By Susan Ferraro, New York Daily News
September 9, 2002

 

NEW YORK — The real reason Ali Bartolone has been taking the pill for 11 years has nothing to do with birth control.

 

"My periods were heavy, painful, long and very irregular," says Bartolone, 27, who lives in Queens, N.Y. "My first years in high school I'd get my period maybe twice in six months, or ridiculously often — every two or three weeks."

 

But after a doctor prescribed birth-control pills to settle down her cycle, Bartolone says that her "periods grew regular, the cramps minimal, if they were there at all." Once, hoping her system had learned its lesson, she went off her regimen.

 

"Right away, my period was heavier and very painful," she says. She went back on the pill.

 

Oral contraceptives revolutionized women's lives in the 1960s. For the first time, they could manage their bodies and plan their families — each a significant boon to their health. Today, 10 million women in the U.S. use the pill, which is available in more than 50 brands and formulas, adding up to a $2.4 billion-a-year market. Long controversial, they have been scrutinized more heavily than just about any other drug.

 

Now, experts say, decades of research finds that the benefits of the pill outweigh its risks. It blocks pregnancies that can, even in modern America, end badly, and it protects against certain cancers and cures other ills. And it does not pose the same risks as hormone replacement therapy in menopausal women. However, the pill is still inappropriate for some women, and many are wary of using hormones to disrupt natural cycles.

 

Birth-control pills work by fooling Mother Nature: They supply hormones women make naturally during pregnancy, and the body either prevents the ovaries from releasing new eggs or blocks sperm trying to reach them.

 

Used correctly, pills that contain both estrogen and progestin, the key female hormones, fail just 0.1 percent of the time — with minimal aggravation, maximum freedom and no "Just give me a minute, Honey" delays that can wreck romantic moods.

 

Progestin-only "minipills" that block sperm do almost as well, studies find. Because most pill use is not perfect, and ovulation is very sensitive to missed doses, the pill's overall success rate is about 95 percent.

 

The pill's chief longterm benefit is also its short-term goal: controlling pregnancy.

 

In addition, the pill can:

 

Be a cancer shield. Pill use cuts the risk of ovarian cancer, possibly because blocking ovulation limits the damage caused by eggs bursting out of the ovaries. Also, research suggests that progestin itself may chemically block cancer.

 

Ovarian cancer is rare, typically posing a 1.2 percent or 1.3 percent lifetime risk, says Dr. Allan Klapper, director of gynecology at Beth Israel Medical Center in New York. But it is usually caught late, when it is often already poised to kill. The pill can reduce risk by 40 percent, Klapper says: "That's important in someone who has a family history."

 

Also, women who take oral contraceptives for one year halve their risk of getting cancer of the endometrium, the lining of the uterus and the most common gynecological cancer, says Westhoff. Better still, the protection lasts for 15 years after stopping the pill.

 

Cure acne. The Food and Drug Administration has already approved two brands for use in suppressing acne, "but probably most of them can," says Krause. Some women ask for it for that reason, she says.

 

Reduce pain. As Bartolone learned, the controlled release of hormones can steady wildly irregular cycles, limit excessive flow and quiet gut-wrenching, nauseating cramps. So successful is the pill in easing monthly discomfort that some doctors put women on extended regimens; one company is developing a formula, now under FDA review, that creates an 84-day "cycle" with just four periods a year.

 

Limit benign cysts. Oral contraceptives seem to decrease two painful conditions, fibrocystic breast disease and polycystic ovarian syndrome, says Krause, probably because it regulates cycles and hormone levels.

 

Treat symptoms of menopause. "There is a huge indication now for birth-control pills to control symptoms leading up to menopause, such as moodiness, vaginal dryness, hot flashes and irregular bleeding," says Krause.

 

Prevent osteoporosis. Some studies show that women who take birth-control pills have greater bone density and, as a result, the prospect of better long-term health: Osteoporosis can be excruciating, and older women often die within a year of breaking a hip.

 

Control endometriosis. Properly managed, oral contraceptives may also ease or control endometriosis, a ravaging disease that occurs when uterine tissue migrates to places where it can only cause trouble.

 

Looming over the benefits of the pill are known or long-suspected risks linked to its use. Most feared, perhaps, is a possible link between taking hormones, which many think seems "unnatural," and developing breast cancer.

 

Moreover, early studies based on the first pills — which had double or more the amount of estrogen than the modern, low-dose pills — showed a connection between oral contraceptives and such medical problems as blood clots, heart attack and stroke.

 

However, as the amount of hormones in the pills has dropped, the dangerous side effects linked to them have diminished, as the studies have grown more sophisticated and doctors have learned more about how women's bodies work, proved unrelated.

 

Most studies over the years show no link between birth-control pills and breast cancer, says Hoyt G. Wilson, Ph.D., an epidemiologist with the Centers for Disease Control and Prevention. To clarify concerns, the CDC and others have done a study of 9,200 women, including the largest sample ever of black women.

 

Results released by the CDC and the National Institutes of Health last month found no connection between use of hormonal birth-control pills — past or present — and breast-cancer incidence in women 35 or older.

 

Other data are not as comforting. Women who have human papilloma virus (HPV), the chief cause of cervical cancer, have a higher risk of developing that cancer if they also take the pill.

 

Though low-dose pills have virtually eliminated the increased risk of a heart attack or stroke in healthy women, there remains some danger of developing blood clots in the legs (a three- to sixfold increase, according to the Kaiser Family Foundation). Also, "a small percentage of women" may have elevations in blood pressure.

 

"Anything you take has potential risk, whether it is the food that you eat, antibiotics for a bug or over-the-counter cough suppressants," says Klapper. "You have to weigh everything against the proven benefits."