Oral Contraception, Norplant and IUD's
(The following is a compilation of facts concerning contraceptive methods. Sue Widemark of Phoenix Arizona compiled the data and references are listed at the end of this document.)
ORAL CONTRACEPTION, NORPLANTS AND IUDS
ACTION OF ORAL CONTRACEPTIVES
There are two basic types of oral contraceptives (OCs) - the mini pill which only contains progestin and the combined pill which is what most women use, contains estrogen and progestin. These medications are steroidal drugs which effect the reproductive system of a woman.
OCs are taken 21 days each month with one week off to allow 'withdrawal bleeding'. True menstrual periods will not occur until the patient has not taken any OCs for at least 2 or 3 months.
The Oral Contraceptive (OC) works in three ways: 1) It generally suppresses ovulation, and that makes it a sterilizing agent, but sometimes "breakthrough ovulation" occurs; 2) it tends to thicken cervical mucus to make sperm migration more difficult, and that makes it a contraceptive; and 3) it affects the inner lining of the uterus- the endometrium -to make it hostile to implantation, and that makes it an abortifacient--an early abortion agent.
SIDE EFFECTS
Side effects of OCs include a greater incidence of uterine cancer. Studies have shown that breast cancer may be increased in women who begin using Oral Contraceptives before the age of 25 and in long term users of OCs before their first pregnancy.
Elevated blood pressure has been observed in Oral Contraceptive users and if women have a predisposition toward hypertension, it is suggested that they use another method of contraception.
Increased incidence of thromboembolic disease and thrombophebitis have been observed both with Oral Contraceptives and Norplants. These are blood clots in various places. If they travel to the heart or brain, death can occur. The risk of thromboembolic disorders is 4 to 11 times greater for women taking Oral Contraceptives than for those not on this contraceptive medication.
There is a greater risk of heart attack in women taking OCs especially women over 30. The risk in women over 30 using 'the pill' is 4-6 times greater than women not using Oral Contraceptives.
The PDR reports that Oral Contraceptives cause 14 deaths in 100,000 in women over 35 and 31 deaths in 100,000 in women between 40 and 45.
Increased incidence of strokes have also been observed in users of OCs.
It is reported that the side effects from Oral Contraceptives are much more pronounced in smokers than in non-smokers.
Oral Contraceptives have been associated with an increase of Blood cholesterol levels and insulin problems in some women especially those with a family history of high cholesterol or diabetes.
In some women, OCs tend to cause or increase the incidence of migraine headaches.
Benign tumors of the liver have been observed in about 3 per 100,000 taking OCs, per year. Although these tumors are not cancerous, they can rupture and cause death through internal bleeding. The risk of such tumors increases after 4 years of the use of Oral Contraceptives.
The breast milk after the delivery of a baby tends to be decreased in amount and quality in women who have taken Oral Contraceptives.
Additional side effects observed, definitely connected to Oral Contraceptives include:
Nausea Vomiting Breakthrough bleeding Abdominal cramps and bloating Water retention (swelling) Changes in weight (either lose or gain) Liver dysfunction Allergic rashes Vaginal fungus (thrush) infections Change in corneal curvature (in the eyes) Intolerance to contact lenses
The following side effects have been observed in users of Oral Contraceptives and the association has been neither confirmed or denied:
Congenital abnormalities Cataracts Optic Neuritis (inflammation of the optic nerve) Cystitis (bladder infection) Nervousness Excess body hair Loss of scalp hair Impaired Kidney function Lupus like symptoms
ABORTION CAUSED
Because the Oral Contraceptives, Norplants, and IUDs are abortifacients, ProChoice advocates believe that if a human rights amendment is passed, these forms of birth control will come under fire also, which is why 'birth control' is mentioned in writings against the Human Life Amendment. It's not 'birth control' in general which would be prohibited or questioned but those forms of birth control which are abortifacients i.e. those which cause a significant number of early pregnancy abortions.
THE NORPLANT SYSTEM
This consists of implanting surgically just beneath the skin of the upper arm, 6 capsules, each 1/8 inch in diameter and 1.25 inches long. These capsules contain a steroidal medication called Progestin. This is released into the blood stream in small doses over a period of 3-5 years after which the Norplants must be replaced with new capsules to continue contraception. The Norplant medication acts in a similar manner to Oral Contraceptives i.e. it interferes with conception and also thickens the mucus of the lining of the uterus, making implantation of the newly fertilized egg impossible. The latter action is considered an abortifacient action.
SIDE EFFECTS - NORPLANT
Because the Norplant is too new to have had many studies on it, the exact side effects are not known but the medical community feels that the side effects of Norplants would be similar to that of Oral Contraceptives since Norplants employ a similar type of medication to prevent conception.
