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Candace Bushnell Celebrates Birth Control Advance

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

This Sunday's final episode of Sex and the City will close the book on Carrie Bradshaw's urban adventures. But her creator, author Candace Bushnell, is helping open a new chapter in reproductive lives of American women.

"In the last 30 or 40 years women's lives have changed profoundly - many women now have successful careers and economic independence," says Bushnell, 45, who helped launch a new oral contraceptive manufactured by Barr Laboratories, Inc. "The beginning of this journey was the birth control pill which really marked the emergence of women first being able to control their reproductive lives."

Data estimates that more than 16 million American women now take oral contraceptives. But today's pill is not the same pill that emerged in 1960.

"Today's pills are safer and have lower doses of hormones and seem to be tailored better to different women's physiology," notes Bushnell, whose novel Trading Up hit the best-seller list last summer. "I have taken the Pill, but I just got married so I'm thinking on the other end of this issue right now.  But I could see myself considering it if I decided not to have children. I like the idea of having more options."

"Hopefully we'll have more options for men too," Bushnell adds. "We've been talking about it for years but it just never seems to happen."

Oral report

The first versions of oral contraceptives contained as much as four times the steroid hormone as today's brands and as such were not well suited to many women.

"The lowest dose pills are now 20 micrograms," says Dr. Mary Lake Polan, professor and chair department of obstetrics & gynecology at the Stanford University School of Medicine. "But while we believe this dose is much safer, when you take the 20 microgram pills you can't miss a pill -- there is no leeway. You have to be far more careful about taking the pill every day."

Polan also says different progestins, or forms of the hormone progesterone, have been developed for today's pills.

"We also have progestin-only pills that contain no estrogen," Polan explains. "Most of the progestins are 19-nortestosterones. They have progestin activity but they also have a little bit of androgen activity."

Another significant difference in modern oral contraceptives is that the original pills released the same amount of hormone throughout the entire month. Polan says now there are triphasic pills to mimic the hormonal fluctuations in a woman's normal menstrual cycle.

While a woman still continues to have a menstrual cycle when using oral contraceptives, a new type of FDA-approved pill, called extended-cycle oral contraception, promises to reduce a woman's monthly event to only four periods a year.

Manufactured by Barr, Bushnell says this new pill -- Seasonale -- is "another step forward for women in oral contraception."

"Let's face it -- women do complain about their periods," Bushnell admits. "Frankly, most of the women I know are quite excited about not having their period as often. The reality is if you ask women about having their period four times a year instead of thirteen they are very interested in this option of having fewer periods."

And women might be interested in oral birth control methods for other reasons.

One study suggests a benefit of the extended-cycle contraceptive pills is that decreased bleeding from fewer periods lessens problems with anemia.

"Oral contraceptives are a wonderful modality because they decrease the thickness of the lining of the uterus and you bleed less," Polan explains. "Pills are also helpful in the peri-menopausal transition. Placing them on a low-dose oral contraceptive helps control the cycle for a year or two. Then we take them off and if they are now menopausal you get past the time when they bleed heavily and can become anemic."

Because oral contraceptives prevent menopausal symptoms, women also don't get hot flashes or vaginal dryness. Taking the pill also prevents bone loss during the peri-menopausal period.

Additionally, birth control pills probably reduce the incidence of some cancers.

"Women who take oral contraception have a lower incidence of ovarian cancer," Polan states. "While there is a higher incidence of cervical cancer, this is probably related to the fact that women who take pills have more sex."

Side Effects

But oral contraceptives are not for every woman. 

Serious side effects can occur when taking hormonal contraceptives. The primary complication is blood clots. Other serious risks include stroke and heart attack, but these predominantly occur in women over the age of 35.  And Polan points out that much of that data is from women who were on higher dose pills than are currently in use.

However, women taking birth control pills should definitely avoid smoking due to an increased risk of serious cardiovascular side effects, particularly in women over 35 years.

"The risk for cardiovascular complications is ten-fold higher over the age of 35 if you smoke," Polan notes.

And Bushnell wants to remind women that oral contraceptives do not protect against STDs or HIV infection.

"Rather than rely on men, women should rely on themselves when it comes to birth control," Bushnell cautions. "It's important to make sure younger women understand that condoms are important to use for protection from STDs but they are not infallible. Birth control pills protect a sexually active woman only from getting pregnant."

Polan recommends a woman discuss her family medical history with her doctor before taking the pill. Several cautions when considering oral contraception include:

  • History of early stroke, heart attack, pulmonary embolism
  • Problems with blood clotting
  • Smoking and alcohol use

"Women have to talk to their doctors about the pros and cons to determine what is best for them," Polan advises. "Then they have to take some responsibility for that decision and educate themselves rather than simply rely on a drug company or doctor.  There are risks and benefits to every form of pharmaceutical. You have to weigh those risks yourself."

And as for the final curtain call for the HBO hit?

"I think the show is absolutely fantastic," Bushnell states. "I'm the show's biggest fan. I love it. I love them all, especially Samantha, but Carrie will always be my favorite character. Carrie is my voice."

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 2/22/2004  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 2/22/2004  -  Donnica Moore, M.D.

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