Medical Matters: the uses of the Pill are wider than contraception

We take the contraceptive pill for granted now, but there was a time in the Republic when it could not be legally prescribed.

The Pill has a number of other medical uses, including the treatment of heavy periods; anecdotally, the number of women suffering from menorrhagia in the 1970s here shot up as it provided a legitimate way for doctors to prescribe a treatment that just happened to prevent pregnancy. It was the classic Irish solution to an Irish problem.

The commonest form of the Pill contains two hormones: oestrogen and progesterone. The combination inhibits ovulation so that the ovaries do not release eggs. And because of the precise and constant cyclical dosage, it regulates periods and makes them less heavy.

For any premenopausal woman who presents with symptoms and signs of anaemia, the most likely cause is excessively heavy periods. This may lead to iron-deficiency anaemia; prescribing the Pill is a useful way to reverse the trend of excessive blood loss because of its effect of shortening and lightening the monthly bleed.

Severe premenstrual syndrome (PMS) can be hugely disabling. For some women the intense anxiety and irritability is similar to a brief bout of clinical depression; add bloating, fatigue and breast tenderness and it becomes quite difficult to function. But again the Pill can help by smoothing out hormonal highs and lows.

Treating acne

A less obvious role for the pill is the treatment of acne in women. One particular Pill formulation is renowned for its ability to reduce oily skin which, combined with its anti-androgen properties, make it a good treatment for acne.

Research suggests the combined pill is as effective at treating the skin condition as are antibiotics; given concerns about their overuse, perhaps we should promote a greater use of the Pill in treating acne in women.

Endometriosis is an unpleasant condition that arises when tissue that normally lines the womb implants itself outside the uterus.

Often found stuck to the ovaries, bowels and other pelvic organs, this endometrial tissue responds to the monthly hormone cycle as if it were still lining the womb. It thickens and bleeds during menstruation, but there is no ready outlet for the blood and tissue. So it forms cysts, adhesions and eventually scar tissue outside the womb.

Endometriosis causes severe pain and fertility problems. While the Pill is not a cure for endometriosis, by making their periods shorter and lighter, it helps ease pain for women with the condition.

I certainly did not regard the Pill as a drug with preventive medical properties until I came across a recent article in the Lancet Oncology showing how effective the Pill has been at preventing cancer of the womb.

Researchers from Oxford University analysed 36 studies involving more than 140,000 women from around the world. They found that every five years of taking birth-control pills was linked to a 24 per cent reduction in the risk for endometrial cancer. And the preventive effect persisted more than 30 years after women stopped using the contraceptives.

Valerie Beral and her colleagues compared data on women who had been diagnosed with endometrial cancer and those who never had the disease.

Use of contraceptive pills was linked to a reduction in the risk of getting endometrial cancer by age 75. Among Pill users, that meant 1.3 women in every 100 would get uterine cancer, compared with 2.3 women in every 100 who didn’t use the Pill, the researchers calculated.

Even though the amount of oestrogen in the Pill declined over the course of the 1960s, 1970s and 1980s, the study didn’t find differences in risk reduction for endometrial cancer over time, an editorial accompanying the study noted. This suggests that there is a threshold effect; a low level of oestrogen is all that is required for cancer protection.

A Pill for every ill? Not quite, but an impressive array of indications nonetheless.

mhouston@irishtimes.com muirishouston.com