Women

"When one approaches the cycle of a woman's body from the standpoint that God made it and has made it for a purpose, one can then understand the relation of the pill to this cycle. To be blunt, a woman's cycle is ordered toward fertility, toward life. The pill, when used as an oral contraceptive, is ordered toward infertility, toward death. The pill (made up of estrogen and progestogen) is ordered toward infertility because it inhibits the release of the follicle stimulating hormone and stops the luteinizing hormone from triggering ovulation. The pill is ordered toward death because both estrogen and progestogen "change the endometrium in such a manner that even if ovulation did take place, implantation of the fertilized egg would be unsuccessful." In some cases, a child is conceived, and the pill acts as an abortifacient. This is the murder of an innocent!"

"Oral contraceptives (OC) convey a protection against ovarian, endometrial and perhaps colorectal cancer. However, OC use is associated with excess risk of breast (current or recent use only), cervical and liver cancer. Benefits and risks of OC use on cancer were reviewed in 2005 by a Working Group at the International Agency for Research on Cancer, which concluded that combined OCs are carcinogenic to humans, based on an increased risk for hepatocellular carcinoma, cervical and (for current use only) breast cancers. The Working Group also concluded that there is conclusive evidence that OCs have a protective effect against cancers of the ovary and endometrium."

"On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time."

"Introduction of the birth control pill in the United States in 1960 marked the end of a relatively short period of time (< 10 years) to intentionally produce an oral contraceptive, and the beginning of a relatively long period of controversy surrounding the use of the pill. Availability of the pill had an impact on various aspects of social life, including women's health, fertility trends, laws and policies, religion, interpersonal relationships and family roles, feminist issues, and gender relations, as well as sexual practices among both adults and adolescents. The pill proved to be highly effective from the outset. Although safety issues developed with the earlier formulations, continued evolution of pill hormones and doses has resulted in a greatly improved and safe oral contraceptive. A broad range of noncontraceptive health benefits also is associated with the pill. These health effects are significant, as they in-clude protection against potentially fatal diseases, including ovarian and endometrial cancers, as well as against other conditions that are associated with substantial morbidity and potential hospitalization and associated costs. The popularity of the pill has remained high, with rates of use in the past 30 years in the United States ranging from one-quarter to almost one-third of women using contraception. Almost 40 years after its introduction, the pill's contraceptive efficacy is proven, its improved safety has been established, and the focus has shifted from supposed health risks to documented and real health bene-fits."

"By the end of their reproductive years, more than 80% of US women will have used oral contraceptives (OCs), for an average of about 5 years. The pill has had a dramatic impact on social life in the US, affecting women's health, fertility trends, laws and policies, religion, interpersonal relations, family roles, women's careers, gender relations, and premarital sexual practices. The emergence of the women's rights movement of the 1960s and 1970s was significantly related to the availability of the pill and the control over fertility it enabled. This capability allowed women to make choices about other life arenas, especially work. Over the past 40 years, both the content and dose of the steroid components of OCs have changed significantly, with consequent reduced health effects. This improved safety profile has been further bolstered by the identification of women with risk factors such as smoking, high blood pressure, history of cardiovascular disease, and diabetes with vascular disease. In recent years, the emphasis has shifted from the health risks of OC use to the noncontraceptive health benefits."

"Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception."

"Progestin-only contraceptives are known to alter the cervical mucus, exert a progestinal effect on the endometrium, interfering with implantation, and, in some patients, suppress ovulation."

"The possibility of hormonal contraception was postulated as early as 1919 by the physiologist Ludwig Haberlandt in Innsbruck. The same year, he began to test his hypothesis in animal experiments. In 1924 he succeeded in his efforts to render mice infertil by orally administering ovarian and placental extracts. He failed to have his method tried in women."

"One of the early female graduates of the Massachusetts Institute of Technology, Katharine McCormick believed in science and in the advancement of women. Margaret Sanger witnessed unwanted pregnancies -- and desperate abortion attempts -- when she worked as a nurse among New York's poorest women. Though they came from different worlds, the two women set out to improve women's lives through "birth control," a phrase Sanger coined. When Sanger and McCormick first met in 1917, women had been working for decades to achieve the vote. Thirty-nine years had gone by since a constitutional amendment for women's suffrage was first proposed, and three more years would pass before the states ratified it. At a time when women struggled for voting rights, job opportunities, or access to education, both McCor-mick, a suffragist, and Sanger, a birth control proponent, were outspoken advocates for giving women more control over their own lives. Thirty years later, McCormick's sizable inheritance combined with Sanger's tireless advocacy would bring about the birth control pill and spark a revolution. "An estimated eighty percent of all American women born since 1945 have taken the Pill," says historian An-drea Tone, giving them the ability to plan their reproductive lives."

