Washington, DC -- The birth control pill, the most studied medication in the world, reaches its 50-year milestone this month. Since the introduction of the pill in the US, numerous types of hormonal and nonhormonal contraceptives have been developed, all greatly expanding women's birth control options. Originally intended solely for pregnancy prevention, decades of research have shown a host of health benefits from the birth control pill and other forms of hormonal contraception, including cancer prevention and relief from menstruation disorders.
"The pill proved to be revolutionary—its societal effects were prompt and profound in the 1960s," said David A. Grimes, MD, of Family Health International in Durham, NC. "With the advent of the pill, women were given the opportunity to safely and effectively plan their pregnancies instead of relying on less effective methods. The pill also opened the door to novel delivery systems for hormonal contraception, including the injectable, implantable, and transdermal."
In May 1960, the US Food and Drug Administration (FDA) granted approval to a pharmaceutical company for the marketing of the first oral contraceptive. The early versions of the birth control pill contained nearly four times the amount of estrogen and nearly ten times the amount of progestin as current formulations of the pill today. Five decades later, there are more than 40 different FDA-approved birth control pills, including branded and generic versions. The pill also led to the development of a wide range of other hormonal contraceptives, including transdermal patches, the vaginal ring, implants, injections, and intrauterine devices (IUDs), that have broadened women's options.
The original birth control pill was approved to be taken daily for 21 days followed by seven days of placebo pills. This regimen allowed women to experience monthly uterine bleeding that mimicked a normal period, even though they did not actually ovulate. Today, the majority of oral contraceptives are still taken the same way, but newer versions have been formulated to include fewer hormone-free days and some are FDA-approved for menstrual suppression to reduce or avoid monthly periods altogether. "In the near future, we're likely to see variations in pill-taking regimens and different estrogens and progestins," Dr. Grimes said, "but no radical changes are in sight."
According to Hal Lawrence, MD, Vice President of Practice Activities at The American College of Obstetricians and Gynecologists, "While pregnancy prevention may be the foremost reason why a woman might use oral contraception, she is also protecting her future health. For example, the longer a woman is on the pill, the greater her protection against ovarian cancer. Long-term pill use can lower the risk of ovarian cancer by about 40%, and possibly up to 80% for women who take the pill for a decade or more."
The pill also reduces the risk of endometrial cancer—the most common gynecological cancer in the US—by up to 50% and protection may last up to 15 years after discontinuing it. Women on the pill also have a reduced risk of pelvic inflammatory disease requiring hospitalization, acne, benign breast disease, and ectopic pregnancy. The pill also helps prevent anemia, heavy uterine bleeding, and endometriosis pain. Experts believe that many of the other types of hormonal contraception confer similar health benefits as the pill.
"The noncontraceptive health benefits of the pill have been one of the most important public health stories of the last century," said Dr. Grimes. For instance, in both the US and United Kingdom, rates of endometrial and ovarian cancer should be rising due to later childbearing and fewer children per women. "But rates of both cancers are declining, presumably due to the use of the pill by tens of millions of women." In fact, according to Dr. Grimes, recent studies from the Royal College of General Practitioners have shown a net reduction in cancers and significantly greater longevity among pill users.
Emergency contraception (EC) is another "offspring" of the pill that is used to help prevent pregnancy among women who have been raped or had a contraceptive failure. Many existing oral contraceptives, as well as the IUD, can be used as EC.
The pill remains one of the safest and most popular forms of contraception in the US. No other single medication has empowered American women and impacted their quality of life as has the pill. "The challenge ahead is to improve more widespread and consistent use of contraception in the US to help reduce the number of unplanned and undesired pregnancies," said Dr. Lawrence.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org
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