What are the top myths about pills?

Your next patient tells you she would like to use oral contraceptives (OCs) for birth control, but she says a family member told her using pills would affect her long-term fertility. What information do you provide her regarding OCs?

Patients aren't the only ones with misperceptions about pills. Clinicians have them as well, says Deborah Kowal, MA, PA, adjunct assistant professor in the Department of Global Health in the Rollins School of Public Health at Emory University in Atlanta. Kowal presented information on the leading myths surrounding oral contraceptives as part of a sneak preview of the soon-to-be-released 20th edition of Contraceptive Technology at the recent Quest for Excellence Conference in Atlanta.1

The gap between correct and real use of pills remains vast. A 2009 review lists cognitive factors, such as false information, misconceptions, and irrational fears, as one of the leading reasons for Pill noncompliance.2 What are the chief misperceptions regarding birth control pills? Check the following list, and add the evidence to your counseling knowledge base.

How about breast cancer?

After more than 50 studies and 50 years, most experts believe that the Pill has little, if any, effect on the risk of developing breast cancer.3 While older studies of early high-dose pills found a slight increase in the risk of breast cancer,4 in a study that separated women who used pills before 1975 from those who used pills after 1975, earlier users had an increased risk of subsequent breast cancer, while those using the post-1975 low-dose formulations did not.5 Women wishing to use combined OCs can be reassured that their decision is unlikely to place them at higher risk of developing cancer.6

According to Managing Contraception for your Pocket, while there are still unanswered questions about pills and breast cancer, the overall conclusion is that pills do not cause breast cancer.3 "Many years after stopping oral contraceptives use, the main effect may be protection against metastatic disease,"4 it states.

What about fertility?

Ever since OCs have been available in the United States, it has been believed that pills will make it difficult for women to become pregnant when pill taking is ended. Women may believe that use of pills will negatively impact their future fertility, says Kowal. However, this is not the case; return to fertility is rapid following pill discontinuation.

A 2009 review looked at studies that have evaluated the return to fertility following cessation of oral contraceptives, including recent evidence in women discontinuing extended-cycle and continuous-use regimens. It concluded that return of fertility in former OC users (cyclic and extended/continuous regimens) who stop use in order to conceive is comparable to that observed with other contraceptive methods.7 Reported 12-month conception rates in former cyclic pill users range from 72%-94%, in comparison to those discontinuing intrauterine devices (71%-92%), progestin-only contraceptives (70%-95%), condoms (91%), and natural family planning (92%). While there is a limited amount of data on the time to conception in women stopping extended-cycle and continuous-use OCs, data suggest that subsequent return to fertility is generally comparable to that of cyclic pill users.7

Counsel women that the return to fertility following pill use is so rapid and consistent that they should expect no more than a two-week delay in menses once pill usage is discontinued.

What about pregnancy?

Ever since pills arrived in 1960, women have been asking this question: "What if I get pregnant while I'm on the Pill?"

While the Pill is highly effective when used correctly and consistently, 8% of women become pregnant in the first year of typical use of oral contraceptives because of inconsistent use.8

Advise women that Pill users have no higher rates of spontaneous abortion, preterm deliveries, birth defects, or complications in the health of their offspring than do non-users, says Kowal.9-13 No additional testing is required during the prenatal period for women who continue to use pills in the early months of pregnancy. If a woman experiences a spontaneous loss following Pill use, she should be counseled that the Pill was not a factor in the loss.

Can OCs impact libido?

Can OCs impact libido? Yes, pills definitely can impact libido. What is a myth is the generalization that pills adversely affect most women's libido. The opposite might be true, because pills diminish a women's fear of pregnancy and lead to less days of vaginal bleeding. Another myth would be that pills have no effect on women's sexual functioning. While oral contraceptives provide safe, effective, and reversible contraception, a review of recent literature indicates women experience positive effects, negative effects, as well as no effect on libido during OC use.14

A recent study looked at the impact of two contraceptive pills with different doses of the same components (ethinyl estradiol [EE] 30 mcg and levonorgestrel (LNG) 150 mcg, or EE 20 mcg and LNG 100 mcg) on plasma androgen levels and female sexual function among women without previous sexual dysfunction. Both groups showed improvements according to the Female Sexual Function Index, a standardized questionnaire.15

References

  1. Kowal D. Contraceptive Technology: Highlights of the soon-to-be-released 20th edition. Presented at the 2010 Contraceptive Technology Quest for Excellence conference. Atlanta; October 2010.
  2. Bitzer J. Contraceptive compliance — why is contraceptive failure still so frequent? Ther Umsch 2009;66:137-143.
  3. Zieman M, Hatcher RA, Cwiak C, et al. 2010-2012 Managing Contraception for Your Pocket. Tiger, GA: Bridging the Gap Foundation; 2010.
  4. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996;347:1713-1727.
  5. Grabrick DM, Hartmann LC, Cerhan JR, et al. Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer. JAMA 2000;284:1791-1798.
  6. Cibula D, Gompel A, Mueck AO, et al. Hormonal contraception and risk of cancer. Hum Reprod Update 2010; 16:631-650.
  7. Barnhart KT, Schreiber CA. Return to fertility following discontinuation of oral contraceptives. Fertil Steril 2009; 91:659-663.
  8. Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York: Ardent Media; 2007.
  9. Raman-Wilms L, Tseng AL, Wighardt S, et al. Fetal genital effects of first-trimester sex hormone exposure: a meta-analysis. Obstet Gynecol 1995;85:141-149.
  10. Lammer EJ, Cordero JF. Exogenous sex hormone exposure and the risk for major malformations. JAMA 1986; 255:3128–3132.
  11. Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990;76(3 Pt 2):552-557.
  12. Cardy GC. Outcome of pregnancies after failed hormonal postcoital contraception an interim report. Br J Fam Plann 1995;21:112-115.
  13. Hemminki E, Gissler M, Merilainen J. Reproductive effects of in utero exposure to estrogen and progestin drugs. Fertil Steril 1999;71:1092–1098.
  14. Davis AR, Castaño PM. Oral contraceptives and libido in women. Annu Rev Sex Res 2004;15:297-320.
  15. Strufaldi R, Pompei LM, Steiner ML, et al. Effects of two combined hormonal contraceptives with the same composition and different doses on female sexual function and plasma androgen levels. Contraception 2010;82:147-154.