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         THE BIRTH CONTROL PILL: HOW DOES IT WORK? IS IT SAFE?
                        by Paul Weckenbrock, R.Ph.
                 Copyright 1993.  All Rights Reserved.

              Reprinted Electronically via Permission of 
                     John F. Kippley, President, 
                     The Couple to Couple League

        Controversy has surrounded "the Pill" ever since it was
        first marketed in the United States in 1960. It has
        been studied medically, sociologically and morally, and
        yet much confusion still exists concerning these potent
        artificial steroids. The billions of dollars at stake
        in the marketing of the Pill and the power of the birth
        control industry to lobby both lawmakers and the media
        can easily divert the average person from the truth.
        Research has been published, books have been written,
        and common sense should make one cautious.

        The following information is presented to raise
        awareness about the Pill. Footnotes are marked with
        asterisks; all footnotes appear at the end of this
        document in a section titled REFERENCES.

        ------------------------------------------------------

        What is the Birth Control Pill?

        The Birth Control Pill is any drug which uses
        artificial hormones to keep a woman from getting
        pregnant or from staying pregnant by interfering with
        her normal fertility.

        ------------------------------------------------------

        Are all forms of the Pill the same?

        No. There are several types of the Pill on the market,
        but they basically break down into two groups:
        combination pills and the progestin-only "minipill."

        The combination type contain two artificial steroids
        that mimic the effects of naturally occurring hormones,
        estrogen and progesterone. Some pills work in a
        "monophasic" way, keeping the dosage of hormones the
        same throughout the pill cycle. Others work in a
        biphasic or triphasic manner which alters the dosage of
        artificial hormones two or three times respectively
        through the cycle of pills, attempting to produce
        fluctuations similar to what a fertile woman would
        undergo naturally.

        The progestin-only "minipill" uses only one artificial
        hormone, progestin, which is a steroid that has a
        progestational effect similar to natural progesterone.

        ------------------------------------------------------

        How does the Pill work?

        The Pill is designed to interfere with several  normal
        functions of fertility in order to make a woman 1)
        unable to conceive due to temporary sterility or sperm
        immobility, and/or 2) unable to carry a pregnancy to
        term(an early abortion). This process can be
        accomplished in various ways.

        1. Suppressing Ovulation: When a woman ovulates,
        hormones released from the pituitary , a gland located
        at the base of the brain, stimulate her ovaries to
        ripen and release an egg. The combination pill usually
        interrupts the release of these pituitary hormones
        resulting in no egg being released from the ovary, thus
        preventing pregnancy from occurring. With no egg
        available for fertilization, the woman is chemically
        sterile. The progestin-only pill, however, has a
        weaker effect. It generally does not suppress
        ovulation.*1*

        2. Inhibiting Implantation: Another important aspect of
        fertility is the process by which the lining of the
        uterus is replenished and maintained. After an egg is
        fertilized, it normally implants in this lining
        (endometrium), drawing nourishment and sustenance. The
        progestin component of the combination pill and the
        progestin-only minipill cause the inner lining of the
        uterus to become thin and shriveled, unable to support
        implantation of the embryo(newly fertilized egg).*2*

        3. Impeding Sperm Migration: Preceding ovulation, a
        woman's cervix produces a watery mucus through which
        sperm swim to meet the egg. The mucus also provides
        nourishment to sustain the life of the sperm cells.
        This mucus thickens under the influence of a progestin
        and so impedes sperm migration.*3*

        There are two other factors in a woman's fertility that
        may be affected by the Pill.

        4. Making changes in the Fallopian Tubes: Progestins
        lower the efficiency with which the fallopian tubes
        propel eggs from the ovaries toward the uterus. This
        can cause the embryo not to reach the uterus in time to
        implant successfully.*4*

        5. Stopping a Pregnancy: After an ovary releases an
        egg, the woman's cycle is controlled by a gland that is
        formed from the now-empty egg sack, the corpus luteum;
        this normally functions long enough to give an embryo
        time to implant in the uterus and for the placenta to
        begin to support the pregnancy.