"McCormick's involvement with the Pill is extraordinary. I think she's one of the most underappreciated figures in not just Pill history, but the entire history of scientific and technological innovation. First of all, it was very uncommon for a woman in the 1950s to have the kind of fortune that McCormick had. She had a fortune that was so vast that, as John Rock said at one point, she couldn't even spend the interest on the money that she had. So she was unique from the get-go in simply having this access to capital... At the time, the pharmaceutical companies which had historically been involved in some kinds of birth control production, like condom production and diaphragm production, saw the Pill project also as too controversial. Many large companies had passed on the opportunity to develop the Pill, including Pfizer and Merck, because they just didn't want to touch it. And so, were it not for McCormick, it's unclear how the Pill would have been developed. She really deserves credit for single-handedly financing one of the most important developments of the 20th century."

"It had already been known for several decades that sex hormones were able to suppress ovulation in animals. Ludwig Haberlandt, an Austrian physiologist is sometimes called the grandfather of the pill. Indeed, in 1921 he found that rabbits and guinea pigs became temporarily sterile after transplantation of ovaries from pregnant animals. These experiments paved the way for pharmacological studies on the effect of progesterone on ovulation. The anti-ovulatory effect of progesterone was demonstrated by A. W. Makepeace and co-workers in 1937 who injected progesterone in mated female rabbits. Large-scale experiments with progesterone, which hitherto had been extracted from animal ovaries became possible after Russell E. Marker, a professor of organic chemistry, found that progesterone could be manufactured from a substance named diosgenin, extracted from the root of a plant (Dioscorea mexicana) which grows in Mexican jungles."

"The most dangerous and well-documented side effects commonly associated with the Pill are heart attacks and strokes. The eight-year Nurse's Health Study at Harvard Medical School found that Pill users are 250 percent as likely to have heart attacks and strokes than those who don't use the Pill, probably because the Pill excessively increases blood clotting ability."

"Pincus made his name in the field of experimental biology when, in 1934, he produced rabbits in vitro by parthenogenesis. In 1944, he established the Worcester Foundation for Experimental Biology where he surrounded himself with a group of brilliant young investigators. One of them was a Chinese immigrant, Min-Chueh Chang, who repeated and refined the experiments of Makepeace and established the experimental model to study the anti-ovulatory effect of sex steroids. The impetus for converting findings of animal experiments into human hormonal contraception was given by Margaret Sanger, founder of the Planned Parenthood Federation of America (PPFA). She approached Pincus in 1951 and provided a small grant to begin hormonal contraceptive research. In the same period, John Rock, an expert in the treatment of infertility, was experimenting with the oral administration of high doses of oestrogen (diethylstilboestrol) and progesterone to induce pseudo-pregnancy in infertile women. He reasoned that high doses of sex steroids promoted the growth of the uterus and the Fallopian tubes and so restored fertility; but he also found that this treatment suppressed ovulation. The biologist Pincus and the gynaecologist Rock shared their experience and their intention to develop a hormonal oral contraceptive."

"Marie Stopes had championed her ‘Pro-Race’ version of the rubber cervical cap because the diaphragm ‘must be worn so as to cover the whole of the end of the vagina and depends on stretching the vaginal walls to stay in position…[so] certain movements of physiological value (particularly to the man) which ideally the woman should make are then impossible’. Van de Velde agreed with Stopes that the diaphragm limited vaginal movements but he commented dismissively that most ‘women to-day are not able to operate their pelvic muscles voluntarily to the best advantage in coitus, so the inability to do so would not represent any appreciable loss to them’. It is possible that the sexual upbringings of women over generations ensured they were unaware of the range of movement the muscles associated with vagina were capable of."

"In 1977, Ruth Hall felt there was ‘little evidence to support Stones’ belief that the vaginal pessary [diaphragm] would stretch vaginal walls’. Yet diaphragms came in sizes ranging from 5 to 9 centimetres in diameter and there was no consensus as to whether the use of larger sizes was more or less uncomfortable for users. As vaginas vary in size, the larger sizes must have stretched the vaginal walls and, in some women, pressed on the bladder or otherwise caused discomfort. This is another example of the willingness to see the vagina as inactive."

"As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed. However, the study provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide."

