Oral Contraceptive Myths and Facts Part 3: Is the Pill Good for All Women?

Recently, we discussed the endocrine system, a system of glands that produce biochemical substances known as hormones. These include sex hormones, which play an important role, not only in pregnancy, but also in events leading to it. Oral contraceptives, also called birth control pills, consist of hormones that interfere with the signaling between hormones and the ovaries. In this series, we are discussing oral contraceptives from various angles, beginning with some common myths and the facts that resolve those myths. This is part three of the myths and facts component. Let’s start with the question of whether the pill is a good fit for all women.

Myth: The pill is the best contraceptive for all women.

Fact: Oral contraceptives are not optimal for everyone. First of all, most women on oral contraceptives don’t follow the schedule so perfectly, and so the effectiveness of the pills for typical use is approximately 91 percent. This means that, of every 100 women who take oral contraceptives in a typical way, 9 become pregnant each year, but again, that’s with typical use. Typical use means that occasionally a pill is forgotten, or is taken too late, which can happen even to the most conscientious for instance if she’s delayed returning home unexpectedly and does not have her pills with her. No contraceptive (other than abstinence) is 100  effective, but the reliability of oral contraceptives rises into the high 90s among women who take them precisely according to the prescribed schedule.

While there are women who are unable, or unwilling to commit to such a schedule, there also are women who cannot take oral contraceptives for medical reasons. For example, women with certain genetic conditions that make them prone to form blood clots, such as a factor V Leiden (FVL) mutation, are advised to avoid oral contraceptives, because oral contraceptives themselves elevate the blood clot risk. Similarly, women who smoke should not take oral contraceptives, not only because smoking in itself elevates the blood clot risk, but also because the risk of clot formation from smoking and oral contraceptives work in a complimentary way, resulting in a risk of blood clots much higher than the risk of blood clots from other smoking or oral contraceptives alone. By a risk of forming blood clots, we are talking clots forming usually in a vein in the leg, or pelvis, although they also can form elsewhere in the body. Known as venous thrombosis, such a clot can generate what’s called an embolus, a traveling clot, when then can get stuck somewhere, such as in the lungs, where it causes a pulmonary embolism. If you smoke and wish to use oral contraceptives, you should first get treatment for your tobacco addiction. Then, once you become a nonsmoker, you’ll be a much better candidate for your doctor to start you on oral contraceptives. If you lie to your doctor about smoking in order to obtain oral contraceptives, and you then take oral contraceptives without quitting smoking, you are playing Russian roulette.

Myth: Oral contraceptives cause or exacerbate acne.

Fact: This is mostly not true. Although acne can flare up when you begin oral contraceptives, or when you switch to a different oral contraceptive, the acne generally improves within a cycle or two, and typically gets better than it was before you initiated the oral contraceptive treatment. In fact, for many women, oral contraceptives actually work well as an off-label treatment for acne. There are many cases of women taking oral contraceptives for acne and not primarily for birth control, or not for birth control at all, either because they are not sexually active, or not sexually active with men. Additionally, women take oral contraceptives to treat a condition called hirsutism, which is characterized by the growth of body hair that is excessive, or thicker than normal, or located on parts of the body where you don’t want it, such as on the face, abdomen, arms, or chest. The combination of acne and hirsutism occur in a condition called polycystic ovarian syndrome (PCOS), which is another reason why women may be prescribed oral contraceptives.

In the next installment, part four, we’ll talk about two oral contraceptive issues that concern many women: weight gain and cancer.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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