Gabor Szendi:
The Risks of Birth Control

Nowadays it is becoming more and more evident that drugs and the pharmaceutical industry are not our friends. Every medication has risks, but there are cases when taking medicines is inevitable. But is it worth taking drugs to treat diseases which can heal without them?

 

 

When I was young I thought I was an enlightened, rational man, who could appreciate scientific advancement, and I took numerous antibiotics and painkillers in this spirit. I just waved my hands at those opinionated doubters who said that taking drugs is dangerous and would cause trouble. It seemed such a superstitious fear, an instinctive aversion not based on facts. However in the last few decades, my way of thinking has changed extensively, as I have become acquainted with the nature of the diseases of civilization, and the side effects of drugs. Now I've reached the same point as the old lady in my neighborhood who would rather groan with pain than take a painkiller.

If anyone spoke against contraceptives when I was young, I would have engaged them furiously, saying sarcastically that of course we should use chastity belts and make pregnant women drink alkali potions again. Now, I believe that contraceptive pills are very dangerous for an entirely different reason.

What does the pill actually do? It blocks the female hormonal cycle and constantly simulates a status of pseudo-pregnancy. The "menstruation" is also a fake bleeding, and does not correlate with the processes of the normal cycle, contrived to make women feel like women.

Countless research papers have been published in the literature to prove that women who stop taking contraceptive pills after years are capable of conceiving at similar rates as women who did not take the pill. I fear this is part of a marketing campaign by the pharmaceutical industry, for two reasons. On the one hand, research conducted in 2015 demonstrated that in individuals who take contraceptives permanently, the size of the ovaries shrinks to half, the number of primary oocytes decreases, and the level of anti-Müllerian hormones - the hormones that most accurately predict the fertility of women - decreases by approximately 20% (Birch Petersen et al., 2015). It is hard to believe that after quitting the pill these levels return to normal immediately. The data is little-known, because in women taking contraceptives permanently the so called ovarian reserve is reduced, which means the fertile life phase becomes shorter (de Vries et al.; 2001; Bentzen et al., 2012).

Furthermore, a large number of women take contraceptives together with anti-depressants, which - in the words of Biological Anthropologist Helen Fisher, 'Kills the love.' Using less poetic words, these drugs inhibit the production of sex hormones and in many women this effect persists even after quitting an antidepressant (Fisher and Thomson, 2006). Lastly, many women suffering from Polycystic Ovary Syndrome receive contraceptives from their doctor which mask their symptoms very effectively, but the problem is only postponed, to years later (Mendoza et al.; 2014).

Another side effect is that the bone density of women decreases proportionately with the length of treatment (Scholes et al.;2010).

The question of cancer is soon raised if we talk about female hormones. The risk of ovarian cancer decreases (Havrilesky et al.;2013), however the risk of breast cancer increases by 50% according to meta-analyses (Soroush et al.; 2016). Venous and arterial thrombosis may be the severe consequences of taking contraceptives. This used to be true for tablets containing some form of estrogen, but now it is also true for newer progesterone derivatives as well: the risk is 5-6 times higher compared to women not taking the tablets. The risk is especially high in women who have thrombosis, stroke or heart attack in their family history, who are more than 35 years old, are smokers, or carriers of Leiden mutation (Brynhildsen, 2014).

A few years ago a letter I received hit me particularly hard, when a mother asked me to write about the risks of birth control pills, because her daughter - probably due to taking the pill - had died of pulmonary embolism at the age of 18. We think that contraception is so useful and harmless, and so many believe that rare side effects only affect others, that only a few women consider the use of non-hormonal, much safer alternatives. The higher risk of unwanted pregnancies connected with alternative methods is a regular counter-argument against them. Of course, if we read the statistics from the pharmaceutical industry this may seem to be the case, but in everyday practice the situation is totally different. In a year, 8% of women taking birth control pills will have an unwanted pregnancy (Wright and Johnson, 2008). There can be numerous reasons for this: Many women sometimes forget to take the pills, while in others the efficacy of the tablet is reduced due to absorption disorders; and many do not know that using several drugs reduces or inhibits the efficacy of birth control pills (Back and Orme, 1990).

Moreover, there is another major problem, which is the consumption habits of individuals and the effects of this on the fate of the Earth. Personal aspects are totally different to global effects. I have already mentioned the individual risks of birth control pills, but this may reveal several other things. Nevertheless, individuals understandably do not consider the effects of birth control pills on human evolution, and neither can they control these effects.