"Giovanni Giacomo Casanova takes credit in his autobiography for inventing a primitive version of the diaphragm/cervical cap (Suitters, 1967). He placed the partly squeezed halves of lemons over his lovers’ cervices. Casanova was exaggerating his own inventiveness. Similar devices had been used for centuries around the world. Asian sex workers applied oiled paper discs to their cervices. The women of Easter Island used algae and seaweed (Himes, 1963). Sponge, tissue paper, beeswax, rubber, wool, pepper, seeds, silver, tree roots, rock salt, fruits, vegetables, and even balls of opium have all been used to cover the cervix in an attempt to prevent unintended pregnancy (Himes, 1963; London, 1998; Skuy, 1995). In 1838, German gynecologist Friedrich Wilde created rubber “pessaries” for individual patients with custom-made molds. Wilde’s pessaries resembled today's cervical caps. He used modern materials to imitate the traditional German custom of applying disks of melted and molded beeswax to the cervix to prevent conception. Primitive rubber pessaries were made by Connecticut inventor Charles Goodyear in the 1850s (Himes, 1963). Pharmacies sold them to married women, supposedly to support the uterus or hold medication in place (Chesler, 1992). By 1864, the British medical association was able to list 123 kinds of pessaries being used throughout the empire (Asbell, 1995). In America, sponges enclosed in silk nets with drawstrings attached were commonly used and advertised in newspapers and magazines (London, 1998). But the Comstock laws that were enacted in the 1870s suppressed the dissemination of contraceptive devices and information in the U.S. (Chesler, 1992)."

"Natural progesterone was hard to come by. Extracting it from animal sources was difficult, time consuming and prohibitively expensive. Natural progesterone drug therapy required huge doses to be effective, and at a cost of anywhere from $80 to $1,000 per gram, only the richest patients could afford the treatment. The only customers for the drug turned out to be world-class race horse breeders, who used it to improve the fertility of their mares. Aside from the high cost, the drug had to be given as an injection, and the shots were painful and not well metabolized. Unless researchers could find a way to produce a highly effective synthetic oral dosage of the hormone, the treatment would remain impractical. In 1943 a chemist by the name of Russell Marker came up with the answer. As a professor at Penn State, Marker had discovered a way to extract progestprogesterone from plant material. Soon after, he was able to create synthetic estrogen from vegetation as well. His path-breaking process, which became known as the "Marker Degradation," remains the basis of synthetic hormone production today. Marker still needed to find a plant that could yield enough progesterone to make mass production possible. He traveled across America in search of the right source, but came up empty-handed. Unwilling to abandon his quest, he headed south to Mexico in search of a plant called cabeza de negro that he had read about by chance in a dusty old regional Texas botany book. His hunch was correct, and the giant tubers proved to be an excellent source for the cheap mass production of progesterone."

"In the early 1950s, Frank Colton and Carl Djerassi, two chemists working independently at separate pharmaceutical companies, took Marker's work one step farther. The scientists each created a highly potent oral form of synthetic progesterone. Working for Syntex, a pharmaceutical company based in Mexico, Djerassi invented norethindrone. This synthetic progesterone was not only orally effective, it was also eight times more potent than natural progesterone. At Searle, Colton created another version of orally effective synthetic progesterone called norethynodrel. With the advent of these new drugs, the Pill came into existence. Although neither Djerassi or Colton developed the drug for contraceptive purposes, both Searle and Syntex had an oral contraceptive right under their noses. Although Djerassi synthesized his version of the drug first, Searle beat Syntex to market. Less than a decade after Colton and Djerassi's breakthrough, with Gregory Pincus making the connection to contraception, Searle's Pill would reach American consumers."

"Although American scientists had been busy studying hormones in the 1930s and 1940s, Marga-ret Sanger's dream of a pill for birth control improbably came to fruition because of the discovery of a wild Mexican yam. The yam was key to the development of synthetic hormones, a scientific advance necessary for the creation of the Pill."

"On October 29, 1959, the pharmaceutical company G.D. Searle filed an application with the U.S. Food and Drug Administration (FDA) to license their drug Enovid for use as an oral contraceptive. Less than a decade after birth control activist Margaret Sanger first told scientist Gregory Pincus about her hopes for a "magic pill," it appeared that success was imminent. The trials presented in the application for FDA approval of Enovid as an oral contraceptive were the largest drug trials ever run. In the trials, 897 women had taken 10,427 cycles of the Pill with no side effects the doctors considered harmful. In 1959 the main hurdle to FDA approval for any new drug was that it be proven safe. Effica-cy was not yet a requirement. Since the FDA had already reviewed the issue of safety when it approved Enovid's use for menstrual disorders in 1957, Searle assumed the application would glide through the process. Searle and the Pill researchers were soon disappointed. The FDA sat on the application, and months went by without any word. Safety wasn't the issue clogging up the review process. It was the revolutionary nature of the Pill itself. Oral contraceptives would be the first drugs whose purpose was not to cure a medical ailment. Instead, the Pill would be given to healthy women for long-term use for a social purpose, and the FDA was uncomfortable with the concept."

