Dear Dr. G,

I understand that, as a urologist, you tend to answer questions related to men’s health. However, I hope you can take the opportunity to discuss contraception.

I am a twenty-three-year-old woman who has recently graduated from college.

I have a great career and have been in a relationship for one year.

Our relationship is going so well that we started living together last month.

Of course, living together would mean our sexual relationship would also go well.

Despite being mature adults, my boyfriend and I do not talk about contraception.

When my period was late last month, I began to realise how much trouble I could have caused myself if I truly were pregnant.

I genuinely believe that having a baby would not only hinder my career at this stage but would also strain our relationship since we have only just begun to enjoy life.

In fact, we often just rely on each other to prevent unwanted pregnancies.

As an independent and sexually liberal woman, I would like to take contraception into my own hands and make the decision that is right for me.

So, I decided to put Dr. G on the spot for an in-depth scrutiny of the Oral Contraception.

Firstly, how long have the pills been available? And what exactly are they? Also, how common is the use of the pills? And why are they not so popular here?

I would also like to know how effective the pills are in preventing pregnancy?

Are there other benefits of the pills besides contraception?

To be honest, I am afraid of taking the pills for an extended period. Could you please outline the short-term and long-term side effects of the pills?

Are there women who would not take the pills?

Thank you in advance for your answers

Regards

Revolutionary Rachel

Oral contraceptive pills (OCPs), commonly referred to as “The Pill,” are among the most widely used methods of hormonal birth control. Since their introduction, they have played a significant role in transforming reproductive healthcare, women’s rights, and societal dynamics. There are essentially two types of OCPs, namely Combined Oral Contraceptives (COCs) and Progestin-Only Pills (POPs). COCs contain both oestrogen (usually ethinyl estradiol) and progestin, while POPs contain only progesterone, which is essentially recommended for breastfeeding women or those with certain health conditions. The Pill has allowed women unprecedented control over their reproductive choices, enabling greater participation in higher education and the workforce. It has become a cornerstone of modern family planning, contributing to smaller family sizes and lower birth rates in many countries. The pills are also recognised as a landmark of the sexual revolution, as sex can be controlled for both procreation and recreation.

Access to reliable contraception contributed to shifting attitudes toward sexuality, especially in Western societies. The availability of OCPs also sparked debates on reproductive rights, religious beliefs, and public health policies in various countries. Usage of oral contraceptives varies widely across countries due to cultural, religious, economic and policy differences. Approximately 12% of women aged 15–49 in the United States use the Pill. While in the United Kingdom, around 25% of women aged 16–49 use hormonal contraception, with OCPs being the most common. Similarly, Australia and New Zealand have high uptake, with government-subsidised access. On the contrary, Sub-Saharan Africa has limited access due to infrastructure and cultural norms. Lower usage in the Middle East and South Asia is due to religious and societal restrictions. Especially Japan, where historically low use of the Pill due to cultural concerns, and condom usage is more popular.

OCPs are one of the most effective forms of contraception, with nearly 100% effectiveness in preventing pregnancy when used correctly. Although the pills reliably prevent pregnancy when taken as directed, typical use can have a lower efficacy of around 91%, due to missed pills or improper use. The pills also offer other non-contraceptive benefits, including regulating menstrual cycles, reducing menstrual cramps, and alleviating symptoms of polycystic ovary syndrome and endometriosis. In fact, some studies even suggest that the pills may offer protective effects in reducing the risks of ovarian and endometrial cancers.

Early formulations contained high doses of estrogen (up to 150 mcg), which led to notable side effects. Over time, formulations were refined to lower hormone levels and reduce risks. Despite concerns regarding the safety of the pills in the early days, they now exhibit minimal side effects, including nausea, breast tenderness, headaches, and mood changes. Serious side effects of the pills are rare; these include Venous Thromboembolism, particularly among smokers and women over 35. Other adverse effects, such as stroke and heart attacks, are observed in women with underlying cardiovascular conditions or those who smoke. Some inconclusive risks also relate to breast and cervical cancer, especially with prolonged use. Furthermore, some studies suggest a link between OCPs and mood disorders or depression, although the evidence remains mixed.

The long-term risks of oral contraceptives render them contraindicated for women with a history of thromboembolic disorders, smokers above a certain age, and those with uncontrolled hypertension or migraines with aura. Physicians generally also discourage women with a history of breast cancer or liver disease from taking the pills. Therefore, OCP is overall safe and commonly used among the general population.

The development of the oral contraceptive pill was propelled by a blend of scientific innovation and feminist advocacy during the sexual revolution of the sixties. The first oral contraceptive pill, Enovid, received approval from the U.S. FDA in 1960 for contraceptive use. Initially authorised for menstrual disorders, its application as a method of birth control was groundbreaking. Oral contraceptive pills now remain one of the most significant advancements in public health and reproductive medicine. They provide considerable benefits beyond contraception and have transformed societal roles, particularly for women. However, they are not without risks, and their usage must be adapted to individual medical histories and requirements. Informed choices, complemented by accessible education and healthcare, are vital to maximising their benefits while minimising potential harms.