Few inventions in history have affected a society as much as the birth control pill (BCP). It has given many women the opportunity to plan and pursue a career by delaying childbirth reliably. It has taken family planning out of the realm of chance. Smaller families and older parents are now the rule and the effects of this are still to be seen.

BCPs are possibly the most studied medication in history. The BCP does more than just prevent pregnancies; it has several beneficial effects that are not commonly known. To understand many of these benefits one must remember that BCPs create a state of imitation pregnancy; this fools the body into not putting out an egg.

Endometriosis is improved or, at least, made less damaging by the pill. The breakdown of this misplaced uterine lining is not as strong when ovulation doesn't occur. This explains why menstrual cramps are often not as severe on the pill. The lining in the uterus also does not get as thick, and blood loss is decreased in many women who take the pill, which makes anemia less likely.

BCPs also create a thick "mucus plug" in the cervix, which apparently blocks the spread of bacteria (i.e. GC, chlamydia, etc.) from the cervix up to the uterus and tubes, where they can cause severe infections and impair future fertility. This, and the effect on endometriosis, makes the BCP the ideal birth control. It prevents pregnancy while protecting the patient's ability to become pregnant later.

Many women also, with ovulation, experience mid-cycle discomfort ranging from a cramping sensation to a mule kick. This is called Mittelschmerz pain, which means "middle pain" in German (in medical school when I first learned about this, I thought it was another doctor with a strange German name). This mid-cycle pain can also be treated with the birth control pill because of its ability to prevent ovulation. The suppression of ovulation also prevents the formation of ovarian cysts that can masquerade as ovarian cancers and lead to unneeded surgeries.

Breast cancer is less frequent in women who bear children before the age of 30. It is tempting to postulate that BCPs may have a protective effect as well, but this hasn't been proven. They do not, at this time, appear to have any influence on breast cancer, one way or the other. Ovarian cancers are clearly less frequent in pill users according to studies; this is possibly because of the thickened cervical mucus blocking some cancer causing agent from gaining access to the ovary. Woman after just 5 years of the pill decrease their risk of this cancer by 50%.

I don't put every woman that comes into my office on them, but if I have a patient that has become sexually in-active I do not necessarily take her off the pill unless she is having a problem on them. The recurrence of sexual activity can be unpredictable and just how a pill that was working fine will do, once it is stopped and restarted, can be equally unpredictable.

Birth control pills are not perfect. In some women, it takes a little effort to find the right type of pill. There can also be side effects and they can even have some risk involved, especially for older women (more so in those who smoke), but considering the number of women that have taken BCPs and the years of experience we now have with them, they appear to be very safe. They are, in my opinion, a modern day miracle drug.


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