"The diaphragm played a special role in Margaret Sanger’s effort to rescue America from the Comstock laws. During a trip to Holland in 1915, she learned about the use of snugly fitting spring-loaded diaphragms that were developed in Germany during the 1880s. In 1916, she was arrested and sent to jail for telling women about them. Her month in jail only strengthened her resolve to teach women how to use diaphragms —she even taught diaphragm use to the women she was with in jail (Chesler, 1992). Sanger had to find a way around the Comstock laws, which prohibited the transport of birth control devices or information through the mail. Her solution, clever ⎯as well as illegal ⎯also involved the diaphragm (Chesler, 1992). Sanger's second husband, Noah Slee, owned the company that manufactured 3-IN-ONE Oil, a lubricant for metal parts. Slee imported diaphragms from manufacturers in Germany and Holland to his factory in Montreal. He had the diaphragms packed in 3-IN-ONE cartons and shipped to New York (Chesler, 1992). Slee also solved Sanger’s difficulty obtaining contraceptive jelly to use with the diaphragm. He got the German formula and manufactured the jelly ⎯illegally⎯ at his plant in Rahway, New Jersey. In 1925, he put up the money for founding the Holland-Rantos Company, which manufactured the first American diaphragms, and ended the need for contraband versions (Chesler, 1992). Sanger met a Japanese physician at an international conference on birth control and got him to mail her a package of diaphragms in 1932, but the package was confiscated by U.S. Customs officers. Undeterred, Sanger decided to test the Comstock laws that forbade distribution of contraceptives and contraceptive information through the mail (Chesler, 1992). She arranged to have another package of diaphragms mailed from Japan to Dr. Hannah Meyer Stone, a New York City physician who supported Sanger's crusade for reproductive rights. This package was also seized by Customs (Chesler, 1992). In 1936, Manhattan Judge Augustus Hand, writing for the U.S. Court of Appeals of the Second Circuit, ruled that the package could be delivered. The case, United States v. One Package—said package “containing 120 rubber pessaries, more or less, being articles to prevent conception” ⎯was a watershed in U.S. birth control history. It severely weakened the federal Comstock law that had prevented dissemination of contraceptive information and supplies since 1873 (Chesler, 1992)."

"When in 1953 Gregory Pincus approached Rock about collaborating on a study of the contraceptive effects of progesterone, Rock unhesitatingly signed on. The two scientists had known each other since the 1930s and closely followed each other’s work. Rock’s finding, in the course of his research on in-fertility treatments, that small amounts of female hormones inhibited ovulation, helped validate Pincus’s similar results in animal trials. Pincus needed someone with Rock’s clinical experience to ex-tend research trials to human subjects. And it helped in terms of fund-raising and public relations that Rock had an unimpeachable reputation as physician and medical researcher. Their cooperative work was made possible by an influx of funds from Katharine Dexter McCormick, whom Sanger had convinced to support Pincus’s promising research. Starting in the summer of 1953, McCormick began to immerse herself in the project and sent regular progress reports to Sanger mentioning Rock’s involvement. In November 1953 McCormick informed Sanger that Rock and Pincus had begun the first human trials in the study. But Sanger, who was preoccupied with setting up the International Planned Parenthood Federation (IPPF), did not appear to be aware of the extent of Rock’s participation. Nor did she feel completely comfortable with his involvement."

"The use of contraceptives can be morally acceptable in other contexts as well, again, because such uses do not constitute acts of contraception. For example, when a woman has severe menstrual bleeding, or pain from ovarian cysts, the hormonal regimen contained in the Pill may sometimes provide a directly therapeutic medical treatment for the bleeding or the pain. This use of contraceptives is an act of medical therapy to address a pathological situation, not an act of contraception. The secondary effect from the treatment, namely, marital infertility, is only tolerated, and should not be willed, desired, or in-tended in any way by the couple. It is worth noting that it would not be acceptable to make use of contraceptives like the Pill for these medical cases if other pharmacological agents or treatments were available which would offer the same therapeutic benefits and effects without impeding fertility."

"By 1960 the world's population had grown to around 3 billion people, having taken just 33 years to increase from 2 billion.1 Although many agreed that growth rates needed to fall, couples at the time had few reversible contraceptive choices: mainly barrier methods, spermicides, and a few plastic-only and metal-based intrauterine devices (IUDs). Many relied on ‘withdrawal’. This was soon to change dramatically because during the 1950s scientists had patented two synthetic progestogens, norethisterone and norethynodrel.2 Clinical studies showed that these hormones inhibited ovulation, although some accompanying oestrogen (initially mestranol, now ethinylestradiol) was needed for acceptable breakthrough bleeding and pregnancy rates. The first combined oral contraceptive was marketed in the US in 1960, and in the UK the following year. Many women enthusiastically embraced ‘the pill’; for some because it separated contraception from the act of intercourse and for others because it could be used without their partner's knowledge. Early on, howev-er, concerns were expressed about the method's carcinogenic potential, and about reports of associated venous thromboembolic and other cardiovascular events.2 Furthermore, the unfolding thalidomide tragedy of the early 1960s provided a powerful reminder of the epidemiological truth that when millions of people use a medicinal product small increases in risk still result in many people affected."

