A Case for Oral Contraceptives

Oral contraceptives (OCPs) have been available since the late 1950s, yet arguably never has their use been more hotly debated. In the past few weeks, the question of whether insurance plans should be mandated to cover contraception has sparked a nationwide debate. The arguments have extended beyond the sphere of politicians and their commentators, to include medical practitioners, religious leaders, and even twenty-something year-old law school students. Why all the hype, when the U.S. has so many other issues to solve? What happened to the economy, the environment, the education system?

That’s not an answerable question, or at least it’s not one I’m seeking to address here. After all, women’s health and the relationship between a woman and her womb (or what may reside within her womb) have always been controversial, to say the least. Instead, I was curious about how and what percentage of women use OCPs for reasons unrelated to contraception.

Indeed, the function of OCPs is not limited to birth control. In fact, the first combined oral contraceptive pill was FDA-approved for treating menstrual disorders and infertility, not as a form of birth control. Enovid first appeared on the market in 1957 and worked by delivering large amounts of estrogen. Increased levels of estrogen trigger a negative feedback system that actually stabilizes the endometrium—the inner membrane of the uterus that thickens prior to menstruation in preparation of pregnancy. Such stabilization of the endometrium via androgen, estrogen, or progesterone delivery systems may serve the only relief for women who have heavy periods accompanied by painful cramps or infertility issues.

It wasn’t until four years later, in 1961, when Enovid became available as a contraceptive. With that came a new era of using OCPs for their now-eponymous function: contraception. That being said, it is still fairly common for women to use OCPs for their non-contraceptive benefits.

According to a report published by the Guttmacher Institute in November 2011, 86% of women using OCPs use them for birth control. 58% of women use OCPs for reasons additional to birth control, and 14% of women who use OCPs use them solely for non-contraceptive reasons. This means approximately 7 million women in the U.S. use OCPs, in part or wholly, to attenuate cramps, menstrual pain, and/or acne, to regulate the menstrual cycle, or to combat an even more serious condition.¹

What are some of the conditions that OCPs can help alleviate? Dysmenorrhea, the typical “cramps” that women complain about during their periods, can be so serious that it forces women to take paid time off. In fact, approximately 10% of women regularly miss work and remain bedridden as a result of dysmenorrhea. Moreover, anemia remains a longstanding problem for women with heavy periods. The rapid loss of red blood cells over just a few days can result in dizziness, fatigue, and headaches, all symptoms that negatively affect a woman’s performance at work. As a result, many women utilize OCPs to manage their menstrual cycle, if only so they can concentrate in the office.²

For teenage women finishing out puberty, primary care physicians oftentimes prescribe OCPs to help control acne. Similarly, hirsutism, or the growth of hair in unusual (androgenic) places, is a less common condition that can be controlled using OCPs. In both cases, androgen regulation can down-regulate the oil-producing glands that lead to excessive acne and abnormal hair growth.

Perhaps most seriously, endometriosis can be relieved by OCPs. When the endometrium - the inner membrane of the uterus - grows beyond the uterus and along other pelvic areas, the result is severe abdominal/pelvic pain, irregular periods, and even scarring. If the post-endometriosis healing process effects the anatomy of the uterus - e.g. if fibrous growths hinder the passage of egg from ovary through fallopian tube to womb - then infertility can and oftentimes does result.

Finally, long-term OCP use is associated with decreased risk of osteoporosis, ovarian cancer, and endometrial cancer. Of course, correlation does not indicate causality, nor does correlation recommend the extended use of OCPs to manage the health concerns of the elderly. Yet history dictates that more needs to be taken into consideration when considering “the pill.” Indeed, it is ironic that a drug originally engineered to treat infertility has now become a hot-button issue in terms of birth control, yet perhaps the debaters are losing sight of the bigger picture. OCPs, despite the name, are not about contraception. They’re about the regulation of various hormones, which involves far more than making sure babies aren’t part of the equation.

Image credit: Audrey Kao

1. Jones, Rachel K. "Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills." Guttmacher Institute, Nov. 2011. Web.

2. "Period Pain 'cripples Women's Careers'" Mail Online. The Daily Mail. Web. 28 Apr. 2012.

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