Oral Contraceptives

Definition

Oral contraceptives are medicines taken by mouth to help prevent pregnancy. They are also known as the Pill, OCs, or birth control pills.

Purpose

Oral contraceptives, also known as birth control pills, contain artificially made forms of two hormones produced naturally in the body. These hormones, estrogen and progestin, regulate a woman's menstrual cycle. When taken in the proper amounts, following a specific schedule, oral contraceptives are very effective in preventing pregnancy. Studies show that less than one of every one hundred women who use oral contraceptives correctly becomes pregnant during the first year of use.

These pills have several effects that help prevent pregnancy. For pregnancy to occur, an egg must become mature inside a woman's ovary, be released, and travel to the fallopian tube. A male sperm must also reach the fallopian tube, where it fertilizes the egg. Then the fertilized egg must travel to the woman's uterus (womb), where it lodges in the uterus lining and develops into a fetus. The main way that oral contraceptives prevent pregnancy is by keeping an egg from ripening fully. Eggs that do not ripen fully cannot be fertilized. In addition, birth control pills thicken mucus in the woman's body through which the sperm has to swim. This makes it more difficult for the sperm to reach the egg. Oral contraceptives also change the uterine lining so that a fertilized egg cannot lodge there to develop.

Birth control pills may cause good or bad side effects. For example, a woman's menstrual periods are regular and usually lighter when she is taking oral contraceptives, and the pills may reduce the risk of ovarian cysts, breast lumps, pelvic inflammatory disease, and other medical problems. However, taking birth control pills increases the risk of heart attack, stroke, and blood clots in certain women. Serious side effects such as these are more likely in women over 35 years of age who smoke cigarettes and in those with specific health problems such as high blood pressure, diabetes, or a history of breast or uterine cancer. A woman who wants to use oral contraceptives should ask her physician for the latest information on the risks and benefits of all types of birth control and should consider her age, health, and medical history when deciding what to use.

Precautions

No form of birth control (except not having sex) is 100% effective. However, oral contraceptives can be highly effective when used properly. Discuss the options with a health care professional.

Oral contraceptives do not protect against AIDS or other sexually transmitted diseases. For protection against such diseases, use a latex condom.

Oral contraceptives are not effective immediately after a woman begins taking them. Physicians recommend using other forms of birth control for the first 1-3 weeks. Follow the instructions of the physician who prescribed the medicine.

Smoking cigarettes while taking oral contraceptives greatly increases the risk of serious side effects. Women who take oral contraceptives should not smoke cigarettes.

Seeing a physician regularly while taking this medicine is very important. The physician will note unwanted side effects. Follow his or her advice on how often you should be seen.

Anyone taking oral contraceptives should be sure to tell the health care professional in charge before having any surgical or dental procedures, laboratory tests, or emergency treatment.

This medicine may increase sensitivity to sunlight. Women using oral contraceptives should avoid too much sun exposure and should not use tanning beds, tanning booths, or sunlamps until they know how the medicine affects them. Some women taking oral contraceptives may get brown splotches on exposed areas of their skin. These usually go away over time after the women stop taking birth control pills.

Oral contraceptives may cause the gums to become tender and swollen or to bleed. Careful brushing and flossing, gum massage, and regular cleaning may help prevent this problem. Check with a physician or dentist if gum problems develop.

Women who have certain medical conditions or who are taking certain other medicines may have problems if they take oral contraceptives. Before taking these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to estrogens or progestins in the past should let her physician know before taking oral contraceptives. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Women who become pregnant or think they may have become pregnant while taking birth control pills should stop taking them immediately and check with their physicians. Women who want to start taking oral contraceptives again after pregnancy should not refill their old prescriptions without checking with their physicians. The physician may need to change the prescription.

BREASTFEEDING. Women who are breastfeeding should check with their physicians before using oral contraceptives. The hormones in the pills may reduce the amount of breast milk and may cause other problems in breastfeeding. They may also cause jaundice and enlarged breasts in nursing babies whose mothers take the medicine.