"Oral contraception is now one of the most scrutinised medicinal products on the market. Two British investigations that celebrated their 40th anniversaries in 2008 have been major contributors to the evidence base for current clinical practice. Both illustrate the enormous research opportunity of NHS clinical records. The Oxford/Family Planning Association (Oxford/FPA) Study began in 1968, when 17 family planning clinics in England and Scotland started recruiting 17 000 white, married women using oral contraception, the IUD or the diaphragm.3 The Royal College of General Practitioners' (RCGP) Oral Contraception Study started at the same time, with 1400 GPs throughout the UK recruiting 47 000 mainly white, married (or living as married) women, half of whom were using oral contraception. Both studies have followed up their cohorts through a mixture of clinic or practice reports, personal contact, and the cancer and death notification services of the NHS Central Registries. Each study has provided, in different ways, key insights into the effects of different contraceptives; as well as novel information about other women's health issues. For example, the RCGP study was the first to show that the risk of cardiovascular disease is much higher in pill users who smoke,5 especially among older women, and that the risk of hypertension and arterial disease is related to the combined pill's progestogen content.6 The Oxford/FPA study assessed the effectiveness, safety, and return to fertility after stopping different methods. Long-term mortality and cancer results from both studies have been reassuring."

"Ludwig Haberlandt (1 February 1885 - 22 July 1932), pioneer in hormonal contraception, was born in Graz, where he graduated from the university in 1909 in medicine summa cum laude and began his career as a physiologist. The idea of temporary hormonal contraception in the female body entered his mind in February 1919, when he was already Professor of Physiology in Innsbruck. He pursued his project ambitiously and by 1921 demonstrated temporary hormonal contraception in a female animal by transplanting ovaries from a second, pregnant, animal. From 1923, after further successful scientific work in this field, he began highlighting the importance of clinical trials in presentations. From then, he was criticized by his colleagues, who accused him of hindering unborn life. His idea was contradictory to the moral, ethic, religious and political agendas of that time in Europe. In 1927 official reports escalated, his family was ostracized by the local population, and Ludwig Haberlandt refused any further interviews. Against all opposition, in 1930 he began clinical trials after successful production of a hormonal preparation, Infecundin, by the G. Richter Company in Budapest, Hungary. Although at the peak of his scientific career, he was unable to pursue other scientific agendas because of the disputed contraception project. After he committed suicide, on 22 July 1932, scientific discussion about hormonal contraception ceased until 1970 when scientists began referring to his earlier medical and scientific work."

"We now have a clearer picture of the cancer risks associated with combined oral contraception. Compared with non-users, current users have an increased risk of being diagnosed with breast,11 cervical,12 or hepatocellular cancer.13 Hepatocellular cancer is rare in developed countries. The breast and cervical cancer risks decline after stopping oral contraception, returning to that of non-users within about 10 years.11,12 Conversely, combined oral contraceptive users have a reduced risk of endometrial,13 ovarian,14 and colorectal cancer.13 The ovarian and endometrial benefits appear to persist for many years after stopping oral contraception, perhaps more than 15 years.13,14 Limited evidence suggests that today's lower oestrogen dose formulations provide similar protection against endometrial and ovarian cancer as older, higher-dose preparations.15,16 At least within the RCGP cohort, the long-term cancer benefits appear to counterbalance the short-term harmful ones; indeed there may even be a net public health gain.8 Collectively, the research shows that benefits of oral contraception use outweigh risks, when provided appropriately. Importantly, prolonged use of oral contraception does not appear to reduce future fertility.17"

"In 1961, Wagner had concerns that his wife, Doris, wouldn’t reliably take her new birth-control pills, which came in a glass bottle with a complex set of instructions. She was to begin taking a five-milligram tablet on the fifth day of her period, continue taking one a day for 20 days, then take five days off, at which point her bleeding would start. “I was constantly asking her whether she had taken ‘the pill,’ and this led to some irritation and a marital row or two,” he later recalled. So Wagner, a product engineer for Illinois Tool Works, came up with a solution: a pill dispenser in the shape of a round plastic disc, which could be rotated to reveal the dose you were to take on any given day. It held 20 pills, plus a week’s worth of pill-size dimples that indicated the off week. His jerry-built design — he fashioned it out of a child’s toy, sheets of clear plastic and double-sided tape — was quickly picked up by Ortho Pharmaceuticals, and in 1963, the company began selling the pill in a Dialpak, a round foil blister pack with pills labeled with the days of the week. “The package that remembers for her,” the company advertised in 1964. “Easy for you to explain ... for her to use,” another ad promised."

