Hormonal birth control

"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."

"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."