OTHER MEDICAL CONDITIONS. Oral contraceptives may improve or worsen some medical conditions. The possibility that they may make a condition worse does not necessarily mean they cannot be used. In some cases, women may need only to be tested or followed more closely for medical problems while using oral contraceptives. Before using oral contraceptives, women with any of these medical problems should make sure their physicians are aware of their conditions:

• Female conditions such as menstrual problems, endometriosis, or fibroid tumors of the uterus. Birth control pills usually make these problems better, but may sometimes make them worse or more difficult to diagnose.
• Heart or circulation problems; recent or past blood clots or stroke. Women who already have these problems may be at greater risk of developing blood clots or circulation problems if they use oral contraceptives. However, healthy women who do not smoke may lower their risk of circulation problems and heart disease by taking the pills.
• Breast cysts, lumps, or other noncancerous breast problems. Oral contraceptives generally protect against these conditions, but physicians may recommend more frequent breast exams for women taking the pills.

• Breast cancer or other cancer (now or in the past, or family history). Oral contraceptives may make some existing cancers worse. Women with a family history of breast cancer may need more frequent screening for the disease if they decide to take birth control pills.
• Migraine headaches. This condition may improve or may get worse with the use of birth control pills.
• Diabetes. Blood sugar levels may increase slightly when oral contraceptives are used. Usually this increase is not enough to affect the amount of diabetes medicine needed. However, blood sugar will need to be monitored closely while taking oral contraceptives.
• Depression. This condition may worsen in women who already have it or may (rarely) occur again in women who were depressed in the past.
• Gallbladder disease, gallstones, high blood cholesterol, or chorea gravidarum (a nervous disorder). Oral contraceptives may make these conditions worse.
• Epilepsy, high blood pressure, heart or circulation problems. By increasing fluid build-up, oral contraceptives may make these conditions worse.

Description

Oral contraceptives (birth control pills) come in a wide range of estrogen-progestin combinations. The pills in use today contain much lower doses of estrogen than those available in the past, and this change has reduced the likelihood of serious side effects. Some pills contain only progestin. These are prescribed mainly for women who need to avoid estrogens and may not be as effective in preventing pregnancy as the estrogen-progestin combinations.

These medicines come in tablet form, in containers designed to help women keep track of which tablet to take each day. The tablets are different colors, indicating amounts of hormones they contain. Some may contain no hormones at all. These are included simply to help women stay in the habit of taking a pill every day, as the hormone combination needs to be taken only on certain days of the menstrual cycle. Keeping the tablets in their original container and taking them exactly on schedule is very important. They will not be as effective if they are taken in the wrong order or if doses are missed.

Oral contraceptives are available only with a physician's prescription. Some commonly used brands are Demulen, Desogen, Loestrin, Lo/Ovral, Nordette, Ortho-Novum, Ortho-Tri-Cyclen, Estrostep, Orthocept, Alesse, Levlite and Ovcon.

The dose schedule depends on the type of oral contraceptive. The two basic schedules are a 21-day schedule and a 28-day schedule. On the 21-day schedule, take one tablet a day for 21 days, then skip 7 days and repeat the cycle. On the 28-day schedule, take one tablet a day for 28 days; then repeat the cycle. Be sure to carefully follow the instructions provided with the medicine. For additional information or explanations, check with the physician who prescribed the medicine or the pharmacist who filled the prescription.

Taking doses more than 24 hours apart may increase the chance of side effects or pregnancy. Try to take the medicine at the same time every day. Take care not to run out of pills. If possible, keep an extra month's supply on hand and replace it every month with the most recently filled prescription.

Try not to miss a dose, as this increases the risk of pregnancy. If a dose is missed, follow the package directions or check with the physician who prescribed the medicine for instructions. It may be necessary to use another form of birth control for some time after missing a dose.

Taking this medicine with food or at bedtime will help prevent nausea, a side effect that sometimes occurs during the first few weeks. This side effect usually goes away as the body adjusts to the medicine.

