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Feb 1, 2008

Power of the Pill

THERE WAS a time when society actually believed that women who resorted to taking birth control pills were sexually liberated and having an active sex life. However, perceptions have changed as oral contraceptives, also known as birth control pills, have been a boon for women, especially those who are into family planning.

According to Assoc Prof Dr Jamiyah Hassan (pix), a consultant at the Obstetrics & Gynaecology Department of Universiti Malaya Medical Centre, there has been a lot of medical advancement over the years and the stigma initially attached to the Pill has slowly been erased.

"In terms of family planning in Malaysia, it is what we recommend. Some 70% of the women prefer the Pill as opposed to other methods," says Jamiyah. Other methods here refer to using contraceptives such as condoms and diaphragms or even calculating one's monthly cycle.

"The Pill is still one of the best contraceptive measures around today. More than 70 million women are on the Pill. It is very popular."

Still, the Pill isn't something you can go into a pharmacy and buy over the counter.

"You have to visit a doctor first to discuss all the pros and cons, because not all women can go on the Pill. They can only buy it with a prescription. The Pill is not for women who have a history of breast cancer, liver disease, hypertension or thrombo embolism, or who are very obese and chronic smokers."

This is because the Pill contains estrogen, a hormone that triggers off problems such as embolism.

When the Pill was first produced 50 years ago, it had 50mcg of estrogen. The Pill being manufactured now has oestrogen levels as low as 20 or 30mcg.

The Pill has both oestrogen and progestin (a natural or synthetic progestational substance that mimics some or all of the actions of progesterone). This oestrogen and progestin correspond directly with the woman's menstrual cycle.

The Pill has to be taken from day one of the menstrual cycle. It is packed in such a way that each packet contains 21 tablets meant for 21 days and must be taken daily.

If the Pill is taken as prescribed, there is a 99% chance of preventing pregnancy. Otherwise, the chances of getting pregnant go higher, even if the woman is on the Pill.

Those on the Pill who decide to have a baby just have to get off the Pill. "Studies have shown that the fertility and ovulation rates return to normal from the next cycle. So there is no problem or complication," adds Jamiyah.

Inherent risks involved

* Long-term risks
Previously, the risk of embolism was always present due to high oestrogen levels. But levels of oestrogen in the Pill are now lower, so the risk of embolism is also much lower.

* Short-term risks
Progestin used to cause side-effects like water retention, weight gain, mood changes and so on. But not any more. "Nowadays, we have a pill that contains progestin called Drospirenone. It reduces water retention and reduces the chances of weight gain," Jamiyah says.

This also reduces the painful effect of pre-menstrual syndrome, or PMS.

Other benefits

Oral contraceptives or birth control pills have other benefits as well.

"The long-term benefits are many. It reduces risk of ovarian cancer by 50%," says Jamiyah. "When we ovulate, we produce eggs, it raptures on the surface of the ovary.

"This causes trauma and it has been postulated as one of the possible causes of cancer of the ovaries.

"When you go on the Pill, you don't produce eggs. Because there is no trauma of the surface, it protects you from ovarian cancer."

She also adds that the risk of uterine cancer and benign breast diseases is also much less.

"It also reduces the risk of anaemia. Some patients bleed a lot. When you go on the Pill, you bleed much less. It also reduces pain and congestion."

Doctors can recommend the Pill not only for family planning but also for women with irregular menstrual cycles.

This is provided the patient does not desire to get pregnant at the moment.

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