        However, hormones from the Pill can cause the corpus
        luteum to function inadequately, allowing the lining of
        the uterus to be shed before the embryo can
        successfully implant.*5*

        In summary, a woman's natural fertility requires
        several systems and organs to coordinate smoothly. The
        synthetic chemicals in any type of birth control Pill
        interfere with this coordination, adversely affecting
        her normal fertility and any "accidental" conceptions.

        -----------------------------------------------------


        How effective is the Pill?

        In theory, the Pill reaches an effectiveness of over
        99%, but in practice the rate is much lower. Between
        1.9% and 18.1% of women will experience an unplanned
        pregnancy in the first year of using the Pill.*6*

        Surprise pregnancies with the Pill are due to a number
        of factors. Interactions between the Pill and some
        other medications interfere with the proper blood
        levels of hormones necessary for their birth control
        effect. These drug interactions may be significant with
        the commonly used "low dose" Pill where slight
        alterations in hormonal blood levels can result in more
        frequent ovulations and hence unplanned pregnancies.
        Another factor in Pill pregnancy rates is not following
        directions, sometimes due to the lack of motivation,
        especially in younger women (ages 15-24).

        ------------------------------------------------------

        Is ovulation always suppressed?

        No. Ovulation occurs in 2% to 10% of cycles of women
        taking the Pill.*7,8,9,10,11,12,13*  If 60 million
        women worldwide are on the low-dose Pill, there would
        be 1.2 to 6 million ovulations per cycle. This is known
        as breakthrough ovulation, and it is even more frequent
        with the progestin-only Pill.*14,15*

        ------------------------------------------------------

        What happens when ovulation does occur?

        When the Pill fails to prevent ovulation, the other
        mechanisms come into play. Thickened cervical mucus may
        make it more difficult for the sperm to reach the egg;
        however, if the egg is fertilized, a new life is
        created. The hormones slow the transfer of the new life
        through the fallopian tube, and the embryo may become
        too old to be viable when it does enter the uterus.

        If the embryo is still viable when it reaches the
        uterus, under-development of the uterine lining caused
        by the Pill prevents implantation. The embryo dies and
        the remains are passed along in the next bleeding
        episode which, incidentally, is not a true menstruation
        even though it is usually perceived as such.

        ------------------------------------------------------

        Does this mean the Pill can cause an early abortion?

        Yes. Preventing the newly conceived life in its
        embryonic stage from being transported to the uterus
        and preventing  implantation in the wall of the uterus
        are the "abortifacient" properties of the Pill.

        Why haven't I heard about this before?

        ------------------------------------------------------

        The Pill manufacturers and many in organized medicine
        are mainly concerned about the Pill's medical side
        effects and its effectiveness in preventing pregnancies
        and are less concerned  about how the drug achieves its
        effectiveness.

        Unfortunately, many "otherwise" pro-life physicians and
        pharmacists find it hard to admit that these
        abortifacient properties exist because they would have
        to discontinue prescribing and dispensing the Pill if
        they were to remain consistent in their respect for
        life at all its stages of development.

        Pro-abortion organizations and their lawyers readily
        admit the early abortion potential of the Pill. In
        February 1992, writing in opposition to a Louisiana law
        banning abortion, Ruth Colker, a Tulane Law School
        professor, wrote, "Because nearly all birth control
        devices, except the diaphragm and condom, operate
        between the time of conception...and implantation..,
        the statute would appear to ban most
        contraceptives."*16* In 1989, attorney Frank Sussman
        argued before the U. S. Supreme Court that ". . . IUDs
        [and] low dose birth control pills. . . act as
        abortifacients."*17*

        ------------------------------------------------------
        ------------------------------------------------------

        Is It Safe? What are the common side effects of the
        Pill?

        There is a range of risks from serious or fatal to
        minor and trivial. The following is a list of the most
        common side effects experienced by women taking the
        Pill. These effects are dose related and not every
        woman will experience them, but the risks still
        exist.*18,19* The synthetic estrogens of the
        combination Pill cause many of these; the progestin
        causes others and is the only risk factor in the
        progestin-only Pill (and the progestin-only implant,
        Norplant).