Taking oral contraceptives may have several benefits outside of their ability to prevent pregnancy. Research indicates that with 10 to 12 years of oral contraceptive use, a woman's risk of ovarian cancer is reduced by up to 80%. There may also be an approximate 50% decrease in the rate of endometrial cancers in women. One other well-known, noncontraceptive benefit of oral contraceptives is an improvement in acne. The combination oral contraceptive ethinyl estradiol/norgestimate has been approved by the Food and Drug Administration for the treatment of acne. Another positive effect of oral contraceptive use is improvement in abnormal uterine bleeding. Older women may also benefit from using oral contraceptives, because the pills can increase bone mass as women enter their menopausal years, when osteoporosis is a growing concern.

Oral contraceptives may also be used on an emergency basis as a means of preventing pregnancy in women who have had unprotected intercourse. Two products specifically designed for this purpose are Preven and Plan B. In 2001, the American College of Obstetricians and Gynecologists (ACOG) recommended that emergency oral contraceptives be available as an over-the-counter medicine. The Food and Drug Administration, however, has not yet approved any measures that would allow this to happen.

Risks

Taking oral contraceptives with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side Effects

Serious side effects are rare in healthy women who do not smoke cigarettes. In women with certain health problems, however, oral contraceptives may cause problems such as liver cancer, noncancerous liver tumors, blood clots, or stroke. Health care professionals can help women weigh the benefits of being protected against unwanted pregnancy against the risks of possible health problems.

The most common minor side effects are nausea; vomiting ; abdominal cramping or bloating; breast pain, tenderness or swelling; swollen ankles or feet; tiredness; and acne. These problems usually go away as the body adjusts to the drug and do not need medical attention unless they continue or they interfere with normal activities.

Other side effects should be brought to the attention of the physician who prescribed the medicine. Check with the physician as soon as possible if any of the following side effects occur:

• menstrual changes, such as lighter periods or missed periods, longer periods, or bleeding or spotting between periods
• headaches
• vaginal infection, itching, or irritation
• increased blood pressure

Women who have any of the following symptoms should get emergency help right away. These symptoms may be signs of blood clots:

• sudden changes in vision, speech, breathing, or coordination
• severe or sudden headache
• coughing up blood
• sudden, severe, or continuing pain in the abdomen or stomach
• pain in the chest, groin, or leg (especially in the calf)
• weakness, numbness, or pain in an arm or leg

Oral contraceptives may continue to affect the menstrual cycle for some time after a woman stops taking them. Women who miss periods for several months after stopping this medicine should check with their physicians.

Other rare side effects may occur. Anyone who has unusual symptoms while taking oral contraceptives should get in touch with her physician.

Interactions

Oral contraceptives may interact with a number of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes oral contraceptives should let the physician know all other medicines she is taking and should ask whether the possible interactions can interfere with drug therapy.

These drugs may make oral contraceptives less effective in preventing pregnancy. Anyone who takes these drugs should use an additional birth control method for the entire cycle in which the medicine is used:

• ampicillin
• penicillin V
• rifampin (Rifadin)
• tetracyclines
• griseofulvin (Gris-PEG, Fulvicin)
• corticosteroids
• barbiturates
• carbamazepine (Tegretol)
• phenytoin (Dilantin)
• primidone (Mysoline)
• ritonavir (Norvir)

In addition, taking these medicines with oral contraceptives may increase the risk of side effects or interfere with the medicine's effects:

• theophylline-effects of this medicine may increase, along with the chance of unwanted side effects
• cyclosporine-effects of this medicine may increase, along with the chance of unwanted side effects
• troleandomycin (TAO)-chance of liver problems may increase. Effectiveness of oral contraceptive may also decrease, raising the risk of pregnancy

The list above does not include every drug that may interact with oral contraceptives. Be sure to check with a physician or pharmacist before combining oral contraceptives with any other prescription or nonprescription (over-the-counter) medicine.

As with any medication, the benefits and risks should be discussed with a physician.

Resources

BOOKS

Beers, Mark H., and Robert Berkow, editors. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck and Company, Inc., 1999.

