack or diabetes

• Previous heart or blood vessel disease

• Smoking

• High blood pressure

• Overweight

• Inactivity (either from too little exercise or from being immobilized)

If you have any of these risk factors, you should ask your physician whether the benefits from taking the Pill outweigh the possible dangers. Doctors and private clinics usually make this decision on a case-by-case basis. Public clinics may have stricter rules against giving OCs to women with certain risk factors.

Here is a description of the symptoms you might experience if you are suffering from a blood clot or blockage, and the technical name your doctor might use to describe it. If you think you have one of these problems, seek medical attention as soon as possible.

• Headache, impairment of the intellect, visual problems, weakness or numbness—Cerebral infarction (stroke)

• Chest pain, difficulty breathing, left arm and shoulder pain, weakness—Myocardial infarction (heart attack)

• Calf pain or swelling, heat or redness in the thigh, heat or tenderness in the lower leg, pain— Thrombophlebitis

• Chest pain, cough, shortness of breath— Pulmonary embolism

• Abdominal pain, vomiting, weakness— Mesenteric vein thrombosis

• Headache, loss of vision—Retinal vein thrombosis

• Cramps, lower abdominal pain—Pelvic vein thrombosis

High Blood Pressure: Although in itself not a life threatening condition, Pill-related high blood pressure—experienced by up to 5 percent of women taking high-dose pills—can lead to heart disease and stroke. If your blood pressure is over 140/90, you should stop taking OCs until it is under control. All women using the Pill should have their blood pressure checked once a year; for women with a history of blood pressure problems, a check once every six months is probably in order.

Increased Blood Sugar Levels: Estrogen and progestin not only can affect blood clotting and blood lipids, they can also raise blood sugar levels. Most experts believe these changes are so minimal, they have no clinical significance. For women with diabetes, however, the situation isn't so straightforward. Some doctors believe that diabetic women with no other risk factors can use OCs with minimal trouble, but others believe prescribing OCs to diabetics exposes them to unnecessary risks.

Liver and gallbladder complications: OCs can cause jaundice—a liver condition that makes the skin and eyes look yellow—but only 1 in 10,000 Pill users experience Pill-related jaundice. OCs can also cause another rare liver condition known as hepatocellular adenoma. The risk of developing this condition is about 3 or 4 per 100,000 Pill users. Liver cancer is another rare complication. Gallbladder disease, which is fairly common among users—and non-users—of the Pill, is not life threatening but could require surgery.

Cervical changes: The thickness and strength of the cervical lining varies with the ebb and flow of reproductive hormones; and OCs can lead to an increase in the area of thin, vulnerable cervical tissue susceptible to sexually transmitted diseases (STDs). Most doctors recommend you use condoms for STD prevention while taking the Pill to prevent pregnancy, especially if you have more than one sexual partner and if you are less than 25 years old.

Eye problems: Use of older, high-dose OCs occasionally caused an inflammation of the optic nerve, resulting in blurred or double vision, swelling, pain, or even loss of sight. This almost never happens with today's OCs. However, any loss of vision warrants an immediate discontinuation of the Pill and a visit to an ophthalmologist or neurologist. You should also stop taking the Pill if a vision problem accompanies a migraine headache.

Returning to fertility: For most women, fertility comes back quickly after discontinuing OCs. However, 1 percent to 2 percent experience some delay in the return of normal reproductive cycles. In rare instances, hormones can stay suppressed for months or even years, though for the majority, menstrual cycles normalize within three months. Cycle suppression is more likely to cause infertility in older women, so if having a child is a high priority, you might consider switching to another reliable contraceptive method as you approach 30.