Is there any ideal method of preventing pregnancy that would meet all the postulates? It can be stated that despite the clear progress, still for many couples proper contraception is unavailable or unacceptable. So there is no ideal method of preventing pregnancy. The consequence of this is the annual number of 50 to 60 million abortions throughout the world.
Hormone-containing pills are now the gold standard for contraception
When, in the early 1950s, Pincus and Djerasi laid the foundations for the production and marketing of the first birth control pill, it was obvious that their product first had to effectively prevent pregnancy. That is why the inventors of the pills in their first products placed large doses of progestagens and estrogens (Enovid - the first contraceptive pill, contained as much as 0.150 milligrams of estrogens in the form of mestranol). As it turned out later, a very high hormone content in contraceptive pills was the direct cause of thromboembolic events. Large doses of hormones and non-selectively acting first progestogens caused a number of adverse reactions, making life difficult for patients. Although more than fifty years have passed since the introduction of pills, the essential feature of hormonal contraception must be its effectiveness.
From the sixties to the end of the twentieth century, leading research centers and pharmaceutical companies tried to propose to the patients contraceptive pills with almost 100% effectiveness, which - on the other hand - would be very safe for users and increase their quality of life (including through anti-acne, limitation spotting / intermenstrual bleeding, elimination of breast pain and water retention in the body). In carrying out these plans, the dose of estrogens was reduced in contraceptive pills and new, selective progestogens (noreghtimat, desogestrel, gestodene, dienogest, drospirenone) were introduced. It seems that there are already very effective and very safe contraceptive pills on the market that meet almost all the criteria of "ideal contraception", yet gynecological clinics still apply for contraception to terminate pregnancy. It turned out that many patients have problems with the ideal adherence to the principle of daily use of birth control pills. Many of the surveyed patients, even several times a year, forgot about taking pills. In this situation, the invention and introduction of contraceptive patches to the market, which should be changed only once a week, was to meet the needs of patients having difficulties in perfectly respecting the rules of using pills.
Hormonal contraception and the risk of venous thrombosis
There is one problem associated with the use of two-component hormonal contraception, which, like a boomerang, returns to the specialist press and the daily press. The problem is the risk of thrombotic events.
Initially, it was thought that this risk is directly proportional to the estrogen dose contained in the birth control pill. But it turned out that taking some contraceptives containing the lowest dose of estrogen, did not give a lower risk of thrombi than the use of preparations containing higher doses of these hormones. As it turned out later, also the second component of the pills (progestagen) may have a slight increase in the risk of blood clots. But when the risk of blood clots is discussed in women using binary contraceptive pills, the scale of this phenomenon must be known.It is known that in young, healthy non-smoking women, the risk is 0.016% (i.e. one case for about six and a half thousand women using pills for one year), while even in women who do not use birth control pills, there is a risk of blood clots (one case per year for about 25,000 women). During pregnancy, the risk of blood clots is much higher and amounts to 0.06% (four times higher than in women using birth control pills). It should also be added that the risk of blood clots is clearly increasing (above the risk resulting from the mere adoption of birth control pills) in women who smoke cigarettes and in obese women.
The possibility of complications of hormonal contraception
Complications may occur after taking any medicine (even taking vitamins does not guarantee avoiding side effects). A large proportion of complications can be avoided if a thorough medical examination is carried out before taking the pills. However, in the professional literature it is stated that the use of birth control pills increases the risk of cardiovascular disease (thrombotic disease, coronary artery disease), hypertension and stroke. It seems that such consequences were much more common in women using older types of pills. Another complication of hormonal contraception is the possibility of a jaundice (very rarely, you may develop jaundice within 2-3 weeks of using the birth control pills, which usually disappears when you stop taking the pills). Sometimes there is also a drug-induced menstrual decline. According to some sources, taking contraceptive pills slightly increases the risk of breast cancer and cervical cancer. When discussing the possibility of complications associated with the use of hormonal contraception, it can not be overlooked by the silence of the whole group of benefits that may result from the use of hormones.
Thanks to thorough epidemiological research, it is now obvious that the balance of possible benefits and risks of using hormonal contraception is clearly beneficial and the benefits far outweigh the risks.
Author: Dr. med. Medard Lech, gynecologist-obstetrician
