The birth control pill is being questioned more and more critically today. Why, explains gynecologist Dr. med. Interview with Dorothee Struck.
On August 18, 1960, the first contraceptive pill came on the US market. At that time, the preparation was a sensation: the first form of hormonal contraception. Just one year later, the pill was already available in Germany. Originally marketed as a remedy for menstrual cramps, it was only prescribed to married women. That it also protects against conception was only stated in small print on the package insert.
Today, 60 years later, women usually grow up taking the pill as a matter of course. The concept of the preparation is being questioned more and more. Do women really still take the pill today for contraception? Dr. med. Dorothee Struck, gynecologist and author of "Contraception without hormones", looks back on the history of the pill in an interview with the news agency spot on news and explains its significance today.
The pill celebrates its 60th anniversary today. As a gynecologist, how do you look back on the history of the contraceptive so far?
Dr. Dorothee Struck: With mixed feelings: I think the pill is good as a safe contraceptive that allows women to live out their sexuality without fear of an unplanned pregnancy. One good contraceptive among many, but a wide range is important to me so that every woman and every couple can find a method of contraception that suits them. The egg-laying woolly milk sow, super safe, free of side effects, inexpensive and reversible, is far from invented. But we have several options, among which the various pills and other hormonal contraceptives are one.
Second, I love the pill as an effective drug for treating certain cycle-related or hormonal ailments and disorders. For example, the pill does not treat endometriosis causally, but it does significantly lower the risk of relapse after an operation and buy the women concerned time for family planning, as the best chance of pregnancy is usually in the first year after the endometriosis operation .
On the other hand, I am also very critical of the pill, especially in the communication with which it was brought to the woman. The cycle under a pill is always a drug-controlled dummy cycle, never a real menstruation. This means that a pill cannot be used to regulate the cycle, as the body's own cycle is suppressed and not "regulated".
I consider this wording, or the designation of using the pill for "menstruation management", to be very difficult. The pill creates a pseudocycle and if the preparation is selected accordingly, it can give almost every woman an uncomplicated, regular, symptom-free bleeding, but only a sham cycle that leads women to believe that everything is fine. Any underlying problems or irregularities are suppressed and the woman does not notice it, the pseudocycle is regular.
The pill is currently very much criticized for this in social media. But how can a drug be criticized for showing the effects that are expected of it? Namely, the suppression of ovulation and the prevention of the formation of an egg bed for the implantation of an egg cell and instead of menstruation there is a hormone withdrawal bleeding. And like any drug that has effects, some of the users also experience side effects.
My main point of criticism is that the pill has temporarily degenerated from a consciously used contraceptive to a lifestyle candy, from which women want smooth skin, less greasy hair and a weak pseudo-menstruation that can be adjusted for a beach vacation.
Why are there phases in which the pill is criticized more sharply?
Struck: Even in the women's health movement of the 1960s to 1980s, the pill was very much in the line of fire of women from the feminist movement, but also of committed doctors. At that time, the reason was primarily the high rate of thromboses and embolisms, i.e. serious side effects that were due to the higher estrogen dose. In addition, it was criticized at the time that the responsibility for contraception was thus shifted to the woman.
With the reduction in the amount of hormones per pill, criticism subsided significantly in the 1990s, and serious complications became less common. Today we have other side effects with newer progestins, such as frequent urogenital infections in some women, which we had not seen before and who are now under criticism. Some new progestins also increase the thrombosis rate again.
The current question is why many colleagues prescribe hormonal contraception so quickly and why so little is given about side effects and alternatives. Quite simply: the time spent on counseling is badly rewarded by the health insurances; every packet of pills is accompanied by a leaflet with the side effects that the woman can read. Of course, we have a duty of care to rule out contraindications, such as familial accumulation of thromboses, strokes, migraines with aura, etc. and to point out serious side effects, but not to list all those listed on the package insert. In addition, the pill is simply a tempting patent solution that often solves several problems at the same time: The young patient is rid of menstrual pain and at the same time has very reliable contraception protection. An unbeatable argument in times when economy and time pressure shape patient contacts.
Even though I am a real fan of hormone-free contraception methods myself, I find the current criticism to be partly outrageous. When women get upset that their gynecologist has prescribed nasty hormones for them for years, but for years they get preparations that can only be obtained in pharmacies on presentation of a doctor's prescription and have a very closely described package insert listing many potential side effects – women must be there but think for once that the packet contains a medicine and not candy. It would be urgent for me to question why contraceptive counseling is not institutionalized in Germany. The length of the consultation depends on the commitment of individual gynecologists to provide it without adequate payment.
In your opinion, there is not enough information about the side effects of the pill?
Yes! When I talk about it, I fall on deaf ears, especially with very young women. What I always find astonishing is that many young women answer no when asked whether they are taking medication. I ask if you are using the pill for contraception, but they say yes. For some women, the pill is not saved as a medication, is an integral part of daily life and shapes the perception of how a normal cycle works. I find that very worrying.