"As more companies bought into the idea, the week of placebo pills was here to stay. Doctors liked that they made explaining the instructions to women easy. Women liked having one fewer thing to remember about their birth control. Few questioned why women on the pill should be having a “period” at all. Today there are a small handful of options that reduce or eliminate monthly bleeding: Seasonale, a form of the pill sold in packets of 84 active pills and seven placebos that make it so bleeding happens just four times a year, became available in 2003. In 2007, the F.D.A. approved Lybrel, the first oral contraceptive to provide continuous active pills, with no breaks for withdrawal bleeding. Doctors agree that a menstrual cycle can be a useful indicator of overall health, and yet it still isn’t necessary. When Dr. Lori Picco’s patients ask if they can skip the inactive pills, she says she tells them to go right ahead. “It’s completely fine — there’s no medical concerns,” says Dr. Picco, a gynecologist at Capital Women’s Care in Washington and a fellow of the American College of Obstetrics and Gynecology. “Honestly, I would think people would want to do it all the time.”"

"Ludwig Haberlandt, physiologist in Innsbruck, tried in the late twenties to develop hormonal contraceptives based on sex hygienic ideas of Sigmund Freud. Although the chemical-physiological knowledge of that time encouraged this plan, after Haberlandt's death in 1932 his tests were dropped and forgotten. It was after World War II, when research in this field was begun in the USA by Gregory Pincus, supported by "Planned Parenthood Federation" under leading of Margret Sanger. Although clinical tests proved to be successful, restrictive social-political conditions in the fifties delayed this project considerably. But in 1958 the first Anti-Baby-Pill reached the US-market."

"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."

"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.”"

"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?"

"The invention of the pill was one of the most significant advancements in the fight for reproductive agency; it allowed us, as a society, to dramatically reconceptualize sexuality and gender relations. At the same time, our relationship to this groundbreaking medical technology has been shaped and con-strained by our own conceptions of what's "natural" and what defines a woman. Similar reproductive and sexually liberating advancements that target men—Viagra, for instance—have not led to similar debates on what it means to be a man, or to have an "unnatural" hard-on. And while Viagra is covered by insurance, Dr. Naliboff says that most insurance companies do not cover extended cycle birth control to this day, even in cases where patients are on the pill for medical issues like primary ovarian insufficiency or endometriosis. The discrepancy in education and affordable access is telling: The normalization of placebo pills and subsequent withdrawal bleeding means that even in 2017, many women do not know that extended cycle pills exist, let alone that menstrual suppression is a safe option. Combined with the fact that the percentage of schools teaching students about contraception has declined drastically since 2000, this means that many women are likely to stay in the dark about their options when it comes to choosing whether or not they want to bleed once a month."

"In the 1960s, manufacturers of the new birth-control pill imagined their ideal user as feminine, maternal and forgetful. She wanted discretion. She was married. And she wanted visible proof that her monthly cycle was normal and that she wasn’t pregnant. In 2019, the user of the pill is perceived as an altogether different person. She’s unwed, probably would prefer to skip her period and is more forthright about when it’s that time of the month. As such, many birth-control brands now come in brightly colored rectangular packs that make no effort to be concealed. But one part of the equation remains: the week of placebo pills, in which hormones are abruptly withdrawn and a woman experiences what looks and feels a lot like her regular period — blood, cramps and all — but isn’t. Physicians have widely described this pseudoperiod as medically unnecessary. So why do millions still endure it? That’s largely the legacy of two men: John Rock and David Wagner."

"By 1941, most doctors recommended the diaphragm as the most effective method of contraception (Tone, 2001). But with the invention of the pill and the increased popularity of the IUD, the diaphragm and cervical cap fell out of favor during the 1960s. Diaphragms continued to be available but U.S. companies stopped producing cervical caps. When the early high-estrogen birth control pills and certain IUDs were found to cause medical problems, American women increasingly returned to using simple barrier methods that didn’t affect their hormones or menstrual cycles (Bullough & Bullough, 1990). Diaphragms became quite popular again, but the cervical cap had disappeared from the American scene (Chalker, 1987). The Food and Drug Administration approved the Prentif Cavity-Rim Cervical Cap for use in this country in May 23, 1988 ⎯nearly 60 years after it was introduced in the United Kingdom. Strenuous efforts by clinicians affiliated with feminist health centers had brought the cap back to America (Bullough & Bullough, 1990). But by 2002, the Prentif cervical cap was displaced in the marketplace by FemCap® (Cates & Stewart, 2004).Today, fewer than 0.01 percent of U.S women rely on diaphragms and caps for contraception (CDC, 2010)."