The need for contraception became more and more important, partly to free up the female work force, through making family planning more easy, but also according to many, to liberate female sexuality, and for the social emancipation of women. Since the appearance of hormonal contraception in the 1960s it has transformed the role of women entirely, because women can delay the time of marriage and childbirth, and because of the opportunities offered to study further and to realize themselves in work.

But everything has its side effects. Women - from the male perspective - became sexually available without the constraint of marriage, and this essentially overwrote the million-year relationship between men and women. Previously, sex sooner or later ended in childbirth, therefore both sides - but women in particular - considered carefully with whom and when to have sex. Nowadays, sexual maturity arrives earlier, and it is completely acceptable to start sexual life from a fairly early age. In these changed circumstances men are less likely to engage in long term relationships. The number of marriages drops radically, less and less children are born, with most of them born into common-law marriages with insecure futures, or growing up in divorced families. Many women - in Hungary the rate is 11% - stay childless forever, partly due to procrastination about childbearing, and partly due to the conscious decision not to have children (Szendi, 2012).

From this perspective the following problem seems minor, and in theory it is also avoidable. That is, a woman who chooses the father of her future child while taking birth control pills can easily have an infertile marriage, or face various complications during her pregnancy, because of immunological incompatibility. The reason for this is that women recognize their immunologically suitable partner through the sense of smell - which is affected by birth control pills. They will therefore find the body scent attractive in men with whom they can only have children with difficulties (Szendi, 2018).

Hormonal birth control is unfortunately a typical example of how humans can lead our evolution in an unwanted direction.

 

References

Back DJ, Orme ML. Pharmacokinetic drug interactions with oral contraceptives. Clin Pharmacokinet. 1990 Jun;18(6):472-84.

Bentzen JG, Forman JL, Pinborg A, Lidegaard O, Larsen EC, Friis-Hansen L, Johannsen TH, Nyboe Andersen A. Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception. Reprod Biomed Online. 2012 Dec;25(6):612-9.

Birch Petersen K, Hvidman HW, Forman JL, Pinborg A, Larsen EC, Macklon KT,Sylvest R, Andersen AN. Ovarian reserve assessment in users of oral contraception seeking fertility advice on their reproductive lifespan. Hum Reprod. 2015 Oct;30(10):2364-75.

Brynhildsen J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther Adv Drug Saf. 2014 Oct;5(5):201-13.

de Vries E, den Tonkelaar I, van Noord PA, van der Schouw YT, te Velde ER,Peeters PH. Oral contraceptive use in relation to age at menopause in the DOM cohort. Hum Reprod. 2001 Aug;16(8):1657-62.

Fisher, H. - Thomson, J. A. 2006. Lust, romance, attachment: do the sexual side effects of serotonin-enhancing antidepressants jeopardize romantic love, marriage, and fertility? In: Platek, S. M. - Keenan, J. P. - Shackelford, T. K. (eds.): Evolutionary Cognitive Neuroscience. The MIT Press, Cambridge, Massachusetts, 245-283.

Havrilesky, L., Gierisch, J., Moorman, P., Coeytaux, R., Urrutia, R., Lowery, W. et al. (2013) Oral contraceptive use for the primary prevention of ovarian cancer. Evid Rep Technol Assess 212: 1-514

Mendoza N, Simoncini T, Genazzani AD. Hormonal contraceptive choice for women with PCOS: a systematic review of randomized trials and observational studies. Gynecol Endocrinol. 2014;30(12):850-60.

Scholes D, Ichikawa L, LaCroix AZ, Spangler L, Beasley JM, Reed S, Ott SM. Oral contraceptive use and bone density in adolescent and young adult women. Contraception. 2010 Jan;81(1):35-40.

Soroush A, Farshchian N, Komasi S, Izadi N, Amirifard N, Shahmohammadi A. The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-analysis. J Cancer Prev. 2016 Dec;21(4):294-301.

Szendi. G: The woman's life.(A nő élete) Jaffa, Budapest, 2012

Szendi, G: The rising and glory of woman.(A nő felemelkedése és tündöklése.) Jaffa, Budapest, 2008/2016.

Wright KP, Johnson JV. Evaluation of extended and continuous use oral contraceptives. Ther Clin Risk Manag. 2008 Oct;4(5):905-11.