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Risks Of Hormonal Birth Control

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The use of OCPs has been associated with an increased risk of cervical intra-epithelial neoplasia and cervical cancer.49 OCPs most likely act as a co-factor in the development of this disease. Oral contraceptives are classified by the International Agency for Research on Cancer as a cause of cervical cancer.50 There are many possible reasons why OCPs increase the rates of cervical cancer. Although HPV appears to be the strongest factor in the causation of the disease, not all women with HPV develop cervical cancer. Oral contraceptives have been postulated to be one mechanism whereby HPV exerts its oncogenic effect on cervical tissue. The OCPs may bind to HPV DNA to either increase or suppress transcription of certain genes.51 Other studies show that OCPs may accelerate the cervical maturation process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.52 Still other studies show that long-term use of OCPs may lead to a more frequent persistence of HPV.53

A population-based cohort study of over 10,000 women showed positive correlation of HPV prevalence with older age and current use of OCPs. This study occurred in South Africa where cervical cancer rates are among the highest in the world.57

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After years of taking the same brand of pill, Yasmin, with no issues, a change in price caused her to try an IUD, before ultimately returning to her original pill.

But the second time around, Miller experienced emotional side effects, including depression and moodiness. She stopped the medication, but still wanted to use a reliable method to prevent pregnancy, so she turned to her gynecologist for guidance.

made a comment about how if I wasnt on birth control, I might as well start taking prenatal vitamins, she says. It was passive aggressive, but also didnt help me in thinking about what my other options are. That broke the trust with me, I didnt feel safe to talk to her to discuss options.

Bryna Harwood, director of the family planning division and program director for the obstetrics and gynecology residency at Cedars-Sinai Medical Center, said its critical for patients to feel comfortable and confident bringing those kinds of concerns to their providers and just as important for providers to meet them.

I would encourage women to speak up, and if your provider is not listening, there are other providers, she said.

This story was updated with additional data on the prevalence of contraceptive methods.

How Do I Change To A Different Pill

If you want advice about changing your contraceptive pill, you can visit a GP, contraceptive nurse , or sexual health clinic.

You should not have a break between different packs, so you will usually be advised to start the new pill immediately or wait until the day after you take the last of your old pills.

You may also be advised to use alternative methods of contraception during the changeover, as the new pill may take a short time to take effect.

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How Does Birth Control Work

Each form of birth control works slightly different. Some of the ways it works include:

  • Preventing sperm from reaching an egg.
  • Preventing your ovary from releasing an egg.
  • Damaging sperm so it cant swim to an egg.
  • Thickening your cervical mucus so sperm cant swim through it.
  • Changing the thickness of your uterine lining so an egg cant implant.

Weighing The Pros And Cons Of Birth Control Pill Use

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Birth control pills have some risks including a small increased risk of breast cancer . However, in addition to preventing pregnancy, birth control pills decrease the risk of uterine and ovarian cancers .

Before making any decisions about birth control pills , talk with your health care provider about the benefits and risks.

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Does The Pill Increase Your Risk Of Cancer Research Shows That Women Who Use The Birth Control Pill Have A Slightly Increased Risk Of Breast Cervical And Liver Cancer

The pill and breast cancer risk

Women who use the birth control pill may have a small increased risk of breast cancer. The risk is smaller for women who used the birth control pill after their first full-term pregnancy.

The pill and cervical cancer risk

The risk appears to be greater for developing early stage cervical cancer than it is for more advanced forms of the disease.

The pill and liver cancer risk

Women who took birth control pills for more than 5 years before doses and formulas changed may have a slightly higher risk of developing liver cancer.

What Is A Birth Control Pill

The Department of Health and Human Services defines birth control pills, also known as oral contraceptives or just the pill, as types of medications taken daily by women in order to prevent unwanted pregnancies. While the majority of women choose to take birth control pills so they dont risk becoming pregnant accidentally, a small percentage also take them for other reasons, including to regulate or temporarily stop their menstrual cycles or reduce symptoms associated with PMS and/or hormonal imbalances .

As of 2012, in the United States alone around 11 million women report using birth control pills, and the number is more than 100 million women worldwide! The total number of women exposed to any type of synthetic hormonal contraception is even higher, since most figures dont account for women using the morning-after pill a type of high-dose hormonal birth control available in the United States without a prescription since 2000. Surveys show that women most likely to take the pill are white women, women in their teens and 20s, never married and cohabiting women, childless women, and college graduates.

Types of Birth Control Pills

There are dozens of different brands of birth control pills, with most falling into one of two categories: combined pills or progestin-only pills.