        ------------------------------------------------------

        Heart and blood abnormalities

        Blood Clots can form, restricting or blocking the flow
        of blood to critical organs and other body systems,
        possibly causing permanent damage. For example, a blood
        clot in the heart would cause a heart attack; in the
        brain it would cause a stroke or brain hemorrhage; a
        clot which moved from elsewhere in the body and lodged
        in the lung would cause a pulmonary embolism; in the
        kidneys a clot would cause a renal artery thrombosis
        and kidney damage; in the retinal arteries it would
        cause temporary or permanent blindness.

        Studies continue to indicate approximately a 2-fold
        increased risk of fatal heart attacks among users of
        the current low-dose pill when compared to non-
        users.*20* This risk is lower than the risk experienced
        with the older high dosage pill, but it continues to be
        significant. Similarly, the risk of a fatal brain
        hemorrhage is increased 1.4 times when comparing users
        to non-users. Among women who smoke, there is a 12-fold
        increase in fatal heart attacks and a 3.1-fold increase
        in fatal brain hemorrhage.*21*

        High Blood Pressure and alterations in the blood
        clotting mechanisms may be seen in women on the
        Pill.*22*  This may contribute to a 3-11 times
        increased risk of developing blood clots in Pill users
        compared to non-users. The risk is especially great for
        women who smoke and/or are over 35 years old.*23*

        ------------------------------------------------------

        Cancer

        Breast cancer has been repeatedly associated with using
        the Pill.*24,25,26,27,28,29,30,31*

        Breast cancer has been increasing at an alarming rate
        in recent years, especially among young women. "Breast
        cancer will kill more than 44,000 American women this
        year alone," a 1991 report noted,*32* predicting
        175,000 more new cases, "especially among young women."

        Why is there such an increase of breast cancer among
        younger women? Note first that women rarely develop
        breast cancer shortly after they start taking
        artificial hormones. It is generally not until ten or
        more years after usage was initiated that women develop
        breast cancer. Then note that in the United States,
        since the mid-1970s, it has been common for the Pill to
        be prescribed for girls in their teen years. Common
        sense connects the link between giving the Pill to
        young girls in the 1970s and the later increase in
        breast cancer 15 to 20 years later among women in their
        late twenties and thirties. This conclusion was
        demonstrated in a study which found that Swedish women
        who took the Pill in the 1960s incurred a five times
        greater increase in breast cancer when compared to non-
        users.*33*

        The increased risk of breast cancer is seen in younger,
        nulliparous women (never having borne children), and in
        long duration groups (greater than five years) of Pill
        users. Large tumors and a worse survival rate are
        associated with the Pill's use at an early age.

        Will the newer formulated low-dose pills decrease the
        incidence of breast cancer? A consensus of
        understanding has not been reached, and another 10 to
        20 years of experience with women using this form of
        the Pill must be gained before more definite
        conclusions can be reached.

        Breast tenderness, enlargement, lumps, and milk
        secretions also may occur in women using the Pill.
        Doctors are warned not to prescribe the Pill to women
        who are "known or suspected" to have breast cancer.*34*
        It is difficult to say what aggravating effect the
        Pill's hormones would have over a truly random sample
        of women taking the Pill.

        Cervical Cancer and cervical dysplasia increase among
        women who use the Pill.*35,36,37,38,39*   How long the
        Pill has been taken, how many sexual partners a woman
        has had, at what age she began having intercourse,
        whether she smokes, the hygiene of sexual partners and
        the transmission of the human papillomavirus(HPV) are
        also factors in cervical abnormalities. Because of
        these several factors, the  connection of the Pill and
        cervical cancer may be clouded over. However, there is
        no doubt that the promotion of the Pill has resulted in
        early intercourse which may be the more direct cause of
        cervical cancer.

        Endometrial and Ovarian Cancer appear to have a lower
        incidence in both women on the Pill and in those who
        have been previous users of the Pill. Much of this data
        comes from studies of women who were using the higher
        dose estrogen/progestin Pill. Currently the low dose
        monophasic and triphasic pills (less than 50mcg of
        estrogen) are the only birth control pills available on
        the U.S. market. It is not known if a similar
        protective effect will be experienced with the
        currently used Pill. More time is needed to study this
        issue, and the slight protective effect is hardly a
        reason to take the Pill at the risk of so many other
        side effects.

