The ABCs of Oral Contraceptives

"The Pill works; it's safe; it's easy to use; and it even provides noncontraceptive health benefits," said ACOG President Douglas W. Laube, MD, MEd. "Our goal is to reach women with the basics—The ABCs of OCs. When it comes to birth control, the Pill might very well be a woman's best friend." The Pill leads the way as the most popular method of reversible birth control and is used today by more than 11 million women in the US, he added.

Speakers answered top consumer questions about oral contraceptives (OCs) and provided updates on the various brands available, hormonal contraception for women with special health concerns, attempts to limit women's access to contraception, how to choose birth control over a woman's lifespan, and newer methods of hormonal contraceptives. Highlights included the following:

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Although a majority of women have used the combined pill (estrogen and progestin) at some point in their lives, many women still question its safety and remain confused about its associated risks and side effects. But according to Dr. Hillard, more research has been done on the Pill than on any other medication in history. The bottom line: over 40 years of data has shown that oral contraceptives are a safe and appropriate option for most women.

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Because informed patients tend to have better outcomes, experts advise revisiting the issue of contraception at least on an annual basis and at times when a woman's contraceptive needs may change, such as postpartum and perimenopause. According to ACOG, women with underlying medical problems should work closely with their ob-gyn to determine what contraceptive methods are right for them.

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"Not only is the Pill 99% effective in preventing pregnancy when taken correctly, but it also provides many health benefits beyond contraception," said Dr. Hillard. The combination pill reduces the risk of a number of health problems, including cancers of the uterus and ovary; ovarian cysts; pelvic inflammatory disease; bone loss; benign breast disease; symptoms of polycystic ovary syndrome; ectopic pregnancy; and anemia (iron-poor blood). "Another perk of the Pill is that certain brands help balance hormone levels, which control acne," added Dr. Hillard.

"Menstrual suppression—taking a birth control pill each day of the month to stop a woman's monthly period—has become increasingly popular among women. For some women it's a matter of convenience, and for others, menstrual suppression provides significant relief from migraines or painful periods. The other value-added benefit of menstrual suppression is a reduced risk of ovarian cancer," noted Dr. Nelson.

Also, according to Dr. Kaunitz, healthy, nonsmoking, perimenopausal women who may be good candidates for the Pill may experience additional noncontraceptive benefits such as increased bone density; treatment of irregular perimenopausal bleeding, heavy flow, and/or painful cramps; reduction of hot flashes; and prevention of ovarian, uterine, and possibly colon cancers.

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"When it comes to the Pill, one size doesn't fit all, and it doesn't need to. With over 40 brands currently on the market, women have options," said Carolyn L. Westhoff, MD, professor of ob-gyn and epidemiology, population, and public health at Columbia University's College of Physicians and Surgeons and attending physician and medical director of family planning at Columbia Presbyterian Medical Center in New York.

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"Of course, the Pill is not for every woman, and no one contraceptive method will meet every woman's needs," noted Vanessa E. Cullins, MD, MPH, MBA, vice president for medical affairs for Planned Parenthood® Federation of America in New York. "As versatile as the Pill is, it may not suit some women to have to take it every day. If that's the case, women can choose from several other methods of hormonal delivery, such as injections, the vaginal ring, and the skin patch."

Dr. Cullins also assessed the impact of the contraceptive most recently approved by the US Food and Drug Administration (FDA) in July 2006: ImplanonTM, a matchstick-like rod inserted into the upper arm by a health care provider that is up to 99% effective in preventing pregnancy. It works for up to three years by releasing a continuous low dose of progestin in a woman's body, blocking ovulation and thickening cervical mucus so sperm cannot enter.

ImplanonTM is the only implantable birth control method available in the US. It has been used by about 2.5 million women in more than 30 countries since 1998 and is expected to be widely available throughout the US by early next year.

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"Birth control is basic health care; it's not a 'frill.' A woman needs contraception to protect both her health and quality of life," noted Dr. Laube. "It's a medical necessity for women during 30 years of their lifespan. To ignore the health benefits of contraception is to say that the alternative of 12 to 15 pregnancies during a woman's lifetime is medically acceptable.

"If this country is truly committed to preventing unintended pregnancies and reducing the number of abortions, we must all become more aggressive advocates for women to ensure that contraception is there when they need it," noted Dr. Laube.