THE PILL has had its day, and our overdependence on it is a major contributory factor to one of the highest abortion rates in the developed world. That is the startling conclusion of an eminent American professor who believes doctors should be encour
aging the use of more effective, longer-acting reversible contraceptives (LARCs) such as implants and injections.
Professor James Trussell, head of the Office of Population Research at the University of Princeton, isn’t the only one who thinks we should do more to make women aware of the limitations of the Pill and the benefits of longer-acting alternatives. The Department of Health has been urging doctors to prescribe more LARCs as part of a campaign to reduce unplanned pregnancies – a huge problem in the UK and not just among under-aged teenagers doing it for the first time behind the bike sheds. Around a third of all pregnancies are unplanned and many of those are due to contraceptive failure in women in their twenties, thirties and forties.
Condoms offer the best protection against catching infections, but their real-world failure rate is too high to make them a dependable form of contraception. And the Pill is little better. Clinical trials suggest the Pill has a failure rate of less than 1 per cent per year, and the condom around 3 per cent per year, but clinical trials rarely reflect everyday life, where nearly half of all women miss at least one Pill per pack and condoms split or are never put on in the first place.
Real-world failure rates for the Pill and the condom are worryingly high – one in eight women using condoms will have an unplanned pregnancy in the first year of use, as will about one in 25 women taking the Pill.
LARCs, such as the three-monthly Depo-Provera injection and the three-yearly Implanon implant, do not have to be taken daily, cannot be forgotten and as such have real-world failure rates of less than 1 per cent. They also contain fewer hormones than the Pill and are therefore less likely to cause potentially lethal oestrogen-related side-effects such as blood clots and strokes.
And it’s not just younger women who benefit from the added protection of LARCs. Older women, who often opt for permanent and irreversible sterilisation because they are fed up with taking the Pill, could benefit too. How about a fully reversible contraceptive method that lasts up to five years, is as reliable as sterilisation and which stops your periods (or at least makes them lighter, less painful and less frequent)? Well, that is exactly what the intra-uterine system Mirena offers, yet it is used by just one per cent of British women between the ages of 16 and 49, because most of them have either never heard of it or enquired as to whether there is an alternative to the conventional triad of Pill, condom and sterilisation.
That said, I think it is a little early to describe the Pill as outdated. If taken properly by the right women it remains an excellent contraceptive with a very good safety profile. While much has been made of links with potentially fatal side-effects such as heart attacks, strokes and breast cancer, these are largely outweighed in carefully selected women by the protection it offers against a range of other conditions including cancer of the uterus and ovary. And as long as you are a healthy non-smoker and are good at remembering to take your tablets, then it is safe to carry on taking the Pill until you reach the menopause (smokers are generally advised to stop it at 35). You don’t need to have a period every month as an increasing number of doctors, myself included, now advise women to run packs back-to-back so they don’t have a Pill-free week and a monthly bleed.
And if you are worried by the number of hormones it contains, then why not switch to the progestogen-only minipill? It’s not as effective as the Pill, and has less margin for error if you forget to take one, but this is balanced by a natural decline in fertility during a woman’s thirties, meaning, to all intents and purposes, it is as good a contraceptive as the Pill in older women, and a lot safer.
So the Pill and mini-pill are far from dead, it’s just that they should no longer be the automatic choice for most women. But old habits die hard and it is the method most GPs still default to during a hurried consultation, so make sure you know the pros and cons of all your options to ensure that you end up with a safe, convenient method suited to your needs.
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The full article contains 853 words and appears in The Scotsman newspaper.
