ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, October 15, 1996 TAG: 9610150046
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: PERSONAL HEALTH
SOURCE: JANE BRODY
Good news may travel fast, but bad news travels faster. Since birth control pills were introduced in the early 1960s, they have been the subject of thousands of reports on their actual and potential hazards.
As a result, millions of women harbor a distorted view of the risks that may be involved in taking them and lack an appreciation of their known and potential benefits beyond their undisputed ability to prevent unwanted pregnancies.
Last week the 17.5 million American women now using the pill and the 80 percent of women who will have used it at one time or another learned from the most definitive analysis to date that the most feared risk of oral contraception - breast cancer - may have been greatly exaggerated and may, in fact, not even exist.
The analysis encompassed 54 studies involving more than 150,000 women in 25 countries and found no long-term increase in breast cancer risk among pill users.
The small increase in breast cancers found among current or recent pill users is believed to reflect greater medical vigilance resulting in a higher detection rate among women on the pill, not a direct effect of the pill on cancer.
It helps to keep in mind that many of the health risks long associated with the pill stemmed from earlier, high-dose formulations that have since been greatly modified, resulting in a reduction or elimination of many problems.
Meanwhile, researchers have refined their methods of examining hazards. One major result was the determination that cardiovascular risks associated with the pill almost exclusively involve women over 35 who smoke. Healthy nonsmokers are now advised that they can use the pill until menopause if they choose to without having to worry about suffering a heart attack or stroke as a result.
Benefits of the pill
With these serious concerns abated for now, it is time to focus on the good that the pill can do. What follows is not just pharmaceutical propaganda, but a summary of the findings of recent medical research.
*Ovarian and uterine cancer: Numerous studies have shown that taking the pill, even for as little as a few years, can reduce a woman's risk of developing one of the deadliest and most common cancers in women, cancer of the ovary.
Over all, women who have used the pill have about half the risk of those who never used it, and those who took the pill for 10 or more years have only one-third the risk of developing this cancer. Each successive year of pill use seems to reduce the risk of this cancer by about 8 percent.
The pill also protects against cancer of the endometrium, the lining of the uterus, probably because there is less buildup of the lining and it is shed each month while the pill is being taken.
Accordingly, the Alan Guttmacher Institute, an independent nonprofit organization that evaluates research on gynecological health, recommends that women take the pill at some time during their reproductive years to reduce their risk of these cancers.
* Pelvic inflammatory disease: This major cause of infertility, commonly called PID, is less likely to occur in women taking the pill. Use of an intrauterine device (IUD) can increase the chances of a pelvic infection, but the pill, which causes a thickening of the cervical mucus, seems to make it more difficult for sexually transmitted organisms to invade the pelvic organs.
* Ectopic pregnancies: The risk of suffering an ectopic pregnancy - a pregnancy that implants in a Fallopian tube instead of the uterus - is reduced by about 90 percent in women who have used the pill, as compared with users of other birth control methods.
Those using an IUD have an increased risk of this problem, which always results in the loss of a tube and, if undetected in time, can threaten a woman's life.
* Cysts and fibroids: In addition to helping to prevent ovarian cancer, pill use reduces the risk of developing ovarian cysts, which often result in the loss of an ovary.
Breast cysts are also less common among pill users. In addition, fibroids - benign growths in the uterus that sometimes necessitate a hysterectomy - are less likely to afflict pill users.
* Endometriosis: This is another important cause of infertility that is less common among pill users.
Endometriosis is the growth of uterine lining tissue outside the uterus and can cause blockages of the reproductive tract and severe pelvic pain. Since ovulation stimulates the growth of the endometrium, the pill, which blocks ovulation, reduces the likelihood of this disorder.
In fact, women with mild cases of endometriosis are often placed on the pill for a year or more to control the condition.
*Menstrual bleeding and pain: Without ovulation, there is less buildup of the uterine lining and less tissue that must be shed during menstruation.
The result is commonly much lighter and shorter periods than a woman would otherwise experience. This, in turn, means a woman is less likely to develop iron-deficiency anemia.
It also often means a reduction in menstrual discomfort because there is less tissue that must pass through the cervical canal.
* Bone density: The pill has not been around long enough to know whether it will reduce the risk of osteoporosis in older women, but pill users do seem to have somewhat of an advantage over nonusers: Their bones tend to be denser, probably because estrogen in the pill helps to prevent bone loss.
Not everyone benefits
Despite these benefits for the majority of women who take the pill, some women are advised to use other methods of contraception.
According to the ``patient package insert'' that is distributed with every pill prescription, the risks of the pill ``increase significantly if you smoke; have high blood pressure, diabetes, high cholesterol; have or have had clotting disorders, heart attack, stroke, angina pectoris, cancer of the breast or sex organs, jaundice or malignant or benign liver tumors.''
The insert warns against using the pill if a woman has any of the following conditions:
* A history of heart attack or stroke.
* Blood clots in the legs, lungs or eyes.
* A history of blood clots in the deep veins of the legs.
* Chest pain.
* Known or suspected breast cancer or cancer of the endometrium or vagina.
* Unexplained vaginal bleeding.
* Yellowing of the whites of the eyes or skin during pregnancy or previous use of the pill.
* Liver tumor.
* Known or suspected pregnancy.
* And, of course, the pill should not be used by women who smoke, especially those over 35 who smoke more than 14 cigarettes a day.
After reading the benefits listed above, you may wonder about the wisdom of some of these warnings.
Dr. Elisabeth Connell, a professor of gynecology and obstetrics at Emory University in Atlanta who has served on six advisory committees to the Food and Drug Administration, is highly critical of these warnings.
``Package inserts for the pill are hopelessly out of date,'' she said. ``There is a gap of about a decade between what the label says and the realities of pill use.''
While warnings are never to be ignored, the wise woman will consult with her doctor before deciding that the pill is not for her.
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