PERIODICALS

"Current Perspectives on OC Formulations." Family Practice News January 15, 2001: 2.

"Physician Group Supports Safety, Availability of Over-the-Counter Emergency Option." Medical Letter on the CDC and FDA March 18, 2001.

OTHER

Medline Plus Health Information, U.S. National Library of Medicine. 〈http://www.nlm.nih.gov/medlineplus〉.

KEY TERMS

Cyst— An abnormal sac or enclosed cavity in the body, filled with liquid or partially solid material.

Endometriosis— A condition in which tissue like that normally found in the lining of the uterus is present outside the uterus. The condition often causes pain and bleeding.

Fallopian tube— One of a pair of slender tubes that extend from each ovary to the uterus. Eggs pass through the fallopian tubes to reach the uterus.

Fetus— A developing baby inside the womb.

Fibroid tumor— A noncancerous tumor formed of fibrous tissue.

Hormone— A substance that is produced in one part of the body, then travels through the bloodstream to another part of the body where it has its effect.

Jaundice— Yellowing of the eyes and skin due to the build up of a bile pigment (bilirubin) in the blood.

Migraine— A throbbing headache that usually affects only one side of the head. Nausea, vomiting, increased sensitivity to light, and other symptoms often accompany migraine.

Mucus— Thick fluid produced by the moist membranes that line many body cavities and structures.

Ovary— A reproductive organ in females that produces eggs and hormones.

Pelvic inflammatory disease— Inflammation of the female reproductive tract, caused by any of several microorganisms. Symptoms include severe abdominal pain, high fever, and vaginal discharge. Severe cases can result in sterility. Also called PID.

Uterus— A hollow organ in a female in which a fetus develops until birth.

Oral contraceptives

Definition

Oral contraceptives are medicines taken by mouth to help prevent pregnancy. They are also known as the pill, OCs, or birth control pills.

Description

Oral contraceptives, or birth control pills, contain synthetic forms of two hormones produced naturally in the body. These hormones, estrogen and progestin, regulate the female menstrual cycle. Some types of oral contraceptives use only progestational hormones, but most use a combination of estrogen and progestin. As of 2004, there were three types of oral contraceptives marketed:

• Monophasic use a fixed dose of both estrogen and progestin during the entire cycle.
• Biphasic oral contraceptives use a constant amount of estrogen during the full cycle, but the amount of progestin is lower during the first half of the cycle and increases in the second half. This shift in dosage is intended to mimic the natural ovarian cycle.
• Triphasic oral contraceptives may vary both the estrogen and progestin levels at different times during the cycle.

The goal of the biphasic and triphasic formulations is to achieve adequate control of the menstrual cycle while using lower doses of both estrogens and progestins, thereby reducing the risk of adverse effects. Reviews of controlled studies have not demonstrated a clear advantage of the newer formulations over the older monophasic drugs.

General use

When taken in the proper amounts, following a specific schedule, oral contraceptives are very effective in preventing pregnancy. Studies show that fewer than one of every 100 females who use oral contraceptives correctly becomes pregnant during the first year of use.

These pills have several effects that help prevent pregnancy. For pregnancy to occur, an egg must become mature inside a woman's ovary, be released, and travel to the fallopian tube. Sperm must travel through the reproductive track to fertilize the egg in the fallopian tube. Then the fertilized egg must travel to the woman's uterus (womb), where it lodges in the uterus lining and develops into a fetus.

The main way that oral contraceptives prevent pregnancy is by keeping an egg from ripening fully. Eggs that do not ripen fully cannot be fertilized. In addition, birth control pills thicken mucus in the woman's body through which the sperm has to swim. Thus it is more difficult for the sperm to reach the egg. Oral contraceptives also change the uterine lining so that a fertilized egg cannot lodge there to develop.

Although contraception is the primary use of these medications, they may also be used to treat adolescent and post-adolescent acne in girls. Some products have this as part of their official indications, but others may be used as well.

Precautions

No form of birth control (except abstinence from sexual intercourse) is 100 percent effective. However, oral contraceptives can be highly effective when used properly. Teens and young women who anticipate having sexual intercourse should discuss the options with a healthcare professional.

