Combined Oral Contraceptive Pill (COCP)
Background
B. C. type	Hormonal
First use	1960
Failure rates (first year)
Perfect use	0. 3%
Typical use	8%
Usage
Duration effect	1–4 days
Reversibility	Yes
User reminders	Taken within same 12 hour window each day
Clinic review	6 months
Advantages and Disadvantages
STD protection	No
Periods	Regulates, and often lighter and less painful
Weight	No proven effect
Benefits	Reduced ovarian and endometrial cancer risks. Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Endometrial cancer refers to several types of malignancy which arise from the Endometrium, or lining of the Uterus. May treat acne, PCOS, PMDD, endometriosis
Risks	Increased DVTs; Increased strokes & MIs if other risk factors present
Medical notes
Affected by broad-spectrum antibiotics, the herb Hypericum (St. Acne vulgaris (commonly called acne) is a Skin disease caused by changes in the Pilosebaceous units (skin structures consisting of a Hair follicle Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis Premenstrual dysphoric disorder (PMDD is a severe form of Premenstrual syndrome, afflicting 3% to 8% of women Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Johns Wort) and some anti-epileptics, also vomiting or diarrhoea. Caution if history of migraines.

The Combined Oral Contraceptive Pill (COCP), often referred to as "the Pill", is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal female fertility. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, A progestin is a synthetic progestagen that has progestinic effects similar to Progesterone. Progestagens (also spelled progestogens or gestagens) are Hormones that produce effects similar to those of Progesterone, the only natural progestagen Combined oral contraceptives were developed by Gregory Goodwin Pincus, John Rock, and Min Chueh Chang. Gregory Goodwin Pincus ( April 9, 1903 - August 22, 1967) American biologist and researcher was co-inventor of the Combined John Rock ( 24 March 1890 - 4 December 1984) was one of the inventors of the birth control pill. Dr Min Chueh Chang ( October 10, 1908 - June 5, 1991) often credited as M ^[1] They were first approved for contraceptive use in the United States in 1960, and are still a popular form of birth control. The United States of America —commonly referred to as the Birth control, sometimes synonymous with contraception, is a regimen of one or more actions devices or Medications followed in order to deliberately prevent They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States. ^[2][3] Usage varies widely by country,^[4] age, education, and marital status: one quarter of women aged 16–49 in Great Britain currently use the Pill (combined pill or minipill),^[5] compared to only 1% of women in Japan. See also Kingdom of Great Britain Great Britain (Breatainn Mhòr Prydain Fawr Breten Veur Graet Breetain is the larger of the two main islands Progestogen Only Pills or Progestin Only Pills ( POP) are Contraceptive Pills that only contain synthetic Progestogens ( Progestins For a topic outline on this subject see List of basic Japan topics. ^[6]

History

By the 1930s, scientists had isolated and determined the structure of the steroid hormones and found that high doses of androgens, estrogens or progesterone inhibited ovulation,^{[7][8][9][10]} but obtaining them from European pharmaceutical companies produced from animal extracts was extraordinarily expensive. A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Progesterone is a C-21 Steroid Hormone involved in the Female Menstrual cycle, Pregnancy (supports Gestation Note This article deals primarily with Human ovulation nonhuman Animal ovulation is touched on briefly at the conclusion ^[11]

