The birth control pill has several ways in which we think it works. And that might be an interesting thing to think about...in that we really don't know exactly how it works. We have four specific thoughts and this you will find in any endocrinological or gynecological textbook.
The first method is to inhibit ovulation. And I think the older birth control pills, which were higher in estrogen dose, were probably more effective in inhibiting ovulation, but we paid for that with women's lives. We saw increased strokes, increased tumors, the very very dire consequences of high estrogen content. So, in order to protect the patients we decreased the hormonal content of the pills, especially the estrogen component, and now have a very low-dose pill. The higher dose pills are actually off the market. None exist nowadays, so that gives you an idea of how risky they were. But, at the same time, with the lower dose pills, we have given up the very low incidence of ovulation and we have a higher risk of escape ovulation. And we see that oftentimes at sonogram time. If women are complaining of pain for some reason and we're doing a sonogram, I will see a large cyst on the ovary and I know that the women has taken the pill...has not skipped a day of the pill, and yet she has a mature follicle in the ovary. Whether or not that follicle will go on to rupture may be up to if the woman takes the pill at precisely the right right time. If she forgets, the next day or the following day, that follicle may rupture and then you have escape ovulation. Sometimes medications also counteract the effect of the pill and they increase the chances of ovulation. So, that is the main method we think that the pill works by inhibiting the majority of ovulations.
The second method is by inhibiting or slowing down the action of the cilia in the Fallopian tube. And cilia are little tiny hairs that line the cells which line the entire length of the Fallopian tube and feed towards the uterus. So, those hairs are actually helping the embryo--which develops when the egg and the sperm meet--to find its way into the uterus where it will fall and implant into the endometrium.
The third very important function of the pill has been shown to decrease the cervical mucus-- and cervical mucus is absolutely essential in the survival of the sperm and introducing the sperm up the uterus and into the tube. It will decrease the amount, if not totally eradicate the amount of cervical mucus, and actually make it very inhospitable to sperm.
And then the fourth very important factor, which is so often overlooked in the training of physicians and medical students, and in the informed consent for patients starting on the pill, is its potential abortifacient nature. And I'll explain that by telling you this-- that the hormones of the pill will make the lining of the inner part of the uterus very very thin. And that is one of the reasons why the pill is prescribed for women who have very heavy periods, because after several months, that woman will notice that her flow decreases. This is because the normal hormones of the woman have shut down, and the woman is responding to only the foreign hormone, which is in the pill - and that is a very controlled amount of hormone. So the woman notices the decrease in flow. But what is actually happening in the uterus is that the lining of the uterus becomes very very thin. Quite often I've had women come in and tell me "I've been on the pill for many many years, and now I have no period..what's wrong?" Actually, the pill has had its desired effect. So the lining of the endometrium is very thin. If there is escape ovulation-- if pregnancy has occurred --as the human embryo comes into the uterus and implants or tries to implant, its not going to find the environment that it needs to survive. It may survive for a few days or a few weeks, have difficulty, die, and then be expelled from the body. The woman may never even realize that she was pregnant. She may have a little bit of a delayed period, a little bit heavier than normal period, and not even realize that she's aborted.
Most physicians don't know, have never been taught, have not read the package insert, that explains that yes indeed, the hormonal contraceptives -- ALL OF THEM -- can be potentially abortifacient. And several of them are specifically abortifacient. But that fact is cleverly hidden by the pharmaceutical companies.
There are several health problems associated with being on the pill. First of all, I'd like to say, imagine a young woman can be on a pill for 10-20-30 years. And actually the female reproductive system is the only system that is functioning quite naturally and with the hormonal contraceptive is suppressed in its natural function -- which in medicine we do not see in any other scenario. You do not stifle, you do not suppress a naturally functioning system. And you will pay for that...sooner or later...the woman is going to pay for that. There's an increase risk of blood clots -- which can be fatal -- there is an increase risk of migraine headaches and strokes. There's an increase risk of a liver tumor, a hepatic adenoma, which many times will resolve with discontinuation of the pill -- but not all the time, and that will require major surgery for the woman. There is an increase risk of breast cancer, and I think women are not knowledgeable of that, and I believe that is one of the reasons why we have such a tremendous surge in breast cancer.
The pill does pose a risk in achieving pregnancy. If you read the work of Dr. Eric Ottoblat from Sweden, his research shows that for every year a woman is on the birth control pill, the cervix ages 2 years. I have seen this to be a tremendous problem for young women who are unaware of that and are prescribed contraceptives by their doctors, and when they get married and want to have a baby and achieve a pregnancy, they have almost no mucus. And then we start the therapies to increase the mucus.
It's interesting that we as gynecologists tend to treat fertility as a curse. It makes me very sad to say that because I am a gynecologist. But in that respect, I am one of them and I can point the fingers. We treat fertility as a curse. And as I mentioned earlier, we stifle a naturally beautiful functioning system with these drugs. Fertility is not a curse. Fertility is a tremendous gift. All you need to do is ask an infertile couple and they will very eloquently tell you what a blessing fertility is.
Martha Garza, M.D.
Endocrinologist/Gynecologist in San Antonio, TX
The last paragraph says it all.
ReplyDelete