Oral contraception is convenient, highly effective and vigorously promoted but has always incurred risks, some of which are still controversial decades after the method was introduced. To understand the issues and decide what is best for you, you need to stand well back from the day-to-day practicalities and look at how contraceptive pills affect your system.
In your loins at the embryo stage of your development were two loaf-shaped pieces of tissue with special survival functions. The adrenal and sex glands which derive from them make for you a series of steroid hormones whose chemistry shares the same basic structural pattern. Production of these is controlled by another range of hormones from the pituitary gland, a key junction box in your primal adaptive system (Leaflet S22) suspended between your nose and your brain. This control system works on a negative feedback principle. Too much steroid hormone reduces your pituitary output of control hormone, which dampens the steroid gland’s over-production. All varieties of the oral contraceptive pill take advantage of this negative feedback mechanism. The usual form contains a pregnancy-hormone (progestogen) combined with a woman-hormone (oestrogen), to trick your brain into believing that more than enough sex hormone is circulating already. So the pituitary stops producing the control hormones and your ovaries cease working. That is why it is such an effective contraceptive.
In effect, the pill puts you back to the stage before you started menstruating. The loss you see each month is not a period but a withdrawal bleed, deliberately contrived by the pill-free week. In market research surveys before the pill was launched, many women expressed misgivings about having their periods abolished altogether, despite their inconvenience. Imitating a menstrual loss overcame this market resistance and appeases you for loss of a normal function. It is in any case safer not to continue medication relentlessly, which further justifies the pill-free week. That alone does not make the pill safe. There is a good deal of commercial interest riding on the issue so that scientific considerations get blurred and confused. Animal research cannot be trusted for such a widely used long-term medication and few human studies have met all the criteria of good science; researchers cannot treat masses of people as experimental animals.
But any continuous mass-medication that profoundly alters a basic function must introduce risks. The pill alters bleeding, over-distends veins which can cause migraine (Leaflet P68), chronic leg discomfort and varicose veins (Leaflet P92), and can alter immune function (Leaflet S11) enough to precipitate allergy (Leaflet P12). By disturbing mineral balance, reducing zinc (Leaflet F06) and raising copper levels in particular, it can predispose you to schizophrenia (Leaflet P82). It makes thrush more likely (Leaflet P91). It may increase a young woman’s risk of cancer (Leaflet P44) in the neck of the womb (cervix) or breast when she is older, though this is hotly disputed.
The progestogen-only pill takes advantage of the feedback mechanism that prevents you from conceiving again when you are pregnant already, by making your secretions and womb lining hostile to sperms and fertile eggs. The side effects are fewer and your ovaries still function, but more erratically.
What to do
1. Contraception cannot abolish risk but exchanges one kind of risk for another. As methods go, the pill minimizes your risk of pregnancy but converts it into exceptional risk of unwanted effects. Be sure you need its guarantee or else choose something less risky. The long-term risks are greatest if you start very young.
2. Ovaries whose function is already precarious may give up altogether after pill use. Avoid it if your cycle is long or irregular, especially if you may later want a child.
3. The continuous pill (progestogen only) is both less effective and less risky because it does not stop your ovaries working, but it sometimes upsets menstrual rhythm and causes erratic bleeding.
4. Take supplements (Leaflet F03) of Zinc (15mg daily — Leaflet F06) and Vitamins B (Brewer’s Yeast 6-9 tablets daily — Leaflet F05) and C (500mg twice daily — Leaflet F04) to cater for increased needs and losses while on the pill, and add Vitamin E (200IU twice daily, Leaflet F18) when you come off it.
5. The Intra-Uterine Contraceptive Device (IUCD, Coil) is a piece of plastic inserted into your womb cavity which makes it much more hostile to pregnancy. Insertion and removal can scratch your womb lining which may spoil a later pregnancy. Sometimes people conceive with a coil in place. Go for the all-plastic type that does not have to be changed at intervals. You may get many trouble-free years from one, but do not depend on conceiving again after long use — low-grade infection or inflammation (Leaflets S12 and 13) may by then have made this impossible.
6. The cap and spermicidal cream can be very effective and user-friendly, if used every time. It does not prevent sperm getting to your womb but makes their journey much longer and more hazardous. Have it fitted properly and check the fitting after each pregnancy and if your weight changes in either direction. Wear the cap all the time except briefly every evening to clean and cream it and of course during your period. Do not take it out within eight hours of intercourse. Check it for pin-holes and tears every day and get a new one every six months.
7. The sheath serves many couples faithfully for years but should be backed up with spermicidal pessaries since tears are rather common. Most couples prefer something safer and less intrusive.
8. The least artificial contraceptives are high dosage Vitamin C (1000mg or more three times daily) taken continuously, which enhances the effectiveness of any other method; and fresh yeast taken with Pennyroyal tea at period time, which stimulates womb activity and makes menstruation more certain. They are not fail-safe, even when combined. Take barrier precautions during your fertile phase, which you should learn to recognize from a competent instructor. Full advice is available at your Family Planning Clinic, or from the Natural Family Planning Association (Address S20).