Oral contraceptives do not protect against AIDS or other sexually transmitted diseases . For some protection against such diseases, teenage males and young men need to use a latex condom . Also, oral contraceptives are not effective immediately after a young woman begins taking them. Physicians recommend using other forms of birth control for the first one to three weeks. Then users should follow the instructions of the physician who prescribed the medicine.

Smoking cigarettes while taking oral contraceptives greatly increases the risk of serious side effects. Females who take oral contraceptives should not smoke cigarettes.

Seeing a physician regularly while taking this medicine is very important. The physician will note unwanted side effects, and patients should follow his or her advice on how often they should be seen.

Young women who take oral contraceptives should be sure to tell the healthcare professional in charge before they undergo surgical or dental procedures, laboratory tests, or emergency treatment.

This medicine may increase sensitivity to sunlight. Females using oral contraceptives should avoid too much sun exposure and should not use tanning beds, tanning booths, or sunlamps until they know how the medicine affects them. Some females taking oral contraceptives may get brown splotches on exposed areas of their skin. These usually go away over time after the women stop taking birth control pills.

Oral contraceptives may cause the gums to become tender and swollen or to bleed. Careful brushing and flossing, gum massage, and regular cleaning may help prevent this problem. Users should check with a physician or dentist if gum problems develop.

Side effects

Serious side effects are rare in healthy females who do not smoke cigarettes. In women with certain health problems, however, oral contraceptives may cause problems such as liver cancer , noncancerous liver tumors, blood clots, or stroke . Healthcare professionals can help prospective users weigh the benefits of being protected against unwanted pregnancy against the risks of possible health problems.

The most common minor side effects are nausea , vomiting , abdominal cramping or bloating, breast pain , tenderness or swelling, swollen ankles or feet, tiredness, and acne. These problems usually go away as the body adjusts to the drug and do not need medical attention unless they continue or they interfere with normal activities. Other side effects should be brought to the attention of the physician who prescribed the medicine. Teens and young women should check with the physician as soon as possible if any of the following side effects occur:

• menstrual changes, such as lighter periods or missed periods, longer periods, or bleeding or spotting between periods
• headaches
• vaginal infection, itching , or irritation
• increased blood pressure

Women who have any of the following symptoms should get emergency help right away. These symptoms may be signs of blood clots:

• sudden changes in vision, speech, breathing, or coordination
• severe or sudden headache
• coughing up blood
• sudden, severe, or continuing pain in the abdomen or stomach
• pain in the chest, groin, or leg (especially in the calf)
• weakness, numbness , or pain in an arm or leg

The adverse effects of oral contraceptives can be impossible to predict. Other than avoiding smoking, there are no effective means of preventing side effects. All observed adverse effects should be reported to a physician promptly.

Oral contraceptives may continue to affect the menstrual cycle for some time after a young woman stops taking them. Women who miss periods for several months after stopping this medicine should check with their physicians. Other rare side effects may occur. Anyone who has unusual symptoms while taking oral contraceptives should get in touch with her physician.

Interactions

Oral contraceptives may interact with a number of other medicines. When interaction occurs, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes oral contraceptives should let the physician know all other medicines she is taking and should ask whether possible interactions can interfere with drug therapy.

These drugs may make oral contraceptives less effective in preventing pregnancy. Anyone who takes these drugs should use an additional birth control method for the entire cycle in which the medicine is used:

• ampicillin
• penicillin V
• rifampin (Rifadin)
• tetracyclines
• griseofulvin (Gris-PEG, Fulvicin)
• corticosteroids
• barbiturates
• carbamazepine (Tegretol)
• phenytoin (Dilantin)
• primidone (Mysoline)
• ritonavir (Norvir)

In addition, taking the following medicines with oral contraceptives may increase the risk of side effects or interfere with the medicine's effects:

• Theophylline: Effects of this medicine may increase, along with the chance of unwanted side effects.
• Cyclosporine: Effects of this medicine may increase, along with the chance of unwanted side effects.
• Troleandomycin (TAO): Chance of liver problems may increase. Effectiveness of oral contraceptive may also decrease, raising the risk of pregnancy.

