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In some cases the Pill raises an unstable blood pressure so abruptly and severely as to cause a blowout in a brain artery—the hemorrhagic type of stroke. Another vascular disturbance is the migraine headache, which results from dilation of peripheral arteries in the head. Any woman who has ever had migraines is likely to find that they strike more often and more severely after she goes on the Pill. Others may suffer their first, alarming and hideously painful migraine when taking the Pill. Among other "contraindications," as doctors call them, are diabetes, liver disease, breast cancer and possibly rheumatoid arthritis. Serious allegations against the Pill which cannot yet be proved or disproved are that it may cause genetic changes, or damage the fetus, as does thalidomide.
Bad Medicine. Of all the reported side effects, the one of deepest concern to young women who have not had all the children they want, is that after they stop taking it their fertility may be reduced. Pro-Pill parenthood planners share this concern. There is indeed a definite suppression of fertility in some women who fail to menstruate or ovulate for a year or two after dropping the Pill. But the true incidence of Pill-induced infertility cannot yet be measured, Kistner points out, because if a woman has never had a child before going on the Pill and does not conceive afterward, she may be among the 10% to 15% of women who are naturally infertile. Even after having borne one child, Kistner said, 7% to 8% of women cannot conceive again.
The most glaring defect in discussion of the Pill has been the slight attention, if any, given to the failure of too many U.S. doctors to study their patients before prescribing it. When a woman aged 15 to 45 asks a physician for the Pill, she is almost invariably handed a prescription that is often, in practice, refillable indefinitely. This is bad medicine. A conscientious doctor will ask the woman, if he does not already know, whether she has had any blood tests, and whether they showed anything unusual about her blood sugar or clotting. Has she had high blood pressure or migraine headaches? If her mother is not still living, the cause of her death and the age at which she died are relevant. If alive, does her mother have high blood pressure, phlebitis or severe headaches?
Then the doctor can quickly decide whether the Pill carries an unacceptable risk for this particular patient. If it does, he is ethically obliged to refuse her the prescription and to suggest some other contraceptive such as a diaphragm or IUD. If all U.S. doctors followed these rules they could avert many, perhaps a majority, of the severe and fatal Pill reactions now being reported.