 |
| Catherine Bagley, DO Commonwealth Ob/Gyn Specialists |
The pill was the first medication approved by the FDA for long-term use
in healthy patients and it still functions as a go-to drug for many different
clinical situations. The pill works primarily through influencing the hormones
that cycle in women naturally, estrogen and progesterone. There is a
progesterone-only pill that works somewhat differently than the combined
hormone pills and is an appropriate clinical choice for patients unable to take
estrogen.
Estrogen stabilizes the uterine lining, reducing breakthrough bleeding
and significantly lightening bleeding for each month that patients are on the
pill. Eventually, researchers discovered that estrogen also inhibits the
development of eggs and helps to prevent ovulation. This combination of effects
resulted in a treatment for menstrual disorders as well as providing
contraception. Today, there are many different combinations of the amount of
estrogen as well as the amount and type of progesterone available in different
medications, including a combination transdermal patch and a removable vaginal
ring.
In the development of the pill, a hormone-free week was built into each
month in order to provide the patient with reassurance that she was not pregnant.
During this week, a patient may take placebo pills or no pills at all. Typically, she will bleed during this week,
and some patients will mistake this for a period, when it is not. The hormones
in the pill prevented ovulation and stabilized the lining of the uterus; the
bleeding that may occur is merely the uterus responding to the withdrawal of
the hormones. When I counsel adolescent patients about the use of the pill, I
often answer questions from patients’ mothers about the safety of continuous dosing,
i.e. avoiding the week of inactive pills built into a typical four week pill
pack. Historically, that week of bleeding was considered normal, but continuous
dosing is very safe and is an excellent option for many patients. Some of the
newest versions of combined pills are designed to minimize bleeding,
representing a shift toward recognizing not only the safety of continuous use,
but the importance of giving women more control over their cycles.
For many women, periods interfere with school, life, and/or social
activities. Whether a woman suffers from
heavy bleeding, painful periods, fatigue due to chronic anemia (because of
heavy bleeding), headaches, or mood changes, the pill can often help alleviate
those symptoms. Pelvic pain, either because of painful periods or other
conditions, such as endometriosis or fibroids, is one of the leading causes of
women missing school and work. Many patients who are treated with the pill are
able to function at the level they were accustomed to prior to the pain. Continuous
use of pills can resolve the symptoms of pre-menstrual dysphoric disorder for
many patients.
Beyond controlling reproductive cycles, there are other benefits to the
pill. These include: the potential to slow excess hair growth and acne because
they suppress production of the male hormone, prevention of menstrual
migraines, improving bone mineral density, normalizing irregular periods, and
allowing women to avoid having their period at inconvenient times, such as
during a business trip, vacation, or honeymoon.
The scientific evidence shows that the longer a woman uses the birth
control pill, the lower her risk for developing endometrial and ovarian cancer
later in life, up to 20 years after discontinuing use. The pill also seems to
offer some short-term protection against colorectal cancer among current or
recent users. Women using the pill for non-contraceptive benefits, generally
return to fertility soon after discontinuing the medication. On the opposite
side of the coin, women who have completed child bearing and may be entering
the perimenopausal state can benefit from the hormone balance the combined pill
provides. Because of recent legislative changes, most every financial barrier
to the pill has been eliminated, which is terrific news for our patients.
All medications carry some degree of risk and it is important for
patients to know whether or not the pill is safe for them. Early formulations
of the pill contained high levels of hormones; the pills available today have
approximately one third the amount of estrogen as the first version of the
pill. Estrogen carries very specific risks that are increased in certain
patient populations. Patients with a history of any bleeding disorders,
especially venous thromboembolism (VTE), deep venous thrombosis (DVT), and/or
pulmonary embolism (PE), are not candidates for combined pills. Patients who
are over the age of 35 and are smokers are also not candidates for combined
pills. For these patients, the estrogen
in the pill increases their risk of developing blood clots.
In addition to the medical risks that medications carry, there are
typically side effects that can dictate whether or not someone is able to
tolerate a medication that has been deemed clinically appropriate and safe for
that patient. Side effects of the pill
are interesting because some of them are the very symptoms that the pill helps
to improve. They can include: nausea,
vomiting, hypertension, headaches, mood changes, and alterations in libido. If
patients fail therapy with the pill, there are other options. With advances in
minimally invasive operative technology, in addition to procedures that have
been performed for many years, definitive surgical treatment is available to
some patients. However, not every patient is an ideal surgical candidate; for
those patients as well as the patients who want to avoid surgery, a different
version of the pill (or a different delivery method of the combined hormones)
may be a viable alternative.
For further inquiries about the pill, contraception or
general gynecology, contact Catherine Bagley, DO, of Commonwealth Ob/GynSpecialists at 804.285.8806, or visit their website at commonwealth-obgyn.com.
No comments:
Post a Comment