The list above does not include every drug that may interact with oral contraceptives. Women should be sure to check with a physician or pharmacist before combining oral contraceptives with any other prescription or nonprescription (over-the-counter) medicine. As with any medication, the benefits and risks should be discussed with a physician.

KEY TERMS

Cyst —An abnormal sac or enclosed cavity in the body filled with liquid or partially solid material. Also refers to a protective, walled-off capsule in which an organism lies dormant.

Endometriosis —A condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and frequently, infertility.

Fallopian tubes —The pair of narrow tubes leading from a woman's ovaries to the uterus. After an egg is released from the ovary during ovulation, fertilization (the union of sperm and egg) normally occurs in the fallopian tubes.

Fetus —In humans, the developing organism from the end of the eighth week to the moment of birth. Until the end of the eighth week the developing organism is called an embryo.

Fibroid tumor —A non-cancerous tumor of connective tissue made of elongated, threadlike structures, or fibers, which usually grow slowly and are contained within an irregular shape. Fibroids are firm in consistency but may become painful if they start to break down or apply pressure to areas within the body. They frequently occur in the uterus and are generally left alone unless growing rapidly or causing other problems. Surgery is needed to remove fibroids.

Hormone —A chemical messenger secreted by a gland or organ and released into the bloodstream. It travels via the bloodstream to distant cells where it exerts an effect.

Jaundice —A condition in which the skin and whites of the eyes take on a yellowish color due to an increase of bilirubin (a compound produced by the liver) in the blood. Also called icterus.

Migraine —A throbbing headache that usually affects only one side of the head. Nausea, vomiting, increased sensitivity to light, and other symptoms often accompany a migraine.

Mucus —The thick fluid produced by the mucous membranes that line many body cavities and structures. It contains mucin, white blood cells, water, inorganic salts, and shed cells, and it serve to lubricate body parts and to trap particles of dirt or other contaminants.

Ovary —One of the two almond-shaped glands in the female reproductive system responsible for producing eggs and the sex hormones estrogen and progesterone.

Pelvic inflammatory disease (PID) —Any infection of the lower female reproductive tract (vagina and cervix) that spreads to the upper female reproductive tract (uterus, fallopian tubes and ovaries). Symptoms include severe abdominal pain, high fever, and vaginal discharge. PID is the most common and most serious consequence of infection with sexually transmitted diseases in women and is a leading cause of female fertility problems.

Uterus —The female reproductive organ that contains and nourishes a fetus from implantation until birth. Also called the womb.

Parental concerns

Parents become concerned that teens who use oral contraceptives are at risk of becoming sexually active. Although studies have been limited, they have failed to show that availability of oral contraceptives leads to an increase in sexual activity among adolescent girls.

Oral contraceptives do not protect against sexually transmitted diseases. When used for contraception, they should be limited to monogamous relationships.

Although the list of potential side effects and adverse effects is very long and contains some severe risks, the actual frequency of these risks is low. In most cases, oral contraceptives have a very high safety margin.

Resources

BOOKS

Mcevoy, Gerald K., et al. AHFS Drug Information 2004. Bethesda, MD: American Society of Healthsystems Pharmacists, 2004.

Siberry, George K., and Robert Iannone, eds. The Harriet Lane Handbook, 15th ed. Philadelphia: Mosby, 2000.

PERIODICALS

Kaunitz, Andrew M. "Enhancing oral contraceptive success: The potential of new formulations." American Journal of Obstetrics & Gynecology 190, no. 4, Suppl. (April 2004): S23–S29.

ORGANIZATIONS

American Academy of Dermatology. PO Box 4014, Schaumburg, IL 60168–4014. Web site: <www.aad.org>.

American Board of Obstetrics and Gynecology. 2915 Vine Street, Dallas, TX 75204. Web site: <www.abog.org>.