"First there’s Rock, a Harvard fertility expert and a developer of the pill. There’s a longstanding myth that Rock, a Catholic, designed the pill in the 1950s with the church in mind and included a week of hormonal withdrawal — and therefore bleeding — to make his invention seem more natural. In fact, the thought never crossed his mind, the Rutgers University historian Margaret Marsh says. Instead, it was Gregory (Goody) Pincus, the other developer of the pill, who suggested that the pill be given as a 20-days-on, 5-days-off regimen. Pincus wanted to provide women in his trials with reassurance that they weren’t pregnant, and to know himself that the pill was working as a contraceptive. Rock agreed. After the F.D.A. approved the pill in 1960, however, those few days of light bleeding took on a new significance. Anticipating the church’s opposition, Rock became not just a researcher but also an advocate. In his 1963 book “The Time Has Come: A Catholic Doctor’s Proposals to End the Battle Over Birth Control,” he argued that the pill was merely a scientific extension of the church-sanctioned “rhythm method.” It “completely mimics” the body’s own hormones, he wrote, to extend the “safe period” in which a woman could have intercourse and not become pregnant. “It must be emphasized that the pills, when properly taken, are not at all likely to disturb menstruation,” he wrote. “It has been my consistent feeling that, when properly used for conception control, they merely serve as adjuncts to nature.” He was stretching the truth. Rock knew that the pill’s synthetic hormones caused the lining of a woman’s uterus to thin out, making it inhospitable for a fertilized egg. During the off week, when the hormones were withdrawn, her body got the signal that it was time to shed the lining. But because this event didn’t involve ovulation, it was better described as withdrawal bleeding than menstruation."

"Women excrete estrogen naturally, and women on birth control pills also secrete the synthetic estrogen in those pills. And these estrogens, depending on the level of wastewater treatment, may not be completely broken down during sewage treatment, so they get discharged into rivers and streams. It doesn't take a lot of estrogen to feminize male fish and, based on the results of our experiment, to impact fish populations."

"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."

"The large influx of poor immigrants and advocacy by women's rights groups provided the impetus for the birth control movement of the early 1900s. The subsequent development of the oral contraceptive pill gave women, for the first time, the ability to control their fertility."

"In 1961, when the pill was introduced to Britain, women pushed their, often reluctant, doctors to give them the drug. By the late 1960s, young women were talking about a revolution in women’s sexual attitudes, but since then the suggestion that the pill just meant women couldn’t say no has been widely repeated, alongside negative assessments of the ‘sexual revolution’. As early as the 1880s, there had been suggestions that fear of pregnancy gave wives an excuse for denying their husbands their conjugal right of sexual intercourse. By the early 1990s, over 80 per cent of British women of reproductive age since the early 1960s had taken the pill."

"In the early 20th century, Margaret Sanger became one of the most avid proponents of contraception in the United States. By 1950, she and Katharine McCormick had contracted with biologist Gregory Pincus to develop an effective birth control pill. A collaborative effort by Pincus and other researchers led to trials of the pill in Puerto Rico, Haiti, and Mexico between 1956 and 1957, which pro-vided the basis for an application to the Food and Drug Administration for approval of the first oral contraceptive."

"[T]he pill did produce a situation in which these pre-existing social conditions led to a new twist on male sexual exploitation of young single women in the 1960s. Throughout the nineteenth and twentieth centuries, the family, the Church, and later schools had attempted to supervise and control unmarried women’s sexual behavior. In this social setting women might have had to struggle against persuasive male arguments and persistent groping but they had the entire weight of society, backed up by the ulti-mate sanction of pregnancy, supporting them if they did not wish to have intercourse. In the 1960s the arrival of the pill meant that for the first time women could have confidence that they would not get pregnant. There is a new sense of excitement and possibilities present in many accounts by heterosexual women who were young and single at this time. In choosing to reject the control of their sexual be-haviour they saw themselves as rejecting control over their lives as a whole However, abandoning the traditional moral position left many confused, with no substantial arguments against casual or dishonest male sexual exploitation. By the early 1970s, men assumed fashionable young women were on the pill and statistics show that well over half actually were."

