Pill users live long, have no cancer

The biggest ever study on the Pill proves women who have it live longer and are less likely to get cancer and heart disease than those who don't. But the Indian woman is still not so sure it is good for her. As the Pill turns 50, we shatter some myths, unearth some facts, and discovers that the positives far outweigh the negatives...

Munmun Banerjee Ghosh had to medically terminate two pregnancies in 2007. The 30-yearold Kolkatan is married, but she and her husband were not ready for a child. The first time around, she got pregnant when the couple practised coitus interruptus or the withdrawal method. The pregnancy was discovered within six weeks and the abortion was non-surgical. Her gynaecologist advised her to go on a combined oral contraceptive pill (COCP or simply 'the Pill'), but she was scared it would do her more harm than good.

Six months later, Munmun realised she was nine weeks into another pregnancy. The couple had used a condom, but it tore during intercourse. What followed was a painful surgical termination of the pregnancy, which may or may not have affected her chances of conception, but which definitely left her psychologically scarred. "I finally went on the Pill, this time without much coaxing from my gynae. How I wish I had started taking it when I got married, or at least after my first pregnancy. I could have avoided the second one," says Munmun.

Dr Rajeev Agarwal, director, Care IVF, Kolkata, whom Munmun consulted - and then selected - for the first termination, says, "I can't fathom why women do this to themselves." Seventy five per cent of the women who come to him for consultation on contraception are apprehensive about going on the Pill. "They come with preconceived notions and almost always discuss how 'safe' it is with friends and family before consulting a doctor. So their opening line usually is, "I have heard from people that the Pill is not safe..., " he says.

The biggest myth surrounding the Pill is that using it long term increases the risk of cancer. "On the contrary, the Pill decreases the risk of ovarian and uterine cancer if taken for a minimum of three to five years," says Dr Mukta Kapila, consultant, obstetrics and gynaecology, Artemis Health Institute , Gurgaon. In a new study by The Royal College of General Practitioners - the biggest and most exhaustive ever undertaken on the use of oral contraceptives - 46,000 women were studied for nearly 40 years, creating 'more than a million woman-years' of observation. The researchers found no link between the drugs and an increased long-term risk of dying sooner. The results, published in the British Medical Journal in March this year, showed that over the longer term, women who used oral contraception had a significantly lower rate of death from any cause, including heart disease and all cancers, than women who had never taken it.

A common refrain among Pill users is that it causes weight gain. The fact is that women gain no more than 2-3 kg a year, and that too if they are on the older generation pill, which has a high dose of hormones. The newer progesterone-only formulations rarely lead to weight gain. "Only 7 per cent of the women gain weight, and this can't be attributed to the Pill alone," says Dr Kapila. "If a pill user feels she is piling on kilos she must consult her doctor. Changing the Pill usually solves the problem. "Adds Dr Agarwal, "One must take into consideration one's diet and exercise pattern before blaming the Pill for the weight gain." According to him, Indian women usually go on the Pill when they get married, a period in which lifestyle changes could be the cause for adding all the flab.

Once the weight gain issue is addressed, the next thing women ask is whether the Pill affects fertility. No, say most gynaecologists in unison. A woman who's been on it can conceive within two to three months of going off it, which is the normal mean time period needed for conception in any case. "In fact, the Pill is used to enhance fertility in certain cases where the woman's hormones have gone awry (say in the case of polycystic ovarian syndrome or PCOS) and need to be aligned better, thereby increasing her chances of conception," says Dr Agarwal.

Then there are those who question whether it is safe to take the Pill over long years, or whether they need to take 'breaks'. Contraception needs are different at different stages in life, say doctors. Explains Dr Kapila, "The Pill works best for single and newly-married women who wish to avoid the first pregnancy. On the other hand, married women who have already had a baby can choose from a wide spectrum of contraceptives depending on their medical history and menstrual pattern. So the question of using oral contraceptives (OC) long term does not arise." However, most gynaecologists feel that the efficacy rate of the Pill is higher than any other type of contraceptive method. "It is best for young couples as it is almost 100 per cent effective. Condoms, which are thought by many to be safe, have a chance of failure if not used properly," says Dr Manju Hotchandani, obstetrics and gynaecology, Moolchand Women's Hospital, New Delhi.

What most people don't know is that the Pill is not just a tool of contraception. It is also used in the treatment of several gynaecological disorders. It can successfully treat PCOS, which afflicts roughly 5-10 per cent of women. OCs with antimale hormones are used to regularise periods in these patients. Pills also combat the associated problems of acne and hirsutism. "I gained nearly 15 kg within a span of a year and did not have periods for three to four months at a stretch," says Sangeeta Sharma, 28, a Delhi-based housewife. "To make matters worse, I started getting adult acne, pigmentation and excess body hair. My gynaecologist diagnosed the problem as PCOS. She put me on the Pill - it relieved the symptoms and also helped me conceive," she adds.

OCs also help in the prevention and treatment of follicular cysts. "These cysts - balloons of water that release oestrogen, thereby causing delayed periods - often form during ovulation. We put such women on the Pill for two to three cycles to get rid of the cyst," says Dr Agarwal. The Pill is also used for the treatment of endometriosis - heavy and painful periods in young women - and dysmenorrhea. "Taking it for eight to nine cycles without a break helps bring down the endometriosis level, decreases pain and bleeding, thereby making life easier for these women," he adds.

So relax, take a chill pill, err the Pill, and let it do more than just keep pregnancy at bay.

28 days to freedom
Our grandmothers could have never imagined something as miniscule as the Pill could set them free from the cycle of pregnancy and multiple childbirths that was part and parcel of their conjugal lives. In May 1960, the FDA approved the first oral contraceptive, Enovoid, produced by US company Searle, and women's lives changed forever. It gave them greater control of their bodies and liberated them sexually. They did not have to depend on their partners to exercise birth control and the sexual act no longer brought with it the fear of conception and unwanted pregnancy. It gave them the chance to join the workforce in numbers larger than ever before.

But the Pill had a difficult and controversial start. It was only recommended for regulating menstrual disorders, and usually prescribed only to married women. Religious parties and conservative critics argued that the Pill would promote promiscuity and thus undermine morality.

However, those who saw it as a means of empowering women fought to make sure that the Pill was accepted by society. The sexual revolution that took off in the 1960s played a big role in this change. Gradually, the Pill came to be seen as an expression of women's liberation. Today, over a 100 million women globally pop the Pill, but in India, of the 49 per cent women using modern contraceptive methods, only 3.1 per cent are on the Pill. Time for change?