50 years of "The Pill": celebrating a golden anniversary

Abstract

The past 50 years have seen great advances in combined oral contraceptives (COCs) that have resulted in reduced risks of adverse events and improved cycle control. The most important changes in COCs over time include repeated lowering of the estrogen dose, development of new progestogens, and the reduction or elimination of the pill-free interval. Most IntroductionThe launch of Enovid-10 ® (G D Searle Co., Skokie, IL, USA), the first combined oral contraceptive (COC), in 1960 revolutionised family planning by giving women control over their own fertility. The social, political and economic implications were so profound that although countless oral medications have been approved both before and after this event, the contraceptive pill is the only one to be known as "The Pill". Indeed, it was Aldous Huxley who first used the term, with eerie foresight, in his essay Brave New World Revisited, published in 1958. Today, half a century later, over 100 million women worldwide use oral contraceptives. 1 Although increased contraceptive use has been accompanied by a trend towards fewer abortions, 2 unplanned pregnancies remain prevalent and their social, health and environmental consequences pose a contemporary global challenge, 3 with population control being described as the "greatest challenge facing humanity". 4 Here we review half a century of oral contraceptive use; examine how and why The Pill has evolved; describe the contraceptive needs of changing societies; and discuss current and emerging issues and developments related to birth control. morbidity and mortality. Among 210 million pregnancies each year, 38% are unplanned and 22% end in abortion. 3,6 In the USA, nearly half of the approximate 6.5 million annual pregnancies are unintended, resulting in approximately US$5 billion in direct medical costs. 7 An estimated 5 million women in 13 developing countries are hospitalised each year due to abortion-related haemorrhage, sepsis or other complications. 8 Unsafe abortions are responsible for approximately 70 000 deaths each year, accounting for an estimated 13% of maternal deaths worldwide 9 and for the orphaning of approximately 2201000 children. 10 Unsafe abortion also poses a significant economic burden and long-term psychological and health issues such as infertility and other disabilities. 10,11 Unintended pregnancies are associated with high-risk antenatal behaviours such as smoking and excessive alcohol consumption, which increase the risk of poor pregnancy outcomes as well as adverse maternal outcomes. 12,13 Unintended pregnancies also have serious environmental and political consequences, with overpopulation described as the world's worst environmental problem. 14 Population growth has placed an unprecedented demand on our planet's finite resources while simultaneously increasing the amount and types of environmental pollution. Indeed, there have been calls to implement universal family planning services as a component of policy responses to environmental degradation. 15,16 The benefi...

Counselling to include tailored use of combined oral contraception in clinical practice: an evaluation

“…The option of tailored COC use is believed to be one of the most important changes since the pill became available over five decades ago 16. Tailored pill use does not reduce COC efficacy nor cause significantly more side effects than standard pill use.…”

Women’s perceptions about reducing the frequency of monthly bleeding: results from a multinational survey

“…These findings suggest a need for appropriate counseling to inform or remind women about the options available to them with regard to reducing the frequency of or completely eliminating their bleeding. from premenstrual symptoms and/or bleeding problems), 19 were the most common reasons cited for regularly reducing bleeding frequency/using an extended OC regimen. Consistent with previous studies, 4,6,7,20 and the first part of the present survey (published elsewhere), 10 the findings suggest that many women would prefer to bleed less frequently or not at all.…”

“…Data indicate that there are in fact a number of health advantages to suppressing bleeding with OCs and remaining amenorrheic, including the avoidance of commonly experienced premenstrual symptoms during the HFI, 23 and improvements in endometriosis 3 and bleeding problems. 19,24 No negative effects have been associated with rescheduling withdrawal bleeding, 3,25 including no negative effects on the uterus or endometrium, and studies have shown that extended OC regimens are effective in women who use them in this way. 4,[11][12][13][14]17 The use of extended OC regimens also does not affect the return to fertility after stopping, 26,27 and effects on lipids, carbohydrates, and coagulation factors are similar to those observed with conventional 21/7 regimen OCs.…”

Saudi Women Information About Two Selected Contraceptive Methods in Riyadh

“…The introduction of oral contraceptives in the 1960s represents one of the significant advances in women's health, impacting women and society from a medical, social and political viewpoint. While, the overall health benefits of contraception and oral contraception have been well documented [3,4,5]. The oral contraceptive pill (OCP) provides very effective reversible contraception/ and has an excellent overall safety and tolerability profile.…”