Pregnancy, Lactation And The Pill

The pregnancy rate in birth control users is about one to two percent. It is frequently due to not taking all the pills, or taking the pills incorrectly. Some studies have found a small, but not significant increased risk of chromosomal birth defects, and heart and limb birth defects, in babies conceived while their mothers were taking the birth control pill. The World Health Organization report also noted a slight increase in the risk of miscarriage in these women.

In 1990, Dr. Bracken, a Yale professor of epidemiology, published two studies in which he found no association between birth control pills and birth defects or infertility. Dr. Bracken also believes that there is no increased risk for birth defects in women who conceive right away after coming off the pill.

Dr. Diane Millar, a Vancouver gynecologist, feels that the progesterone only pill is the best birth control choice for breast-feeding women.

On the other hand, Dr. Steinberg refers to two recent studies that show that low dose combination pills do not interfere with breast-feeding, and claims that the pill does not alter the quality or volume of breast milk. "At present," he says, "There are no recognized long-term effect on the neonate." (Diagnosis, July/87).

However, The Boston Women's Health Collective maintains that the pill decreases the amounts of protein, fat and calcium in breast milk and that some estrogen will come through the milk and be absorbed by the baby.

Until the long-term safety of the birth control pill has been proven for babies, I would be seriously concerned about recommending its use to breast-feeding mothers.

Teenagers And The Pill

According to Dr. Steinberg, "Once menstruation has begun, the growth spurt in adolescents is usually completed. Therefore, (the birth control pill) can be safely used without fear of growth inhibition." (Diagnosis, July/87).

However, the main risk for teenage women is the serious risk of chlamydial infection and sterility. Since the pill makes the teenage user more susceptible to chlamydial infections, and provides no protection against chlamydia or other sexually transmitted diseases, including AIDS, barrier methods are the preferred method for teenagers who can reliably use them.

The Pill And Women Over 35

The birth control pill is now being recommended for women over 35 who do not smoke or have other risk factors. Taking the pill may mask the beginning of menopause. Women over 35 should be followed in the first six months for blood lipids and blood pressure levels, and possibly fasting blood sugar levels as well.

Dr. Diane Millar suggests the use of the mini-pill or the progesterone only pill for older women. It has a slightly higher failure rate than the combination pill, but it may be safer overall. However, there may be an increased risk of tubal pregnancy with this pill.

Dr. Steinberg notes that older women who come off the pill may develop problems, "including menstrual irregularities, which may require surgical treatment or hormonal intervention." (Ontario Medicine, Sept/92).

However, at present there are no well designed studies that establish the safety of continued use of birth control pill past age 40. These studies may not be available for another ten years.

Thyroid And Adrenal Effects

The pill alters thyroid function blood tests, but this is not thought to be significant. In addition, it also alters adrenal function tests but this is not thought to pose any risk to health.

Infections

Pill users definitely have an increased risk of getting persistent and difficult to treat yeast infections. The pill is a definitive causative agent in the developing of chronic candida syndrome, a widespread infection of candida that involves every organ system in the body.