There are countless drugs -- prescription and over-the-counter -- that are approved by the Food and Drug Administration, but only one is known universally as The Pill.
Though it's the most researched drug on the market, the birth control pill remains a topic of confusion. Women have filed lawsuits claiming the pill causes near-fatal blood clots. Women worry about missing pills and wonder whether it's safe to skip periods.
Women wonder whether a male birth control pill will ever debut, so men can share the responsibility.
The birth control pill was born at G.D. Searle Co. in Skokie, where John Rock and Gregory Pincus developed the first pill, Enovid-10, in 1960. It was a synthetic combination of hormones designed to suppress the release of eggs from a woman's ovaries.
That year, Time magazine said the side effects, production cost and lack of supply would hinder the pill from becoming "a matter of widespread practical concern."
This prophecy proved false.
In 2002, 82 percent of American women had taken the pill, making it the most widely used form of contraception, according to the Centers for Disease Control.
Despite its prominence, hormonal birth control is neither flawless nor fail-safe.
Different forms of hormonal contraceptives have been released since the pill debuted in 1960. Hormonal birth control -- the pill, the patch, the vaginal ring -- releases synthetic estrogen and progestin to prevent ovulation.
Modern birth control pills contain the lowest dosage of estrogen, ranging from 20 to 50 micrograms. The original pill, Enovid, had 150 micrograms. Yet, women in the 1960s embraced the pill for the freedom it provided, even though the high estrogen levels caused severe side effects, including nausea and vomiting.
The progestin in the active pill is what prevents ovulation. The estrogen in the pill serves an ancillary function and mitigates the side effects, including cramping, bloating, acne and premenstrual syndrome symptoms, said Kathleen Parker, a nurse practitioner at Northwestern University Health Service.
Many women today find it difficult to maintain their pill routine. And forgetting or taking a pill late, especially the progestin-only pills, greatly affects the efficacy rate.
If taken it correctly, the pill is 99.5 percent effective. Doctors and pill manufacturers alike advised using a backup form of contraception, such as a condom, to increase efficacy and to protect against sexually transmitted infections.
"We talk about 'ideal use' because there's not a single birth control, including abstinence, that works unless you use it," said Dr. Scott Hite, a private-practice OB-GYN in Chicago's Loop.
Doctors, however, may prefer some forms of contraception over others. Dr. Lisa Perreira, an obstetrician and gynecologist at University Hospitals Case Medical Center in Cleveland, said she espouses intrauterine devices, or IUDs, and the Depo-Provera shot over birth control pills. She said these alternatives are more effective, have fewer side effects, are easier to use and may be less expensive in the long run.
IUDs earned a bad rap in the 1970s, when the poorly designed Dalkon Shield caused a dozen fatal infections. But Dr. Melissa Gilliam, a professor of obstetrics and gynecology at the University of Chicago, said IUDs are re-emerging as a popular option, especially Mirena and Perigard. She said women like IUDs because don't have to worry about pill routines.
DOES IT MAKE BLOOD CLOT OR NOT?
Just as when the pill first was introduced, oral contraception still is not recommended for women who smoke, and there remains a risk for blood clots. In ongoing lawsuits against Bayer Healthcare AG, patients including Katie Kraus, Mae Walker and Lottie Green allege that Yaz, Yasmin and Ocella pills caused near-fatal blood clots, deep-vein thrombosis and pulmonary embolism. But is the pill really to blame?
Doctors insist the pill is a safe drug, and every birth control package warns women about the increased risk for blood clots. Hite said the pill is the "most well-researched drug in the history of mankind" and has garnered more scientific attention than any other drug, including aspirin.
He said a woman's normal risk for blood clots is two in 10,000 women, but on the pill it can increase to four or six in 10,000 -- still a "tiny risk."
A woman is at a greater risk for blood clots when she's pregnant than when she's on the pill.
"What often gets left out is that pregnancy poses more of a risk for blood clots than birth control pills do," Perreira said.
Despite the increased risk for blood clots, "It's the safest prescription drug that's ever been developed," said Dr. Teresa Woodruff, a professor of obstetrics and gynecology at Northwestern University. She said 50 years of medical research have made the pill one of the best understood drugs on the market, and long-term pill use has been shown to reduce a woman's risk of ovarian, uterine and endometrial cancers.
NO NEED TO BLEED?
Cramps, cravings and infamous moodiness make many women wonder whether they can skip the pesky withdrawal bleed -- the placebo days that allow women to have a period. Research actually proves that skipping periods may lower one's risk of ovarian and uterine cancer, Perreira said.
So it is OK to skip periods? The answer is an emphatic yes.
"It's absolutely, 100 percent totally OK," Perreira said.
Because the birth control pill prevents ovulation, there is no real need to shed the uterine lining -- there's not even an egg there. Monthly periods actually can increase a woman's risk for anemia, and there often is nothing to "clean out," Perreira said. So it's perfectly safe for a woman to skip her period and continue taking monophasic pills, or insert a new NuvaRing immediately after removal of a used one.
The "placebo week" was invented because Rock, one of the pill's developers, felt the synthetic hormones were against his religious and moral beliefs. He decided a withdrawal bleed would be more natural and "create a sense of normalcy," according to Gilliam.
"The monthly period is a modern invention," Hite said.
He said, however, that skipping the withdrawal bleed increases a woman's risk for breakthrough bleeding, or light spotting between periods.
For women not on birth control, the uterine lining thickens each month in anticipation of fertilization. When the egg is not fertilized, the nutrient-rich lining and the egg are shed -- menstrual bleeding -- and the cycle repeats.
BIRTH CONTROL FOR MEN ... BUT WHEN?
There has been talk of a male birth control for as long as the pill has been in use. Perhaps a male birth control pill will hit the market, though doctors are skeptical of its practical use. It only takes one sperm to fertilize an egg, but each ejaculation carries millions of sperm. Female contraception seems more feasible for now, because it needs to inhibit only one egg per month.
"It's harder to inhibit the production of all those sperm than to inhibit the release of our one egg a month," Perreira said.
Gilliam wondered whether women would trust male contraception without evidence that it's being used.
Parker said female medical professionals recently shared concern over a male's consistency in taking a birth control.
"They wouldn't necessarily be trusting of their male partner to take something every day when it wouldn't be (men) getting pregnant," Parker said.
Woodruff isn't sure men would latch on to birth control because lowering sperm count or testosterone levels could affect their libido.
"If you block testosterone, you block fertility," she said. "Males don't want to take that, obviously, because they want to have testosterone."
As for the future of birth control, Woodruff and Parker don't think much will change. While we have progressed with pills, shots, patches and vaginal rings, there is little funding toward "any kind of new contraceptive development" for men and women.
"There's also a move toward taking things already in the pill and using other devices to release the hormones," Gilliam said.
Possibilities abound, and only time will tell what the next 50 years will bring in the world of contraception.
