On May 11, 1960, the first hormonal oral contraceptive pill, Enovid, was approved for sale by the United States Food and Drug Administration – an unprecedented move during a time when several US states prohibited the sale of contraceptives.
The move ushered in a new era for women the world over. For the first time, they had the power to circumvent nature and avoid unplanned and unwanted pregnancies. Since then, the pill has had many critics and challenged entrenched family values which oppose premarital sex and promiscuity. Fifty years on, it has emerged stronger than ever. These days, the pill benefits women in other ways too.
Ms Edna Dawn Sha’ari, 25, is no stranger to the oral contraceptive pill, having first taken it when she was 14.
It was not to avoid pregnancy though. “I had such horrible menstrual cycles from the age of 12 – more than 20 days of periods a month, not to mention excruciating cramps,” said the housewife and mother of two. In 1999, she fainted in school because of the pain and heavy flow and was prescribed contraceptive pill Progyluton. “My mother was initially hesistant. She thought, ‘Why would a Secondary 3 student need birth control pills?’,” recalled Ms Sha’ari. “That was the perception – birth control instead of hormonal control.”
Empowering women
 Today, that perception has shifted. The pill is no longer known simply as a birth control method, but more as a method for women to control the quality of their lives. On top of pregnancy prevention, the pill can also suppress period pains, regulate menstrual cycles and curb acne.
“The pill has empowered women,” said a senior consultant at the department of obstetrics and gynaecology in Singapore. “It allows them to choose how to plan their lives. For example, it has allowed women, who were otherwise crippled by pain, to lead active lives.”
Containing synthetic female hormones oestrogen and progestin, the pill simulates a pregnancy-like state. Ovulation – the release of an egg from the ovaries – is inhibited. The absence of an egg prevents pregnancy. The lack of ovulation also means that the lining of the womb that is shed monthly during menstruation is thinner. Hence, the pill was also effective in reducing menstrual flow and regularising periods, said Dr Wee Horng Yen, an obstetrician and gynaecologist at KK Women’s and Children’s Hospital. Such non-contraceptive benefits were the driving force behind the pill’s several modifications since its debut 50 years ago.
Today, there are over 10 brands to choose from in the local market. There are more than 300 brands of the pill worldwide. The trend over the years has been to use less oestrogen to minimise the dose without sending it below the effective level. Indeed, the latest addition, Yaz, by Bayer Schering Pharma, has 20 micrograms of oestrogen – 60 per cent less oestrogen than the pill of the 1960s.
The lower dose is said to reduce side effects such as water retention, mood swings and nausea. It also lowers the risk of pre-menstrual dysphoric disorder (PMDD), a severe form of pre-menstrual syndrome. Sufferers of PMDD tend to experience extreme emotional and physical symptoms such as depression and headaches that can impair their day-to-day activities.
Beyond contraception
Dr Jerry Chng, the medical director of Bayer Schering Pharma (Singapore/Brunei), noted that these additional benefits fall in line with the changing demands of women. “Expectations of the pill have increased over the years. Women now desire pills that look beyond contraception – for example, pills that can improve their skin and reduce side effects like weight gain,” said Dr Chng.
“Today’s pills are made to meet the expectations of the modern woman.” The wider variety today gives women the choice of a pill that not only suits their needs, but also their personal preferences. “Each type of pill has its pros and cons – some are cheaper, some more widely used, some are better in treating conditions like acne,” said Dr Wee.
“For example, side effects affect every patient differently. Some women may feel uncomfortable with breast engorgement, but others may think that it’s a good thing. So brand selection depends on patient preference as well.”
Fears and misconceptions
Even so, pill usage is low here. Only about five to six per cent of Singaporean women are on the pill, said Dr Chng. Misconceptions are probably the greatest barrier. When the pill was first introduced in Singapore in the 1960s as part of the government’s family planning programme, the high dosage of oestrogen led to many reports of unpleasant side effects. These fears were passed down to the younger generation.
The fears perpetuated numerous myths about the pill, which have persisted despite the fact that women are now more educated and open-minded. One example is the myth that taking the pill will unbalance hormonal levels and hinder future pregnancies. Furthering the resistance is a deep-seated cultural mentality that medicine is only for the sick, said Dr Wee.
The fact that the pill contains hormones worsens the problem. People are scared of hormones; it’s like a bad word. A gynaecologist in Singapore had a patient who phoned him, exclaiming that the box had a ‘poison’ warning, when all drugs are considered poison and would carry that label.”
The fear towards hormones may be linked to the breast cancer risk scare tied to hormone replacement therapy (HRT) in 2002. Designed for menopausal women, HRT is used to reduce problems such as vaginal dryness. However, the pill has not been found to carry such dangers. In fact, a study published in the British Medical Journal in March concluded that the pill does not cause long-term health risks.
Furthermore, there has been a slew of other research showing that the pill offers protection against endometrial, womb and ovarian cancers, said Dr Wee. It also helps suppress endometriosis, where the tissue lining the womb travels out and grows in abnormal locations. For now, the direction for the pill is clear – to debunk the myths and increase awareness about its extra health benefits.
Ref: V10
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