        It should also be noted that these forms of cancer are
        rare and primarily occur among postmenopausal women in
        their fifties and sixties. Second, these cancers tend
        to occur in those women who had long cycles (i.e., with
        a prolonged estrogen-dominant phase) or those who have
        a family history of these types of cancer. Third,
        extended breastfeeding amenorrhea offers the same type
        of protection against these cancers since the menstrual
        cycle would be suppressed and therefore the exposure to
        estrogen suppressed.

        Liver Tumors in younger women (15 to 40 years) have
        increased as the use of oral contraceptives has
        increased. Almost unheard of in this age group before
        the use of synthetic hormones became commonplace, liver
        tumors usually do not occur until the sixth decade of a
        woman's life.

        A study by the American College of Surgeons' Commission
        on Cancer found "a large peak in the 26-to-30-year age
        group which corresponds with the increased use of oral
        contraceptives in this age group."*40* Liver cancer in
        women on the Pill is typically associated with those
        over 30 who have used it more than four years, but
        cases of liver cancer in younger women have been
        cited.*41,42,43,44*

        Other Cancers: Skin cancer (melanoma) has also been
        found to increase among women on the Pill. Naturally
        occurring estrogen is involved with maintaining healthy
        skin tissue. It is reasonable to suspect that exposure
        to the more potent synthetic estrogen in the Pill
        increases the risk of this type of cancer.*45,46,47*

        ------------------------------------------------------

        Cycle irregularities

        Women who take the Pill have been reported to
        experience bleeding or spotting in mid-cycle, changes
        in menstrual flow, and even loss of menstruation, which
        can lead them to wonder if they are pregnant. For some,
        painful menstruation (dysmenorrhea) has been reported
        to worsen, even though many women take these hormones
        in an attempt to relieve the problem.*48*

        Although some women are given the Pill for irregular
        cycles, it does nothing to improve the underlying
        problem causing the irregularity. Often the
        irregularity returns when the Pill is discontinued,
        sometimes more severely.

        ------------------------------------------------------

        Are there other side effects?

        Yes. Some side effects are minor while some may be more
        severe and call for discontinuing the drug.*49,50,51*

        The following adverse effects have been experienced by
        women on the Pill:

        Headaches, migraines, mental depression (even to the
        point of suicide and/or suicidal tendencies), a
        decrease or loss of sexual drive, abdominal cramps,
        bloating, weight gain or loss, and water retention;
        nausea and vomiting(in about 10% of users); symptoms of
        PMS, vaginitis and vaginal infections, changes in
        vision (temporary or permanent blindness, and an
        intolerance to contact lenses); gall bladder disease
        and either temporary or permanent infertility, when
        discontinuing the Pill, in users with previous
        menstrual irregularities or who began the drug before
        full maturity. Several of the symptoms, such as
        migraine headaches, contraindicate the use of the Pill
        because of life endangering complications.

        Consult the Physicians' Desk Reference at your public
        library or consult your pharmacist for a more complete
        list of the Pill's harmful effects.

        ------------------------------------------------------

        Is the Pill safer than pregnancy?

        No. The health risks of the Pill outweigh by far the
        risks of pregnancy and childbirth to a woman's
        health,*52* and any claim to the contrary is based on
        erroneous comparisons between healthy women on the Pill
        and women who do not receive normal care during
        pregnancy.

        A precondition for obtaining the Pill is routine
        medical care and checkups. For example: if such a woman
        on the Pill is diagnosed as "precancerous," or if some
        other side effect is exhibited, she has the advantage
        of early detection. However, many pregnant women do not
        receive routine medical care. A clearer picture of the
        safety of the Pill compared to the safety of pregnancy
        would be made if healthy women receiving routine
        medical care during pregnancy and delivery were
        compared with women receiving routine medical care
        while taking the Pill.

