Four Decades of the Birth Control Pill

From the WebMD Archives

May 8, 2000 -- It was in 1960, the cusp of the women's movement and the sexual revolution, when "the pill" was given formal blessing by the U.S. Food and Drug Administration. On May 9, the birth control pill celebrates its 40th birthday. During those four decades, experts say, the pill has been a revolutionary force in the lives of many baby boomer women -- and now, their daughters. And its best years may still be ahead.

In 1962, Gloria Feldt was one of the first to try oral contraceptives; today, she is president of the Planned Parenthood Federation of America.

"I'd had three children in a four-year period. I was 20 years old. The pill saved my life ... and my sanity," she says, laughing. "I took those pills instantly with very little question of their safety.

"The pill was the most socially significant medical advance of the century for women," Feldt tells WebMD. "I don't think it's an exaggeration to say that women's reproductive history has changed more since the advent of the pill than in all of previous history. ... When a woman cannot control her fertility, she has very little control over anything else in her life. .... At last, it was possible for women to control childbearing by taking a pill, safely and very effectively. "

Women were also maturing earlier than ever before, says Feldt. "Biologically, we are different than we were a century ago. The pill came along at exactly the right time. Because of the pill's effectiveness, it allowed women to have many choices in life." And many women accepted it immediately, she remembers. "By the time it had been on the market 10 years, there were already 10 million women taking it. It's continued at about that level ever since."

Still, women have not always completely trusted the pill. In the 1970s, as women began wondering about its long-term effects, many turned to intrauterine devices (IUDs). When problems developed with those, many returned to the easy-to-take, once-a-day contraceptive pill, despite their worries.

This all happened against a backdrop of profound social change. But did the birth-control pill bring about the sexual revolution? No, Feldt says. "To imply that the pill caused the revolution has the emphasis on the wrong syllable," she says. "Most human beings have sexual relationships, and most of the time they don't want to risk pregnancy every time they have sex."

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"It certainly gave women more freedom, and that is an advance in social justice that is in keeping with democratic values," Feldt tells WebMD. "Can a woman now feel sufficient power over her reproductive capacity that she can make other life choices for herself, like whether she will or will not stay in a bad relationship? Yes."

While the pill has changed millions of women's lives and lifestyles, many remain distrustful today. But attitudes are shifting as research reveals the pill's health benefits.

Surveys have found that as recently as 1985, three-quarters of women believed there were "substantial health risks" associated with pill use. In 1993, 54% of women distrusted the pill; in April 2000, 41% of women said they feared it. Women still cite cancer as their number one fear, when, in fact, studies have shown the pill has protective effects against certain types of cancer, says the American College of Obstetricians and Gynecologists.

Since 1970, ovarian cancer incidence and deaths have declined among U.S. women between the ages of 35 and 59. A few studies have shown that the duration of contraceptive pill use is a key factor in reducing the risk of ovarian cancer.

Stanford University researchers are among many working to further pinpoint the pill's protective effects. "The study shows that while the pill seems to protect pre-menopausal women, the protective effect may not carry over into older women," researcher Susanne Gnagy, whose study appears in the May issue of the journal Epidemiology, tells WebMD. Gnagy is an epidemiologic researcher in the Stanford School of Medicine's Health Research and Policy Department.

Another study, in the March Epidemiology, showed that oral contraceptives' protective effects against ovarian cancer multiply over time, and that they may last 15 years or more after a woman stops using the pill. There was a 7% decrease in risk for this cancer for each year of pill use, says researcher Victor Siskind, of the Queensland Institute of Medical Research in Australia.

"There was little evidence of waning protection with time ... or from early commencement of pill use," Siskind writes. "Oral contraceptives may act by both suppressing ovulation and altering the tumor-promoting [environment]."

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Now that pill usage has reached maturity, we can expect more studies of the pill's effects, both long-term and short. "There haven't been many studies of women who have used the pill for a long period of time. Now that we've had 40 years of women using the pill, we're just beginning to raise questions," Gnagy tells WebMD.

While some risks of taking the pill, such as strokes and blood clots, are the same today as they were in the early 1960, "data show that the chances of someone (not on the pill) dying of a clot is 1 in 100,000; it's two or three times higher for a woman on the pill; but for a pregnant woman, the chances are 9 in 100,000," says James Roberts, MD, head of gynecology at Stanford University School of Medicine. "So you've eliminated or at least vastly decreased that problem by taking the pill (to prevent pregnancy)."

The pill has also been shown to decrease the risk of precancerous changes in the uterus, Roberts says. "The other benefits are less significant, but if you have someone with very heavy periods, very irregular periods, lots of cramps, or discomfort from PMS symptoms, using the pill can decrease a lot of those symptoms. The pill has also been used for treating endometriosis, a condition that is one of the major causes of infertility. It's a little paradoxical; the same pill that stops pregnancy may also help you get pregnant."

While one pharmaceutical company has been advertising a new pill as having the ability to decrease acne, "that was something we saw from the very beginning, so it's not particularly new or unique to that pill," Roberts says. "But you see people [on the pill] who have less oily skin, less acne. It's one of the side effects that's a fringe benefit."

How long can a woman safely take the pill? Conventional wisdom has changed a bit since the '60s. "Initially, people thought you could go to age 40 -- or age 35 if you were a smoker -- but what we've found is that if people smoke and take birth control pills, they have more difficulty with clotting abnormalities," Roberts tells WebMD. "What's turning out is that you can probably can go beyond age 40, and may well be able to go into menopause, then switch to postmenopausal hormone replacement."

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Many women find that the pill controls premenopausal symptoms like hot flashes or irregular periods, according to data from the American College of Obstetricians and Gynecologists.

Roberts, who has monitored the pill phenomenon during the past 20 years, says that public health threats have changed since the early days of oral contraception. "We now have a situation where pregnancy is not the major concern that people have, with HIV and HPV infection. Studies have suggested that the pill would increase cervical cancer because there would be less concern about having intercourse with multiple partners."

Today, there are nearly 50 different oral contraceptive pills from which doctors can choose. An emergency birth control pill -- the so-called "day-after pill" -- has been quietly used for more than 20 years, although it only received official FDA approval for that purpose in 1998, Feldt says.

"We've found that as soon as we could advertise availability of the emergency contraceptive, we've seen very dramatic increases in ... people seeking information about it, so they would be informed should they need it, but also dramatic usage," she says. "Research indicates that unintended abortion could be reduced by half if every woman could have emergency contraception."

Of the myriad of oral contraceptives on the market, all are variations of the basic structure, fine-tuned to give the effects women want -- protection from pregnancy -- and minimize side effects.

"Like some of these targeted estrogen replacement therapies, they're trying to find drugs that interact with estrogen receptors that don't make people have headaches, don't make them gain weight, don't affect clotting," Roberts says.

"Maybe we want to catch just the ovum and not make it mature. Or make a minor change in the uterus so the ovum can't implant. Most of the research is on trying to refine them, to do just exactly what you want, like 'smart bombs.'"

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