Combined birth control pills:

Progestin-only birth control pills :

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Women not using oral contraception compared to women using third-generation oral contraception

Among the other various negative effects of the hormonal methods is difficulty regulating a womans testosterone levels even when she no longer uses the method. Researchers have found that abnormally low amounts of unbound testosterone caused by the use of the Pill persist after women cease using it. Womens bodies use testosterone, as mens do, to regulate sexual function, though in far lower amounts. Report coauthor Dr. Irwin Goldstein clarified: This work is the culmination of 7 years of observational research in which we noted in our practice many women with sexual dysfunction who had used the oral contraceptive but whose sexual and hormonal problems persisted despite stopping the birth control pill.5

It Requires Consistent Use

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Unlike hormonal birth control methods such as implants and injections, nonhormonal options require some planning since they must be used each time you have sex.

Whenever you skip your chosen method, theres a chance you might get pregnant.

No question is too small to ask your doctor, whos a valuable resource in your decision-making process. Possible queries include:

  • Is hormonal birth control safe with my medical history?
  • How often will I need to refill my prescription?
  • Is there any type of medication that can make birth control less effective?
  • How can I manage side effects?
  • Can I change from one hormonal option to another?

If you write down your questions as you think of them, its easier to remember them during your appointment.

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Tips For Maximum Benefit

Here are tips for getting the most benefit from your acne treatment:

  • Continue taking other acne treatment prescribed by your doctor. An oral contraceptive targets only part of the acne problem.
  • Be sure to precisely follow the schedule for taking birth control pills. Doing so provides the maximum benefit and safety.
  • Talk with your doctor about possible side effects of the birth control you’re considering. These can include breast tenderness, headaches, breakthrough bleeding, or an initial, temporary flare-up of acne. It’s important to know what to expect.
  • Tell your doctor about any other medications you’re taking. Some can interfere with the effectiveness of an oral contraceptive and lead to an unwanted pregnancy. Taking some types of birth control pill together with oral rifampin may make it necessary to use a back-up form of contraception.

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Is It Safe To Use Birth Control Indefinitely

Most people can safely use hormonal contraceptives for many years, provided their doctor has recommended it.

However, many long-term birth control methods contain hormones. This can cause problems depending on a persons medical history, age, and overall health. Doctors may advise some people to avoid using certain types of birth control.

If a birth control pill causes side effects, people can speak to their doctor and change pills until they find one that works for them.

People with a history of blood clots may prefer progesterone-only birth control pills or the hormone-free IUD.

There are several long-term birth control options. All hormonal methods of birth control, including the pill, patch or implant, may cause similar side effects and long-term risks.

There is no one best method of birth control. The best option depends on a persons lifestyle and medical history.

Most long-term birth control options involve the use of hormones. The hormones work in two main ways: stopping ovulation and thickening the cervical mucus, which makes it difficult for the egg and sperm to meet.

Long-term non-hormonal options are also available, including the non-hormonal IUD.

Long-term contraception methods include the following:

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What Are The Most Effective Forms Of Birth Control

The most effective form of birth control is to not have sexual intercourse . Even for the most motivated couples, this can be difficult to maintain. So, its important to have a backup form of birth control in mind.

Birth control only works when you use it correctly and consistently. Forms of birth control that are more convenient and dont require much maintenance are usually most effective. These forms include the birth control implant, intrauterine devices and sterilization.

Methods of birth control like fertility awareness or pulling out are least effective at preventing pregnancy.

Doubling-up on birth control is typically best like using a condom and a birth control pill. Thats because youre protecting against STIs, using a barrier method, and taking hormonal medication all at the same time.

Increased Breast Cancer Risk

Birth Control Side Effects

According to the National Cancer Institute Surveillance Epidemiology and End Results, breast cancer is the most common female cancer in the U.S. and worldwide. According to rates obtained from 2005 to 2007, the lifetime risk that a woman will develop breast cancer is 12.15 percent . Another way to look at the data is to say that 122.9/100,000 women will develop breast cancer per year .22

Cervical cancer prevalence varies depending upon where the patient lives. For example, in Eastern Africa, cervical cancer is the leading cause of death from cancer, while in developed countries, the rates are lower. Worldwide, the International Agency for Research on Cancer estimates that 15.3/100,000 women will develop cervical cancer worldwide per year. In Africa, the rate increases to 25.2/100,000 women.23 According to the SEER data, in the U.S., 8.1/100,000 women will develop cervical cancer. For blacks, this rate increases to 10.1/100,000 women and for Hispanics, 12.0/100,000 women.24

Uterine and ovarian cancers occur at higher rates in the U.S. than they do worldwide, but they still lag way behind breast cancer, which is by far, the most frequently occurring cancer in the U.S. and worldwide. The incidence of uterine cancer is 23.5/100,000 women. The lifetime risk of developing uterine cancer is 2.58 percent .27 Ovarian cancer incident rates are 12.8/100,000 women. The lifetime risk of developing ovarian cancer is 1.39 percent .28

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What Is Known About The Relationship Between Oral Contraceptive Use And Cancer

Nearly all the research on the link between oral contraceptives and cancer risk comes from observational studies, both large prospective cohort studies and population-based casecontrol studies. Data from observational studies cannot definitively establish that an exposurein this case, oral contraceptivescauses cancer. That is because women who take oral contraceptives may differ from those who dont take them in ways other than their oral contraceptive use, and it is possible that these other differencesrather than oral contraceptive useare what explains their different cancer risk.

