Fifty Years of “the Pill”: Risk Reduction and Discovery of Benefits Beyond Contraception, Reflections, and Forecast

Abstract

Widely regarded as a revolutionary drug in its early years, "the pill" may be considered the first designer or lifestyle drug. Approximately 85% of women in the United States will use an oral contraceptive (OC) for an average of 5 years. Since the introduction of OCs in the 1960s, both health benefits and safety concerns have been attributed to their use. Widespread use of OC formulations by women throughout their reproductive life cycle gave rise to concerns about the effects of OCs on risk factors for cardiovascular disorders and cancer. In most instances, the noncontraceptive benefits of OCs outweigh the potential risks. As with many first in class drugs, lessons can be learned from its development and use. Indeed, "the pill" played a significant role in reshaping the regulatory process for new drugs during the second half of the 20th century. The birth control pill celebrates its 50th birthday this year, as women and men celebrate five decades of this revolutionary method of family planning. Recent scientific and technological advances in genomics, proteomics, new materials, and new drug delivery systems, along with a new understanding of reproductive biology, offer the promise of new, safe, and effective forms of contraception. In addition to the history of OC therapeutic advances and unintended side effects, the noncontraceptive health benefits that women experience beyond pregnancy prevention are discussed. This article summarizes a symposium presented at the 50th Anniversary of the Society of Toxicology National Meeting, held from 6 to 10 March 2011 in Washington, DC.

Race-Ethnic Differences in Sexual Health Knowledge

“…Non-Hispanic black women tend to view their own sexuality more positively than non-Hispanic whites (Bancroft, Long, and McCabe 2011), so they may weigh concerns over reduced sexual desire more heavily. Similarly, hormonal contraceptives have been linked to serious problems such as stroke and heart attacks, though these risks are very low overall and are much reduced relative to earlier versions of the pill; further, serious problems rarely occur among those who do not have other risk factors (such as smoking or hypertension) (Chadwick, Burkman, Tornesi, and Madaheven 2012). The evidence on a link between hormonal contraceptives, particularly oral contraceptives, and cancer is mixed – the pill protects against uterine and endometrial cancer, but it is less clear how breast cancer risk is affected.…”

Understanding the cognitive impact of the contraceptive estrogen Ethinyl Estradiol: Tonic and cyclic administration impairs memory, and performance correlates with basal forebrain cholinergic system integrity

“…Since EE is 10 times as potent as E2 (Fotherby, 1996), the high EE dose was one-tenth of a similar dose of E2 previously shown to enhance performance on spatial tasks (Talboom et al, 2008). The high dose of EE also corresponds to a 75–80µg/day dose of EE (in a 60–70kg woman), within the range of previously available contraceptives for women in the 1960’s, before the benefits of lower-dose formulations were known (Chadwick et al, 2012). Doses exceeding this are also currently used for emergency contraceptives (Curtis et al, 2005).…”

Ovarian hormones: a long overlooked but critical contributor to cognitive brain structures and function

“…Hormonal contraceptives have various routes of administration, including oral, transdermal, and intrauterine. Here, the focus is on oral contraceptives (OCs) because they are common, and will be used by over 85% of women in the United States for at least 5 years of their life . It is important to note, however, that OCs are heterogeneous.…”