Additionally the following has been observed:
One side effect noticed has been a slight increase of cancer at the site of the Norplant.
Difficulties removing the Norplants (based on 849 subjects) Pain or itching near the implant site (comes and goes) Infection at implant site (where the Norplants are inserted in the upper arm) Weight Gain Loss of hair on scalp
The following may be associated with the Norplant system and have a 5 percent greater frequency of occurrence during the first year:
Infection of the cervix Pain in the muscles and bones Pain in the abdomen Vaginitis
Norplants are manufactured using Dichlorodifluoromethane which 'harms public health' and is destructive of the ozone layer. They do not contain these chemicals however.
THE IUD
This is a device made of polyethylene less than an inch long. It is made in different shapes depending on the manufacturer. The IUD is inserted through the cervix and into the uterus to prevent the newly fertilized egg from implanting. The exact action is not known but it is thought that implantation is prevented by the 'foreign body' reaction in the lining of the uterus.
SIDE EFFECTS
If a patient becomes pregnant with an IUD in place, septic abortion and septic shock and death can occur.
There is an increase in ectopic pregnancy in IUD users.
Pelvic infection is common.
An increased risk of tubal infertility has been observed in IUD users and this increase is significant enough that women are cautioned to discuss the option at length with their doctors before inserting the device.
Partial embedding of the IUD can cause difficulty in removal.
Perforation of the uterus can occur. This can be a silent process until widespread infection is apparent.
The IUD can come out or travel to the wrong place.
RU486 - THE ABORTION PILL
In the last several months a new early-abortion drug called RU-486 has been making the headlines. Its development has been followed for years, and just two and a half years ago the news wires reported that researchers had found it to be 85 percent effective in causing abortions in the first six weeks of pregnancy. More recently it has been found to be as much as 95 percent effective in causing abortions when used in conjunction with prostaglandins (labor inducing agents).
RU-486 acts both to prevent implantation of a newly conceived baby and to dislodge the baby who has already implanted in the mother's uterus. It does this by interfering with the normal action of progesterone, a hormone secreted after ovulation to maintain the lining of the uterus and to maintain pregnancy if it has occurred. There is no ambiguity about its action: RU-486 is intended to cause abortion.
Several side effects have also been observed with the RU486 pill, some of them long term. This year, Planned Parenthood will be testing the RU486 pill on hundreds of clients throughout the country.
Whether and when RU-486 will be marketed in the United States is not known. The risk of boycott, the cost of liability insurance, and unknown market factors may keep it off the American market for some years.
HOW CAN FAMILY PLANNING BE SAFELY EFFECTED
Johns Hopkins Institute called Natural Family Planning (NFP) the best method of birth control - 99 % effective (as effective as the Oral Contraceptives) and 100 % safe. Natural Family Planning is based on Billings Ovulation i.e. the woman learns to observe when she's ovulating by recognizing the distinctive secretions from her vagina. Abstinence must only be practiced during ovulation and a day or two after. (about 5 days each month).
Ever since late 1971 the Couple to Couple League has been helping couples get out of the dilemma birth control side effects by teaching them natural family planning (NFP). It is simply amazing that so much ignorance about NFP still exists, but few couples know about NFP in any realistic way unless they have attended NFP classes or read good NFP materials. My experience indicates that former users of the Pill are among the most enthusiastic users of NFP and that they tend to praise the marriage-building aspects of NFP even more than couples who have never used unnatural methods of birth control.
In the last year, we have been hearing from doctors who are abandoning their former practice of prescribing the Pill for birth control. One West Coast physician ordered 100 of the recently published CCL Home Study Course for Natural Family Planning since he didn't have a CCL teacher in the area to whom he could make referrals.
Practical help with NFP is available for anyone in the English speaking world by writing the Couple to Couple League, Box 111184, Cincinnati, OH 45211, or calling (513) 661-7612.
REFERENCES
<1> the PDR, 48th edition - 1994 (Physicians' Desk Reference)
<2> RN Magazine's THE NURSE'S DRUG HANDBOOK (Delmar, 1994)
<3> John Peel and Malcolm Potts, TEXTBOOK OF CONTRACEPTIVE PRACTICE (New York: Cambridge University Press, 1969), p. 99.
<4> "We are close to lowest steroid dosage in the Pill," a report on the work of Dr. Nine van der Vange, NEWS AND VIEWS, excerpts of the Second Annual Meeting of the Society for the Advancement of Contraception in Jakarta, Indonesia, November 26-30, 1984.
<5> J.C. Barrett and J. Marshall, "The risk of conception on different days of the menstrual cycle," Population Studies 23 (1959), pp. 455-461.
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