Women

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April 10, 2026

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April 10, 2026

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"Dr J. Lippes (Figure 3) is an example of the thoroughbred American (born at Buffalo, NY in 1925), who since 1957 has been Head of the Department of Obstetrics and Gynecology of the State University of New York at Buffalo. Although he had become acquainted with the Gräfenberg Ring in 1952, he had not dared to use it for fear of being accused of malpractice. Seven years later, two papers on intrauterine contraception appeared, both in English. The first, written by the Japanese gynecologist Ishihama and published in the Yokohama Medical Journal, gave an enthusiastic clinical assessment of the Ota Ring. In the second paper, Dr W. Oppenheimer of Jerusalem overviewed the results of three decades of personal experience with the modified Silk Ring. The fact that the latter paper had been accepted by the authoritative American journal of Obstetrics and Gynecology was perceived by Dr Lippes as a sign that intrauterine contraception had become a discussable subject in his country. That same year he started inserting Silk and Presea Rings under the auspices of the Buffalo PIanned Parenthood Center. The former device being too flexible, and the latter too stiff, Dr Lippes decided to remove the spokes from the Ota Ring and affix a piece of monofilament nylon to the IUD to facilitate removal and to allow the wearer to check that the device was still present. However, the modified Ring tended to rotate in utero and to wind the marker thread into the cavity, eliminating its intended uses. Therefore, to prevent IUD rotation, a radical change of shape was needed. After many experiments, the double-S Loop (the Lippes Loop) emerged in 1961. Due to its particular shape (trapezoid), the Lippes Loop fits the (relaxed uterine cavity snugly. The Lippes Loop was to become extremely popular and, of all first-generation IUDs, had the greatest worldwide impact."

- Intrauterine device

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"In fact, Dr Lippes had a predecessor in this field; Dr Lazar C. Margulies (Figure 4). Dr Margulies was born in Galicia (now part of Poland) in 1895. As a medical student, he had served in the Austro-Hungarian army during World War I. Following the armistice, he graduated from the University of Vienna in 1921, where he specialized in obstetrics and gynecology. He started practising in Vienna, but, expelled from the hospital, this Jewish gynecologist emigrated to the USA in 1941. In New York City he joined the staff of the Mount Sinai Medical Center in 1954 and was promoted to Associate Professor 9 years later. Dr Margulies died of a cerebral hemorrhage in 1982. His Chief at Mount Sinai, Dr Alan Guttmacher, who had opposed intrauterine contraception during Gräfenberg's life (Gräfenberg himself had practised at Mount Sinai for a decade and a ha1f) encouraged Dr Margulies to attempt to improve the Silver Ring. Most certainly, Guttmacher's change of mind was prompted by the alarm over the world's demographic surge, and was reinforced by the 1959 IUD papers from Israel and Japan. Gambling on the use of thermoplastics, Dr Margulies conceived his famous spiral-shaped IUD in 1960, the Perma-Spiral, marketed by the Ortho Pharmaceutical Company as Gynecoil. To insert the Margulies Spiral, the unwound device was introduced into a thin plastic tube and expelled with a plastic plunger. Dr Lippes later borrowed this technique for the insertion of his Loop IUD."

- Intrauterine device

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"Over the last couple of decades a reduction of estrogen by at least 80% in combined oral contraceptives (OCs) and much research have resulted in effective and safe contraception. We still do not know longterm effects of OCs however. OCs may protect against endometrial and ovarian cancer. A link between current OC use and liver cancer exists in areas where liver cancer is rare. An association between OC use and cervical cancer disappears when researchers control for sexual activity and barrier method use. Some research shows OC use increases the risk of breast cancer, while other research does not. There does appear to be an increased risk of breast cancer developing in women younger than 46 years of age and who have used OCs for at least 10 years. Women who have a preexisting cardiovascular condition and/or smoke should not use OCs. OC progestogens may impair glucose metabolism in healthy women, but just for 6 months. Women with diabetes mellitus can use OCs, but may need to increase insulin intake. OCs can cause hypertension in 4-5% of healthy women and worsen hypertension in about 9-16% of hypertensive women. Progestogen-only OCs have fewer systemic side effects than combined OCs, but often cause menstrual changes. Their long term effects are not yet known. Injectables containing a progestogen cause few, if any, adverse effects. The subdermal implant, Norplant, tends to cause menstrual disturbances, but is safe and effective. Progestogen - only vaginal rings are as effective as progestogen-only OCs, but menstrual irregularities are common. Failure rates for combined vaginal rings match those of combined OCs. Long-term effects of vaginal rings are not known. Postcoital contraception does not cause serious side effects, but may cause vomiting and menstrual irregularities. A levonorgestrel-releasing IUD is effective and reduces menstrual blood loss, sometimes resulting in amenorrhea. Hormonal injections in men are unlikely in the near future."

- Hormonal birth control

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"Today, the science is more settled, though there hasn't been a long-term study on the continuous use of oral contraceptives yet. But based on data from the long-term use of non-extended cycle birth control pills, which are chemically the same as extended cycle contraceptives, gy-necologists have largely reached the conclusion that the practice is safe. "At this point, I can't think of any OB/GYNs that would have a problem with [extended cycle oral contraception]," says Dr. Lauren Naliboff, a fellow at the American Con-gress of Obstetricians and Gynecologists. A study by the Cochrane organization found that women on extended cycle pills "fared better in terms of headaches, genital irritation, tiredness, bloating, and menstrual pain" than those on pills with monthly bleeding. A peer-reviewed article by Acta Obstetricia et Gynecologica Scandinavica acknowledged that long-term studies are lacking, but ultimately concluded that continuous use oral contraceptives showed no unique side effects beyond increased spotting, and still resulted in less "bleeding days" than non-continuous birth control pills. Philosophical and scientific debates aside, perhaps the largest barrier between women and their right to decide whether or not they want to bleed is a lack of information. Many women are una-ware that consistently skipping withdrawal bleeding is an option, let alone that extended cycle pills ex-ist, or that menstrual suppression can also be accomplished with hormonal IUDs, NuvaRing, birth control injections, and contraceptive patches."

