One-month pill container with pills ULY MARTÍN
When the pill was legalized as a contraceptive method in the United States in the 1960s, a new era began in which women finally had total control over their bodies, and could decide when to get pregnant. Those first pills have little or nothing to do with the ones we take now: "The doses that were given 60 years ago, when the pill began to be prescribed, were in some cases up to 12 times what is applied today ," he says. José Gutiérrez Alés, gynecologist and president of the Spanish Contraception Society (SEC). “Those contraceptives are no longer marketed, which caused a whole tangle of symptoms; we have taken the pills to the minimum dose necessary to achieve the contraceptive effect. ”
And, despite everything, women continue to show certain reluctance to take them. This is what shows the latest survey published by the Spanish Contraception Society (SEC) last November on contraceptive consumption habits, where, despite confirming that the contraceptive pill is the second most used pregnancy prevention method in Spain, only behind the condom, stands out that the most important obstacles to its consumption have to do with the concern of women for their health (61.5%) and, within these, what is most worrying are the risks derived of the use of hormones (29.1%)
Are they unfounded fears? Mar Muñoz, head of Gynecology and Obstetrics at the La Paz University Hospital (Madrid), firmly affirms that "the pills are safe." Of course, he emphasizes, "they are not innocuous." The expert recalls that, like all medicines, they present a series of contraindications and adverse effects that must be taken into account previously. "A woman should not start taking a pill on her own and at risk, it must always be prescribed by a doctor, who will previously check the main problems that may occur," explains the doctor.
The most frequent side effects are tension. breast, water retention, headache, slight weight gain, increased cellulite, inhibition of sexual desire, acne, altered mood or blemishes on the face. Effects that, as Francisco Carmona, head of the Gynecology Service of the Hospital Clínic de Barcelona and professor at the University of Barcelona assures, are "mild and well tolerable" .
Contraindications imply that a woman who has been fit to take the pill at any given time may no longer be fit if her circumstances change
In addition, all the experts consulted assure that these effects have a transitory nature and tend to give way with the passage of time: "When a woman starts taking oral contraceptives, she has to understand that she is going to have to live a period of adaptation," says Gutiérrez. Alés.
More serious side effects can occur which, according to Gutiérrez Alés, tend to appear shortly after starting to take the pill and are usually related to contraindications. Some of them are an increase in triglycerides, the appearance of thrombosis, blood clots in the legs or erythema nodosos or multiformes.
Therefore, knowing the contraindications (in which cases the pill is not indicated) is almost as or more important than the Adverse effects. The list is extensive: women with migraines with auras, patients who have had recent breast cancer, people with decompensated diabetes, hypertensive or with liver problems of some relevance such as hepatitis … And, above all, having a tendency to suffer from thromboembolism, The pill increases the risk of cardiovascular accidents and blood clots in these patients.
A woman who at one point has been fit to take the pill may stop being fit if her circumstances change. Gutiérrez Alés gives an example: "I may take pills and nothing happens, but if I suddenly break my leg and have to rest for three months, the new circumstances may increase the risk of thrombosis." That is why biannual meetings with the gynecologist are so important, who must update the patient's medical history and confirm that she can continue taking the pill.
Estrogen: culprit for serious side effects
But why is the pill discouraged in so many cases? To explain it, you have to look at one of the two ingredients that they contain: estrogen (the other is gestagen). This hormone is included for reasons that have more to do with regulating menstruation and bleeding than with preventing pregnancy. Gestalt, the most common type of which is ethinylestradiol, also increases the risk of thromboembolic events.
Hence, there are either the combined type pills –with two hormones, estrogen and gestagen– or only gestagen: “If you you use a contraceptive method that only carries gestagen, you are getting rid of these thromboembolic phenomena, but the menstruation rhythm and the bleeding pattern are slightly altered, ”says Carmona, from the Clinic. For this reason, those that carry only gestagen are used above all "in very specific cases, such as breastfeeding, in women with a high risk of thromboembolic events or in elderly smokers," says Muñoz, from La Paz.
Despite having more adverse effects, the one most commonly consumed is always combined (two hormones). Its main advantage is that, as we have said before, it achieves a control in menstruation, that is, "that women manage to have a perfect period most of the time, once a month, little and no pain", he points out. Muñoz. It also prevents endometriosis, permanently reduces the risk of ovarian and endometrial cancer, as well as fibroids, and protects against future osteoporosis
One type of pill for every woman
When choosing which type of oral contraceptive to prescribe, women Doctors also look at the size of the dose and the type of gestagen they contain, because that will allow them to add a series of extras depending on the particular situation of each patient. It is not the same that they have a certain tendency to have more hair, acne or that they have a tendency to have a polycystic ovary, since "one type of hormone is better for these women than others," says Carmona. "In the end, you have to try to personalize them to choose the right gestagen," he concludes.
"We have discovered a long time ago that specific training in contraception was very deficient in Spain"
This range of possibilities allows contraceptive treatment to be highly personalized, although it is not always right the first time: “It is more of a trial and error system. We do not have a clear guideline for which woman is best served by one pill or another. Many times we give one, and see if it goes well. If not, we change to another ”, recognizes Carmona. That is why it is vital that, over all the first months, you go to the doctor to make a general assessment and determine if another type of pill is necessary or if it works well.
In an extreme case, treatment must be stopped and alternatives sought : “The same that exists in pills, we also have it in patch and vaginal ring; what changes is the route of administration, ”says Muñoz. “The advantage is that the woman can choose. We have a varied and safe offer, with many planning methods that are highly effective, ”says the doctor.
Lack of communication
If the pills are safe, why do some women continue to have these concerns? Much of the problem comes precisely from insufficient communication with the patient: "We have discovered a long time ago that specific training in contraception was very deficient in Spain," acknowledges Gutiérrez Alés, from the SEC.
From this society, he indicates, They are conducting workshops and masters on contraception, not only focused on gynecological personnel , but also on any professional to be able to advise in the most effective way possible: "Counseling training is our great challenge," he concludes. His colleague Carmona agrees: “These things, more than an expense or a waste of time, are an investment in trust.”
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