The Pill

Another well-accepted method of contraception is the 'pill'. The possibility of modulating the woman's reproductive physiology by using chemicals to ensure that no pregnancy takes place emerged as we understood more about ourselves. As early as in 1912, Australian physiologist, Ludwig Haberlandt, mentioned the possibility of 'hormonal sterilisation'. It took years for scientific knowledge about ovarian hormones and their role in ovulation to build and for a commercially prepared hormonal preparation to be available.

Interestingly it took the courage of frail Margaret Sanger, who had made history by pioneering the opening of birth control clinic, to initiate the making of the first ever oral contraceptive. Later, the Searl Company marketed the first 'pill', called enavid, made of norethynodrel and mestranol, the two steroids that resembled ovarian hormones. Several types of hormonal compositions are now available as user-friendly oral contraceptives.

In general, the 'pill' is a preparation of progesterone and/or oestrogen. Taken together (combination pill) or in a phased fashion, the preparation inhibits ovulation in women. How it does so is easy to understand. The circulating steroid hormones have a 'feedback' effect on the hypothalamic secretions, which in turn inhibit prodution of the luteinising hormone and the follicle stimulating hormone. In absence of these two hormones, neither maturation of ovarian follicles nor ovulation takes place. This happens as a normal process when a woman is pregnant and has high levels of steroids in circulation. Steroids taken as the 'pill' mimic the endogenous steroids and not only suppress ovulation but also alter the character of the reproductive tract such that implantation becomes unlikely.

Steroid preparations today can be available as four kinds of pills :
1    progesterone only pill - a daily dose of progesterone to be taken for twenty-one days;
2    combination pill - of oestrogen and progesterone - a dose of identical tablets to be taken on consecutive days for twenty-one to twenty-two days;
3    a biphasic pill - where oestrogen and progesterone is taken in definite but varying concentrations for twenty-one days;
4    progesterone tablets follow sequential preparation - with oestrogen tablets.

Modern pills are progesterone only or combined pills with low levels of oestrogen and progesterone. This makes the pill readily acceptable as it substantially reduces the side effects. In general pills are available as a packet of twenty-one tablets. One tablet a day needs to be taken, starting from the fifth day after the beginning of the menstrual bleeding.

 

 

For effective contraception it is essential that the woman remembers to take the pill daily. If she does forget, it is recommended that an additional pill should be taken the next day. For more omissions, an additional method of contraception is advised to avoid any rist of conception. At the end of the course, the next set of tablets should be started after a gap of seven days. During this period there is bleeding because of withdrawal of hormones and for the woman it is an equivalent of menstruation.

In many societies, women during menstrual bleeding are considered 'impure' and not permitted to participate in religious functions during the time. Women, keen to find a way out, often use hormones to regulate bleeding by taking hormonal preparations. While no physiological effects of such use is apparent, it indicates an irrational acceptance of the 'impure' state of menstruating women by women themselves. This acts rather negatively on the psychology of teenaged girls, reinforcing poor self-esteem. On the other hand, there are others who feel that this may introduce the use of pill in traditional societies with a positive overtone.