Pop a Pill, save your life

IT BEGAN with the purpose of allaying menstrual disorders and then birth control. That was a revolution in itself, but now, 50 years later, new findings on the birth control pill include the fact that it prevents endometriosis cancer, besides ovarian cancer.

A landmark review of 15 case-control studies and at least four large cohort studies have found a decrease in the risk of endometrial cancer of about 50 per cent for women who have used or are currently using combined oral contraceptives (COCs). The review was published in the September issue of the international journal Endocrine-Related Cancer.

According to the review: 'This protective effect persisted for more than 10-15-20 years after cessation of the COC. An increasing protective effect with longer duration of COC use has been found in most studies.'

Endometrial cancer is the fifth most common cancer among women in Singapore.

This news might just revise public opinion about the Pill, which is currently rather poor, thanks to the fact that a lot of women still think it causes weight gain or acne.

Firstly, it's most important that old wives' tales and myths about the Pill are debunked, says Dr Christopher Ng, obstetrician-gynaecologist of GynaeMD Women's and Rejuvenation Clinic at Camden Medical Centre.

Usage of the Pill among Singaporean women is low - less than 10 per cent, it is estimated - mainly because women feel that taking the pill has negative side effects, such as weight gain, reckons Dr Ng.

'In the earlier days it was true because doses were really high. But birth control pills today have lower doses, from 20 to 30mg, so the risks of side-effects are much less.' Very few find it does not agree with them, he explains.

Side effects

Side effects

With advanced research, most brands have been formulated to have positive effects, in fact, besides preventing pregnancy. Some target acne, for example, with women reporting an improvement in their complexions. Birth control pills are also prescribed to reduce menstrual pains and cramps. Then, new formulations like the inclusion of drospirenone (a new progestin hormone) in the brand Yaz, allows women to avoid estrogen-related water retention that can lead to weight gain and edema.

'All brands have the same type of estrogen, though the dose may vary,' explains Dr Anupriya Agarwal, consultant at the Department of Obstetrics and Gynaecology at the National University Hospital. '(It is) the progesterone component of the Pill that varies among different preparations. Hence the differences in effects as well as side-effects.'

Depending on their menses type, body weight and hormone sensitivity, different women will respond differently to various preparations of the Pill. Common side effects include nausea, headaches, breast tenderness and weight gain when starting on the Pill. 'But these undesirable effects will go away after a few cycles,' says Dr Agarwal.

For those who fear negative side-effects of being on the Pill, Dr Ng points out that the daily benefits are more regular, lighter and shorter periods with less cramping. 'It reduces the risks of unwanted pregnancies - being 99 per cent effective when taken correctly - and reduces the risk of endometriosis, fibroids and benign ovarian cysts,' he adds.

Reducing cancer risk

Reducing cancer risk

One of the best side-effects for Pill-users however has to be the fact that it reduces risk of ovarian and endometriosis cancers. The protective effects of the Pill against ovarian cancer was reported a couple of years ago, where researchers found that the longer the women were on the Pill, the better their protection.

If a woman were to take the Pill for five years, she reduced her risk of ovarian cancer by a third. If she took the Pill for 15 years, she reduced her risk of ovarian cancer by half. The shorter the time of cessation from taking the Pill, the greater the protection persisted. This reduction in risk persisted for more than 30 years even after they had stopped taking the Pill.

'Although taking the Pill is associated with a small increase in the risk of developing breast cancer, this risk is much smaller and exists only while on the Pill and just after stopping it,' says Dr Ng. 'Whereas for ovarian cancer, the protection persists for decades.'

Worldwide, the Pill has already prevented 200,000 ovarian cancers and 100,000 deaths from the disease and with more than 100 million women taking the Pill today, it is estimated that it will prevent more than 30,000 ovarian cancers per year over the next few decades.

But it is not that doctors will start prescribing the Pill to prevent ovarian and endometriosis cancers, he notes.

For medicine to be indicated for prevention of a disease, it must be 90 per cent effective in its objective, Dr Ng explains. And unlike liver cancer or cervical cancer, where viruses can cause cancer, there is no 'vaccine' against ovarian cancer, which is largely dependent on age, family history and genes. 'For women on the Pill, prevention of womb and ovarian cancers is just a very positive side benefit,' he adds.

Despite advocacy for the Pill, not every woman can be prescribed it, notes Dr Agarwal. Women with a medical history of uncontrolled hypertension, deep-vein thrombosis (clots in the veins of the calves), breast cancer, active liver disease, stroke, or heart attack will not be prescribed the Pill, she says. She also added that women smokers who are over 35 are not prescribed the Pill as their cardiovascular risks are increased by consuming it.