- Hormonal birth control

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"What Pike discovered in Japan led him to think about the Pill, because a tablet that suppressed ovulation—and the monthly tides of estrogen and progestin that come with it—obviously had the potential to be a powerful anti-breast-cancer drug. But the breast was a little different from the reproductive organs. Progestin prevented ovarian cancer because it suppressed ovulation. It was good for preventing endometrial cancer because it countered the stimulating effects of estrogen. But in breast cells, Pike believed, progestin wasn’t the solution; it was one of the hormones that caused cell division. This is one explanation for why, after years of studying the Pill, researchers have concluded that it has no effect one way or the other on breast cancer: whatever beneficial effect results from what the Pill does is cancelled out by how it does it. John Rock touted the fact that the Pill used progestin, because progestin was the body’s own contraceptive. But Pike saw nothing “natural” about subjecting the breast to that heavy a dose of progestin. In his view, the amount of progestin and estrogen needed to make an effective contraceptive was much greater than the amount needed to keep the reproductive system healthy—and that excess was unnecessarily raising the risk of breast cancer. A truly natural Pill might be one that found a way to suppress ovulation without using progestin. Throughout the nineteen-eighties, Pike recalls, this was his obsession. “We were all trying to work out how the hell we could fix the Pill. We thought about it day and night.”"

- Hormonal birth control

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"Today, a growing movement of reproductive specialists has begun to campaign loudly against the standard twenty-eight-day pill regimen. The drug company Organon has come out with a new oral contraceptive, called Mircette, that cuts the seven-day placebo interval to two days. Patricia Sulak, a medical researcher at Texas A. & M. University, has shown that most women can probably stay on the Pill, straight through, for six to twelve weeks before they experience breakthrough bleeding or spot-ting. More recently, Sulak has documented precisely what the cost of the Pill’s monthly “off” week is. In a paper in the February issue of the journal ‘’Obstetrics and Gyne-cology’’, she and her colleagues documented something that will come as no surprise to most women on the Pill: during the placebo week, the number of users experiencing pelvic pain, bloating, and swelling more than triples, breast tenderness more than doubles, and headaches increase by almost fifty per cent. In other words, some women on the Pill continue to experience the kinds of side effects associated with normal menstruation. Sulak’s paper is a short, dry, academic work, of the sort intended for a narrow professional audience. But it is impossible to read it without being struck by the consequences of John Rock’s desire to please his church. In the past forty years, millions of women around the world have been given the Pill in such a way as to maximize their pain and suffering. And to what end? To pretend that the Pill was no more than a pharmaceutical version of the rhythm method?"

- Hormonal birth control

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"Ludwig Haberlandt is the 1st great name in hormonal contraception. As early as 1919 he was conducting studies which showed that transplants of tissues or extracts of these tissues (now known to contain progesterone) could produce infertility in rabbits and mice. In 1930 Reiprich of Breslau suggested that the antifertility action of estrogen might be the result of pituitary inhibition. In 1938 ethinyl estradiol was synthesized and 1 year later Dodds and his group reported the synthesis of a series of nonsteroidal estrogens (stilbestrol, hexestrol, and dienestrol). None of the clinical trials conducted in the 1940s could have demonstrated the superiority of 1 estrogen over another with respect to ovulation inhibition at equivalent estrogenic dosage. Studies of this aspect lagged until the 1960s. At that time it was clearly demonstrated that the ethinyl side-chain imparted an augmented pituitary inhibiting potency to estradiol as compared either to other natural estrogens or to other synthetics. It was a fortunate accident that the early clinical preparations of contraceptive progestins contained about 1% contamination with mestranol from the process of manufacture. While this quantity appeared trivial to the chemists, the presence of about 150 mcg of mestranol in the original 10 mg doses of the 19-norprogestins could have accounted totally for their contraceptive efficacy. It was not until several years later than estrogen-free norprogestins were prepared and their intrinsic antiovulatory action proven. When these purified progestins were used for contraceptive therapy, an increased incidence of menstrual irregularities appeared. One standardized quantity of ethinyl estrogen was reincorporated into contraceptive preparations for the control of menstrual regularity, but without any idea that a contribution was being made to contraceptive effectiveness. Clinical studies with continuous low-dose progestin only formulations have demonstrated that their effectiveness in inhibiting ovulation is substantially lower than that of sequential or combination type preparations. A progestational agent added to a baseline estrogen dose appears to produce a greater suppression of plasma gonadotropins than estrogen by itself. While cyclic estrogen administration is capable of inhibiting ovulation with a high degree of efficiency, such a therapeutic regimen is impractical from the point of view of menstrual regularity. The entire matter of cardiovascular hazards related to OC use has been called into question by studies of mortality statistics in the U.S., Great Britain, and Taiwan. In none of these studies is the predicted mortality from cardiovascular disease in OC users confirmed."

- Hormonal birth control

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