Contraception: Freedom from Fear

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progestin (with a protective smidgen of estrogen added) for five or six days. The sequentials, like the combinations, tend to regularize the cycle, and most women who take them have an acceptably mild menstrual period.

Skipped a Day. All the pills of both types now approved by the Food and Drug Administration for U.S. prescription (see box, page 80) are as close to 100% effective as any medication ever devised for any purpose. When a woman "on the pills" has become pregnant, it has been shown in virtually every case—and suspected in the others—that she has skipped a pill or two. The failure rate is slightly higher on the sequentials, apparently because the estrogen taken early in the cycle wears off rapidly, and a single day's missed pill may spell pregnancy. The progestin combinations afford a slightly broader margin of safety.

Like all other potent medicines, the pills produce many incidental effects. Some are good, some bad. Largely because of the thalidomide disaster, which occurred soon after the pills went on the market, many women are leary of them. Says a 31-year-old Houston woman who has only two children: "I'm just not convinced that the doctors know all they need to know about the pills yet, and their possible side effects." In fact, the doctors know a great deal.

The side effect most commonly complained of is weight gain—up to 20 lbs., say some women. Yet most gynecologists believe this was caused only by early, high-dosage forms, and that today's one-milligram pills rarely provoke a gain of more than five pounds. The sequentials usually cause less weight gain than the combinations. The next most frequent complaints are nausea ("like being four months pregnant"), breast tenderness and breakthrough bleeding. These usually disappear within three months.

Despite dark fears, there is not a shred of evidence that the pills cause cancer. In fact, they may even give some protection against it. But because estrogens are believed to promote the growth of some breast and cervical cancers, the pills may not be prescribed for women who are known or suspected to have this type of disease. Similarly, there is no evidence that the pills cause blood clots that might travel to the lungs or develop in the brain. But for safety's sake, they are not prescribed for women with any history of clotting problems.

Prescribed for Acne. Some women complain that the pills cause acne. This is physiologically impossible, because acne is associated with an excess of androgens (male hormone) over estrogen. Since the pills supply estrogen, they are often prescribed for treatment of acne. Other women complain that they don't menstruate while on the pills. This is seldom true, because of the pills' regularizing effect. A Los Angeles mother says that the pill was "magic—a godsend" for her 15-year-old daughter, whose menstruation was so irregular and heavy that she suffered serious blood loss and near-shock, and needed transfusions. On the pill for six months, she now has "pink cheeks, regular periods, a good figure and has gained ten pounds." Wryly, a young woman in Miami says, "They've improved my complexion, done away with menstrual problems, eliminated worry, and I feel better physically. But they haven't straightened out my lousy love life."

It is not only

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