The introduction of birth control pills in i960 revolutionized contraceptive practices around the world. Millions of women turned enthusiastically to this convenient and effective method of preventing pregnancy, but within a decade reports of serious side effects of the pill began to appear and the popularity of this method declined substantially. Now, after twenty-five years of observation, what are the facts about the pill?

There are two types of oral contraceptives currently in use: a combination pill, which contains a synthetic estrogen and a progesterone-like synthetic substance called "progestogen," and a minipill with progestogen only in low dosage. This discussion will focus on combination pills (unless otherwise specified) because they are most commonly used.

Birth control pills prevent pregnancy primarily by blocking the normal cyclic output of FSH and LH by the pituitary, thus preventing ovulation. In addition, the progestogen makes

implantation difficult by inhibiting the development of the lining of the uterus, and it also thickens the cervical mucus, decreasing the possibility that sperm can get through.

Birth control pills are taken one per day for twenty-one days beginning on the fifth day of the menstrual cycle (that is, four days after a period begins). Some brands of birth control pills are packaged with seven inactive pills (usually of another color) which the woman takes on a daily basis to complete the cycle, whereas with other brands the woman must remember to resume her pills one week later.

If a pill is missed, two pills should be taken the next day. If two pills are missed, it is likely that the pill will not work properly and an alternate form of contraception must be used to prevent pregnancy.

Birth control pills are the most effective nonsurgical method of contraception. Among women who use the pill consistently, only one pregnancy will occur among 200 women during a year. Among all women using the pill — including those who sometimes forget to use it — two or three pregnancies will occur in 100 women annually.

The minipill, which is taken every day, even during menstruation, is less effective than the combination pill. If it is used perfectly, one or two pregnancies will occur in 100 women during a year. In actual use conditions — including the occasional forgotten pill — five to ten pregnancies occur in 100 women using the minipill for a year.

Birth control pills have now been used by more than 150 million women around the world and have probably been studied more intensively than any other medication in history. Despite scare stories that appear regularly in the press, the evidence shows that the pill has more health benefits than risks for many users. For example, there is no reliable evidence that birth control pills cause cancer, and they actually protect against cancer of the ovaries and of the uterine lining. Furthermore, women who use birth control pills are only one-fourth as likely to develop benign (non-cancerous) breast tumors as non-users, one-fourteenth as likely to develop ovarian cysts, one-half as likely to develop rheumatoid arthritis, and two-thirds as likely to develop iron deficiency anemia.

Other beneficial side effects of the pill have been noted. Many women find that the pill reduces the amount of menstrual flow and produces more regular cycles with less menstrual cramping. Acne can be improved by the pill (although sometimes it is worsened), premenstrual tension can be reduced, and pelvic inflammatory disease — a serious cause of infertility — is only half as common in pill users as non-users.

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