Gynaecologist & Endoscopic Surgeon

Contraceptive Pill

  • Contraceptive Pill
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  • 1. What are the risks and benefits associated with use of the oral contraceptive pill?

    In recent times it has become apparent that the pill is a remarkably safe preparation with significant health benefits. From an evolutionary point of view it should be noted that multiple episodes of ovulation and menstrual cycles were rare. Consider that prior to 40 years ago most women would have spent most of their reproductive years either pregnant, breastfeeding or dead. These women would have had possibly 40 menstrual cycles in their whole life.

    Nowdays women experience an earlier puberty, later menopause, have fewer children and breastfeed for less time. They by contrast would have up to 400 menstrual cycles, a significant order of magnitude greater than their forebears. It has been established for some time that recurrent (or "incessant" as it has been termed) ovulation is associated with a number of problems including ovarian cysts and cancer, uterine cancer, benign breast cysts, anaemia, endometriosis and adenomyosis. Temporary cessation of ovulation by either being pregnant or breastfeeding or using the pill appears to protect against all these problems. Additionally the pill protects against certain pelvic infections and the development of some types of rheumatoid arthritis.

    The significant drawbacks of the pill appear to be minimal. These include remote risks of developing blood clots, elevated blood pressure and unusual liver disorders. Many people notice other minor effects, such as weight gain and mood changes. These usually recede within a few months.

    For most women the benefits would appear to outweigh the risks to the extent that in the USA there is some debate as to whether the pill should be allowed over the counter without a doctor's prescription.

  • 2. Does the oral contraceptive pill help with endometriosis?

    Endometriosis is tissue that responds to the influence of hormones produced by the ovaries. Under normal circumstances ovulation is accompanied by the release of a large concentration of these hormones within the pelvis which act locally on the nearby endometriosis. If you stop ovulating, either by going through the menopause or taking the oral contraceptive pill, the high concentration of hormones active within the pelvis is substantially reduced to much lower levels. These lower levels have less effect on the endometriosis and hence many people notice some relief from their symptoms.

    There is some evidence to suggest that women who use the pill for extended periods have less chance of developing endometriosis. Following from this it is reasonable to use the pill after surgery to help decrease the risk of any recurrence. Unfortunately the pill does not remove or get rid of existing disease. The pill is therefore of no help in getting pregnant if fertility is an issue.

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