%u201CThe Pill%u201D at 45: The Revolution Evolves

Internal Medicine World ReportOctober 2005

“The Pill” at 45: The Revolution Evolves

NEW YORK CITY—First introduced 45 years ago, the oral contraceptive (OC) pill

remains the most widely used method of contraception among American women,

even as the use of other contraceptive hormonal delivery systems grows and sterilization

becomes increasingly popular among baby boomers. “Obviously, sterilization is not going to

be the method of choice for most young women or couples who are uncertain about whether to have children or another child,” said Susan Wysocki, RN, president of the National Association of

Nurse Practitioners in Women’s Health, at a meeting in New York City marking the 45th anniversary of the birth of the birth control pill. “The pill has been refined, is safer now, and, most importantly, is effective at preventing pregnancy. Its durability comes from the fact that

it does the job.” Among the findings presented were data from an industry-sponsored and

ongoing nationwide phone survey called FACTS (Female Attitudes and Contraceptive

Trend Study). According to this survey, on average, a woman uses 3 pregnancy

prevention methods during her lifetime, and 8 of 10 women aged 15 to 50

years have used the pill at some point. “This confirms the intuition that women

use different methods of contraception at different times because of different life

situations,” said Vanessa Cullins, MD, vice president for medical affairs at the Planned

Parenthood Federation of America. “The pill might be ideal when a woman is

younger. It’s easy, reversible, and affordable. But, with age, the IUD [intrauterine

device] or even sterilization might become an attractive option.” Ms Wysocki and Dr Cullins both noted the renewed popularity of the IUD among American women following decades of

disuse after the Dalkon Shield, a defective IUD, was withdrawn from the US market in the 1970s.

“This is a terrific development,” said Ms Wysocki. “While the upfront costs of the

procedure can be high, when the cost is spread out over the 5-plus years that it

remains implanted, it turns out to be the cheapest form of birth control, very highly effective, and something you can forget about for a long time.” Dr Cullins said that while research

indicated that the Dalkon Shield posed health dangers, “other IUDs are safe

and effective, and the method of insertion has been advanced to limit the risk

of infections.” Noting the approval of the norelgestromin/ ethinyl estradiol transdermal patch

(Ortho Evra) in the United States since 2001, Dr Cullins said, “This is just a switch in how the hormones are delivered. It is a great relief for women who need relief from the stress of ondering if they took their pill today but who are not ready for an IUD or sterilization.” Both Dr Cullins and Ms Wysocki emphasized that whatever method of birth control a woman chooses, it should be combined with the use of a condom. “People should use both. A pill, patch, an injectable, or whatever is not going to stop sexually transmitted diseases,” Ms Wysocki said. According to data prepared by the Alan Guttmacher Institute and submitted to the Office of Population Affairs, Department of Health and Human Services in July 2005, 47% of women use OCs. This

is a 15% decrease from the 62% of users in 1995. Until 2004, the decrease in OC use

was largely offset by greater use of injectable hormonal contraceptives. In 2002, injectable medroxyprogesterone acetate (Depo-Provera) was the method of choice of 20% of contraceptive users, compared with 12% in 1995. But use of medroxyprogesterone acetate decreased

to 18% in both 2003 and 2004. Two new hormone delivery methods, the patch and the ring (norelgestromin/ ethinyl estradiol transdermal patch and etonogestrel/ethinyl estradiol vaginal ring

[NuvaRing]), have steadily increased in popularity, from 3% in 2002 to 7% in

2003 to 8% in 2004. A total of 18% of female contraceptive users said that condoms were their primary birth control method, up from 13% in 1995; 3% of users rely on sterilization,

and 0.5% use spermicidal methods. IUD use has remained constant at 2% since 2002. Numerically, IUD users have risen by 105% over 9 years, from 38,000 in 1995 to 78,000 in 2004.

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