"In subsequent years, resourceful investigators produced scores of originally (and sometimes peculiarly) shaped plastic IUDs. One of these was the notorious Dalkon Shield fitted by the inventor (Dr H.J. Davis, 1970) with a soft sheath filled with hundreds of nylon filaments instead of the usual stiff monofilament polyethylene thread. Serious, and even lethal, infections were observed, and it was claimed that the tailpiece of the Shield IUD acted as a wick conveying bacteria from the vagina upward into the uterine cavity. The thousands of lawsuits which followed discredited the inventor of the Dalkon Shield, caused financial ruin to the producer ( A.H. Robbins Corporation) and had a deleterious effect on the practice of intrauterine contraception."

"Because the first intrauterine contraceptive device proposed by Dr Richard Richter in 1909 was ignored, the Silver Ring of Dr Ernst Gräfenberg (1928) is currently labeled as the prototype of modern IUD generations. The Ring of Gräfenberg, however, was proscribed in the 1930s, and, although the basis for the condemnation was more political than scientific, three decades had passed before the rebirth and general acceptance of intrauterine contraception. The development of the plastic IUDs, announced by Dr Lazar Margulies and Dr Jack Lippes in 1960-61, solved the insertion problem of metallic IUDs, but did not eliminate the main side-effects, that is, bleeding and pain. In 1969, the first copper-bearing device was introduced by Dr Jaime Zipper and Dr Howard Tatum. The metallic contraceptive adjuvant, though allowing reduction of the platform size, did not solve the menorrhagia problem. This was achieved by Dr Tapani Luukkainen thanks to the invention of the gestagen- releasing IUD (Ng Nova-T) in 1977. The final step in IUD engineering was the invention of the GyneFix, a flexible, frameless copper-bearing IUD anchored permanently to the uterine tissues, which the inventor (Dr Dirk Wildemeersch) calls an intrauterine contraceptive implant or IUCI."

"Years of disappointment had taught Pincus that it wasn’t always the science that determined an experiment’s success; it was often the forces surrounding the science, including public sentiment. Now that Pincus had settled roughly on the hormone progesterone as the key to his pill, he needed to build the team to do the scientific work, forge alliances with manufacturers, conduct his trials, and, if all went well, spread the news of the coming invention so that it might have a chance at acceptance. He knew that his progestins (synthetic forms of progesterone) stopped ovulation in rabbits and rats. The next step was to test them on women. And to do that, he would have to add a player to his team—a doctor who could reassure patients they were safe and would convey to the drug companies supplying the drugs that no one would be harmed. There had never been a medicine made for healthy people before—and certainly not one that would be taken every day. The risks were enormous. Pincus settled on a physician named John Rock, a gynecologist respected by his peers and adored by his patients. Rock looked like a family physician from central casting in Hollywood: tall, slender, and silver-haired, with a gentle smile and a calm, deliberate manner. Even his name connoted strength, solidity, and reliability. Rock had one more thing going for him: He was Catholic."

"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."

"In Japan, Dr. Tenrei Ota, born in 1900, began pioneering intrauterine contraception in the 1930s. Once his country had joined the Axis and contraception was forbidden, Dr Ota became a political target, changed his name and finally went into hiding. As a consequence, knowledge of the Ota Ring would reach the Western world only after the end of World War II. Dr Ota had initiated his experiments in intrauterine contraception by inserting objects made from a great variety of materials and shapes, from gold spheres to coils of human hair. Since the rudimentary IUDs were expelled too easily, he decided, in 1933, to modify the Gräfenberg Ring (of which he had heard but never seen). He stiffened the Silver Ring by providing it with a central disc attached to the outer ring by spokes. Dr Ota called his silver or gold IUD the 'Precea Ring', ‘precea' being Anglo-Japanese for 'pressure'. The Pressure Ring was to remain popular in Japan well into the 1980s. Less well-known is that Dr Ota may have been the first physician to devise a plastic IUD. However, the inferior quality of plastic material put at his disposal ruined the idea."

"In the 1940s, alarm about the worlds burgeoning population, and the naive belief that the phenomenon could be curbed by the introduction of improved contraceptive methods, led to extensive research in the USA. The results of these endeavors were the pill and the plastic IUD. Plastic devices solved the problem inherent in the insertion and retrieval of the Rings of Gräfenberg and Ota. Made of thermoplastics, the new IUDs were given a memory of their original shape, could be straightened to fit inside a narrow straw-type inserter tube and regained their initial contour after introduction into the uterus. The notion that intrauterine contraception is safe and effective was proven in the early 1960s by the medical statistician Dr Christopher Tietze (1908-84), a Jewish emigrant to the USA, and a great admirer of Gräfenberg (Figure 2). Having collected and analyzed clinical results obtained with the Gräfenberg and Ota Rings, Dr Tietze organized the first international symposium on intrauterine contraception in New York City in 1962, sponsored by the Population Council. At the conference, the pioneers of the plastic devices, Dr Margulies and Dr Lippes, were invited to demonstrate their invention and report preliminary clinical results."