        The mortality statistics of childbirth have
        continuously declined since the early part of this
        century, mostly due to better maternal healthcare.*53*
        Most of the high risk pregnancies and deliveries occur
        to women who have not sought proper medical
        attention.*54*  This is most evident in the Third World
        where adequate health care is sparse.

        Mortality statistics of pregnancy and delivery, usually
        called maternal mortality, include the mortality rates
        due to abortion. Abortion is clearly used as birth
        control, preventing the birth of the child; therefore
        it must be included with the mortality statistics of
        birth control methods. In one study, 25% to 50% of the
        reported maternal mortality was a result of deaths from
        abortion.*55*

        Fifty percent of woman taking the Pill discontinue it
        within the first year because of side effects, the
        development of benign breast disease, or some
        abnormality of the sexual organs. Studies of Pill usage
        do not include these women, and the result is an
        unbalanced picture of only the healthiest of women who
        tolerate the Pill.*56* This is compared with the
        general population of women who are pregnant.

        The fact is that there are 13.8 million women in the
        U.S. and 60 million women worldwide who use the Pill
        (conservative numbers).*57*  And there are 7.9 Pill-
        related deaths per 100,000 women ages 15-44.*58*

        Therefore, one can calculate that there are over 1090
        deaths each year in the U.S. alone simply due to the
        Pill.

        ------------------------------------------------------

        But I've heard there are no side effects with the Pill
        I use.

        All drugs, including all brands of the birth control
        pill, have potential side effects. There is no telling
        in advance how any particular woman will react to the
        Pill, but there is a good chance of some type of
        reaction. It is possible that a woman will be unaware
        that there is any connection between the reaction and
        the Pill especially if it takes years to manifest
        itself.

        ------------------------------------------------------

        Aren't there any therapeutic benefits from the Pill?

        The only "indication," or use for the Pill that is
        approved by the Food and Drug Administration is "the
        prevention of pregnancy in women . . . as a method of
        contraception."*59*  Some unapproved uses, considered
        experimental, include its use as a "morning after" pill
        (causing an early abortion), and for relief from the
        symptoms of mild endometriosis.*60*

        ------------------------------------------------------

        I'm breastfeeding my baby; can I use the Pill?

        No. Artificial hormones pass from breast milk to the
        baby; the Pill also decreases both the quantity  and
        protein content of the milk produced.*61*

        ------------------------------------------------------

        What is my alternative to using the Pill?

        Natural Family Planning (NFP) is safe, healthy and
        effective and it's also inexpensive. A woman observes
        and records changes in her basal body temperature, the
        normal flow of cervical mucus, and if she wishes, the
        physical changes in the cervix itself. She then
        crosschecks these signs of fertility to follow, day by
        day, the natural course of her fertility cycle. No
        drugs, no devices, no surgical procedures, no threat of
        death, no side effects, no chemical abortions!

        ------------------------------------------------------

        Does NFP really work?

        Yes. Married couples can achieve a  99% effectiveness
        if they learn the method, correctly interpret the
        fertility signs, and follow the rules.*62* One positive
        side benefit for couples who are committed to making
        this method work is the potential for a healthier
        marriage -- psychologically, physically and
        spiritually.*63,64*

              -- Paul Weckenbrock, R.Ph.

         ------------------------------------------------------

        How can I find out more about Natural Family Planning?

        Write the national office of The Couple to Couple
        League, P. O. Box 111184, Cincinnati, OH 45211, USA; 1-
        513-661-7612.


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        57. Hatcher RA (1990). 228.

        58. Harlap S (1991). 98-99.

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        c 1993 The Couple to Couple League International, Inc,
        P.O. Box 111184, Cincinnati, OH 45211-1184, USA, 1-513-
        661-7612. CompuServe Address: 73311,256.  Web home
        page:  http://www.dris.com/~megamall/cathlc/ccl

        The information contained in this document is for
        private use and may not be reproduced, published,
        broadcast or otherwise distributed without the prior
        written permission of the Couple to Couple League.

        This information is from a brochure titled "The Pill:
        How does it Work? Is it Safe?"  The brochure and
        related material may be ordered from Couple to Couple
        League direct.
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