I recently overheard a group of women, obviously friends in their 20s and 30s, talking about birth control pills — which types they had tried, which ones they liked, which brands had unpleasant or dangerous side effects. When was the last time you had such a conversation with your girlfriends… or with your doctor?
If you are heading toward menopause, you are due to have that discussion with your gynecologist, I was told by Richard P. Dickey, MD, PhD, chief of reproductive endocrinology and infertility in the department of obstetrics and gynecology at Louisiana State University Medical School. Reason: Recent research provides surprising revelations about the benefits and risks of oral contraceptives. So if you are not taking “the Pill” now and thought that you were too old, you might want to reconsider. If you are on it, you need to make sure that it is still safe, given your lifestyle and medical history… and also make sure that the type you are taking has minimal side effects for you.
Have you heard? To minimize the risk for an unintended pregnancy, you should continue to use birth control until one full year has passed without a menstrual period. And despite what many women think, oral contraceptives do not delay the onset of menopause.
Here’s what you need to know now about oral contraceptives…
The Pill recently celebrated its 50th birthday (like many of its users), and it is taking middle age quite well despite earlier fears that it might be detrimental to users’ long-term health. Evidence: A recent study in BMJ (British Medical Journal), which involved more than 46,000 women who were observed for up to 39 years, found a significantly lower rate of death from any cause among women who had ever used the Pill, compared with women who had never used it. Also, a study published in Contraception found that oral contraceptives strongly protected against death from uterine cancer and ovarian cancer. Surprisingly, many of these protective effects persisted for years after users stopped taking the Pill — which means that oral contraception often is a particularly good choice for women with a family history of uterine or ovarian cancer, Dr. Dickey said.
Good news for the perimenopausal: Combination estrogen/progestin oral contraceptives (the most common type) alleviate many annoying menopausal symptoms, including hot flashes, night sweats and vaginal dryness… and also may help midlife women maintain muscle tone in the pelvic floor, which is important for preventing incontinence. Bonus: Oral contraceptives (particularly the low-dose type) often lighten perimenopausal menstrual periods or make them stop altogether.
All birth control pills are not created equal — different brands have different ratios of estrogen to progestin — so if one brand causes side effects for you, talk to your doctor about other options. For instance, Dr. Dickey said, developing migraines might mean that your pill has too much estrogen… developing depression, fatigue or increased appetite might suggest too much progestin.
Some studies indicate that being overweight interferes with the contraceptive effects of the Pill. To reduce pregnancy risk, overweight women may be advised against using a low-dose formulation and also should be careful to take their pills exactly as prescribed, Dr. Dickey suggested.
Important: Many drugs and supplements (including acetaminophen, antibiotics and St. John’s wort) can interact with progestin, reducing the Pill’s effectiveness. Be sure to tell your doctor about any medications or supplements you take.
Who should not use the Pill: If you are over age 35 and a smoker, oral contraception is not an option for you — there is a clear link between Pill users who smoke and an increased risk for breast cancer, cardiovascular disease and potentially life-threatening blood clots. Also: Oral contraceptives containing estrogen are not appropriate for women with a history of heart disease, uncontrolled hypertension, blood clots or estrogen-dependent cancer. It is not that the Pill is believed to cause those conditions, Dr. Dickey said, but rather that it can exacerbate existing conditions. Some women with such conditions can take a progestin-only oral contraceptive, however, so discuss this possibility with your doctor.