Planned Parenthood Federation of America. 434 West 33rd St., New York, NY 10001. Web site: <www.plannedparenthood.org>.

WEB SITES

"Update on Oral Contraceptives." American Family Physician. Available online at <www.aafp.org/afp/991101ap/html> (accessed September 28, 2004).

Deanna M. Swartout-Corbeil, R.N. Samuel Uretsky, PharmD

ORAL CONTRACEPTIVES

Hormone Manipulation

The concept behind oral contraceptive pills is fairly simple. Every month, women have a cycle of hormones produced by their ovaries. This cycle leads to ovulation, or the production of an egg that can become fertilized to result in pregnancy. The two main hormones produced by the body in this cycle are estrogen and progesterone. If their levels do not rise and fall in accordance with the body's requirements during the monthly cycle, ovulation normally does not occur, and even if it does, unbalanced hormone levels could prevent the uterus from accepting the resultant pregnancy. The oral contraceptive pill was designed to manipulate levels of these two hormones to prevent unwanted pregnancy effectively.

The Team

An interesting group of people was involved in the development of oral contraceptives. Margaret Sanger was a pioneer of women's rights and founded the organization Planned Parenthood. Her friend Katherine McCormick was an heiress (McCormick farm machinery) who funded much of the project. Gregory Pincus and M. C. Chang were Massachusetts biologists. John Rock was a Boston gynecologist willing to try the new method on women volunteers. Russell Marker was a chemist and entrepreneur who made it all possible because of his work with Mexican yams.

A Marriage of Interests

Pincus approached Sanger with a report about his research on oral contraceptives in 1951. Sanger was impressed with his work and introduced him to McCormick, who eventually gave more than $2 million to the project. Synthetic estrogens were developed in the 1950s by Syntex chemists G. Rosenkranz, C. Djerassi and F. Sondheimer. Their synthetic hormones could be taken orally to control the body's estrogen level, but the progesterone component had to be controlled as well for effective birth control. That is where yams came in.

EXPANDING UNIVERSE

In September 1952 Dr. Walter Beade of Mount Wilson-Palomar Observatories made an announcement to the International Astronomical Union that shocked astronomers. Observations with the two hundred-inch Hale telescope at his observatoy had revealed that all objects beyond the Milky Way were twice as far from Earth as previously believed. By the new calculations the Andromeda Nebula was shown to be 1.7 million light-years from Earth, meaning that whatever light from the nebula might reach us would have begun its travel 1.7 million years ago.

Dr. Beade's discovery affected calculations of the age as well as the size of the universe. His best estimate was that the universe was 3.9 billion years old, not 1.8 billion years, as astronomers had previously believed. The new calculation corresponded to radioactive dating of the Earth's crust.

Source:

William T. Couch, Collier's 1954 Year Book (New York: Collier's, 1954).

The Pill

Marker was able to produce progesterone in large amounts at a very low cost from the yams. Pincus recognized that Marker's research had identified a source for the previously rare and costly hormone, and he engaged Rock to help set up human testing when the time was right. After initial development and testing to develop the final product, the G. D. Searle Company announced its sponsorship of the Pincus and Rock tests in 1955 at a Planned Parenthood meeting in Tokyo. In 1956 fifteen thousand women in Puerto Rico and in Haiti volunteered to test the effectiveness and safety of the contraceptive. The results were positive, and for the first time women had access to a highly effective, safe, inexpensive, convenient form of totally reversible temporary birth control. Although thousands of types of pills are produced annually by American pharmaceutical companies, the oral contraceptive had such a dramatic social impact that it is known as the Pill. In 1960 it was approved for use throughout the United States.

Sources:

Kenneth Morris, Marc Robinson and Richard Kroll, American Dreams: One Hundred Years of Business Ideas and Innovation From the Wall Street Journal (New York: Abrams, 1990);

Trevor Illtyd Williams, Science: A History of Discovery in the Twentieth Century (Oxford & New York: Oxford University Press, 1990);

Lawrence Lader and Milton Meltzer, Marganet Sanger: Pioneer of Birth Control (New York: Crowell, 1969).