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.