Overall, however, these studies have provided consistent evidence that the risks of breast and cervical cancers are increased in women who use oral contraceptives, whereas the risks of endometrial, ovarian, and colorectal cancers are reduced .

Who Can Use The Combined Pill

If there are no medical reasons why you cannot take the pill, and you do not smoke, you can take the pill until your menopause. However, the pill is not suitable for everyone. To find out whether the pill is right for you, talk to a GP, nurse or pharmacist.

The pill may not be right for you if you:

  • smoke and are 35 or older
  • stopped smoking less than a year ago and are 35 or older
  • are very overweight

The pill may also not be right for you if you have :

  • blood clots in a vein, for example in your leg or lungs
  • stroke or any other disease that narrows the arteries
  • anyone in your close family having a blood clot under the age of 45
  • a heart abnormality or heart disease, including high blood pressure
  • severe migraines, especially with aura
  • disease of the gallbladder or liver
  • diabetes with complications or diabetes for the past 20 years

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How Could Oral Contraceptives Influence Cancer Risk

Naturally occurring estrogen and progesterone stimulate the development and growth of some cancers . Because birth control pills contain synthetic versions of these female hormones, they could potentially also increase cancer risk.

In addition, oral contraceptives might increase the risk of cervical cancer by changing the susceptibility of cervical cells to persistent infection with high-risk HPV types .

Researchers have proposed multiple ways that oral contraceptives may lower the risks of some cancers, including

  • suppressing endometrial cell proliferation
  • reducing the number of ovulations a woman experiences in her lifetime, thereby reducing exposure to naturally occurring female hormones
  • lowering the levels of bile acids in the blood for women taking oral conjugated estrogens
Selected References
  • Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. American Journal of Obstetrics and Gynecology 2004 190:S522.

  • Does Taking The Progestogen

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    Fewer people use the progestogen-only pill. This makes it more difficult to find out about its effects on cancer risk.

    We need more research to know if the progestogen-only pill could slightly increase the risk of breast cancer in a similar way to the combined pill.

    The progestogen-only pill could also increase risk of cervical cancer, but we need more evidence to understand if there is a link.

    Research has not linked ovarian cancer or womb cancer to progestogen-only products.

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    What Other Information Should I Know

    Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor’s directions for examining your breasts report any lumps immediately.

    Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives.

    If you wish to stop taking oral contraceptives and become pregnant, your doctor may tell you to use another method of birth control until you begin to menstruate regularly again. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. However, it is possible to become pregnant within days of stopping certain oral contraceptives. If you want to stop taking oral contraceptives but do not want to become pregnant, you should begin using another type of birth control as soon as you stop taking oral contraceptives. Discuss any questions that you may have with your doctor.

    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

    The Preventive Care Mandate

    The new government contraceptive mandate requires that we, as physicians: 1) treat a normal physiologic function, fertility, as if it were a disease 2) consider OCPs as preventive medicine and 3) as we have demonstrated, violate our Hippocratic Oath to do no harm.

    Regarding the premise that fertility is not a disease, we have a scientific culture that has always compared the risks of contraception to the risks associated with pregnancy. Why has this convention been so successfully used? Shouldn’t the risks of contraceptives be compared to the non-pregnant state? In other words, when we evaluate the risk of VTEs with OCPs, for example, why is this compared to the risk of VTE during pregnancy instead of during the non-pregnant state? Is it because the problems associated with OCPs will then appear smaller than they otherwise would? And, is it also because pregnancy and fertility have successfully been positioned as disease states rather than natural phases in the reproductive cycle of a human being? Perhaps a more appropriate comparison would be between OCPs and modern methods of delaying pregnancy .

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    Risks Of Hormonal Contraceptives

    While there generally are more pros than cons to the use of hormonal birth controlâwhether as a pill, patch, or intravaginal ringâit may not always be the best option for women over 40.

    One of the major concerns is that ongoing exposure to estrogen may increase the risk of stroke and thrombosis in older women. This includes life-threatening deep vein thrombosis and pulmonary embolism .

    According to a 2011 review in Pediatrics, perimenopausal women on the pill have between a three- and five-fold increased risk of thrombosis compared to women under 35 who take the pill. 

    Estrogen-containing birth control pills are also associated with a 20% increased risk of breast cancer, especially if taken for more than five years. High-dose estrogen and triphasic pills pose the greatest risk overall. While it is unclear if estrogen-containing patches or rings can increase the risk of breast cancer, most experts believe the risk is low.

    Ethinyl estradiol can also be hard on the liver and cause injury to women with acute liver disease. The risk appears to be limited to the pill, which is metabolized by the liver, rather than patches or rings, which deliver estrogen directly to the bloodstream.

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