In 1939, Russell Marker, a professor of organic chemistry at Pennsylvania State University, developed a method of synthesizing progesterone from plant steroid sapogenins, initially using sarsapogenin from sarsaparilla which proved too expensive. Russell Earl Marker ( March 12, 1902 &ndash March 23, 1995) was an eccentric American Chemist who invented the octane Organic chemistry is a discipline within Chemistry which involves the scientific study of the structure properties composition reactions, and preparation The Pennsylvania State University (commonly known as Penn State) is a state-related, land-grant, space grant public research University Progesterone is a C-21 Steroid Hormone involved in the Female Menstrual cycle, Pregnancy (supports Gestation For the drink see Root beer. Sarsaparilla (IPA /ˌsæspəˈɹɪlə/ ( Smilax regelii and other closely related species of After three years of extensive botanical research he discovered a much better starting material, the aglycone moiety of the saponin, diosgenin, from inedible Mexican wild yams found in the jungles of Veracruz near Orizaba. Saponins are a class of chemical compounds one of very many Secondary metabolites found in natural sources with saponins found in particular abundance in various plant Diosgenin, a steroid sapogenin is the product of hydrolysis by acids strong bases or enzymes of Saponins, extracted from the Tubers of Dioscorea Dioscorea villosa is a species of a twining tuberous vine that is native to and found growing wild in North America Veracruz, formally Veracruz de Ignacio de la Llave is one of the 31 states that constitute the republic of Mexico. Orizaba is a city and municipality in the Mexican state of Veracruz. Unable to interest his research sponsor Parke-Davis in the commercial potential of synthesizing progesterone from Mexican yams, Marker left Penn State and in 1944 co-founded Syntex with two partners in Mexico City before leaving Syntex a year later. Parke-Davis is a Subsidiary of the Pharmaceutical company Pfizer. Laboratorios Syntex SA was a pharmaceutical company formed in Mexico City in 1944 by Russell Marker to manufacture therapeutic steroids from the Mexican yam Mexico City (in Spanish: Ciudad de México, México DF, México or simply Méjico) is the Capital city of Mexico Syntex broke the monopoly of European pharmaceutical companies on steroid hormones, reducing the price of progesterone almost 200-fold over the next eight years. ^{[11][12][13][14][15][16][17][18][19][20][21][22][23]}

Midway through 20th century, the stage was set for the development of a hormonal contraceptive, but pharmaceutical companies, universities and governments showed no interest in pursuing research. Hormonal contraception refers to Birth control methods that act on the hormonal system ^[15]

Studies of progesterone to prevent ovulation

In early 1951, reproductive physiologist Gregory Pincus, a leader in hormone research and co-founder of the Worcester Foundation for Experimental Biology (WFEB) in Shrewsbury, Massachusetts, first met American birth control movement founder Margaret Sanger at a Manhattan dinner hosted by Abraham Stone, medical director and vice president of Planned Parenthood (PPFA), who helped Pincus obtain a small grant from PPFA to begin hormonal contraceptive research. Physiology (from Greek grc φύσις physis, "nature origin" and grc -λογία -logia) is the study of the mechanical physical Gregory Goodwin Pincus ( April 9, 1903 - August 22, 1967) American biologist and researcher was co-inventor of the Combined The Worcester Foundation for Biomedical Research ( WFBR) is a Non-profit Biomedical Research institute based in Shrewsbury Massachusetts Shrewsbury is a town in Worcester County, Massachusetts, United States. Margaret Higgins Sanger ( September 14, 1879 &ndash September 6, 1966) was an American Birth control activist an advocate Manhattan Island, in New York Harbor, is much the largest part of the Borough of Manhattan, one of the Five Boroughs which form the City of New York Planned Parenthood is the collective name of organizations worldwide who are members of the International Planned Parenthood Federation (IPPF Research started on April 25, 1951 with reproductive physiologist Min Chueh Chang repeating and extending the 1937 experiments of Makepeace et al. Dr Min Chueh Chang ( October 10, 1908 - June 5, 1991) often credited as M that showed injections of progesterone suppressed ovulation in rabbits. In October 1951, G. D. Searle & Company refused Pincus' request to fund his hormonal contraceptive research, but retained him as a consultant and continued to provide chemical compounds to evaluate. GD Searle & Company or just Searle was a company focusing on life sciences specifically pharmaceuticals agriculture and animal health ^[11][16]

In March 1952, Sanger wrote a brief note mentioning Pincus' research to her longtime friend and supporter, suffragist and philanthropist Katharine Dexter McCormick, who visited the WFEB and its co-founder and old friend Hudson Hoagland in June 1952 to learn about contraceptive research there. Philanthropy is the act of donating money goods services time and/or effort to support a socially beneficial cause with a defined objective and with no financial or material Katharine Dexter McCormick ( August 27, 1875 – December 28, 1967) was a U Frustrated when research stalled from PPFA's lack of interest and meager funding, McCormick arranged a meeting at the WFEB on June 6, 1953 with Sanger and Hoagland where she first met Pincus who committed to dramatically expand and accelerate research with McCormick providing fifty times PPFA's previous funding. ^[16][24]

Pincus and McCormick enlisted Harvard clinical professor of gynecology John Rock, chief of gynecology at the Free Hospital for Women and an expert in the treatment of infertility, to lead clinical research with women. Harvard Medical School ( HMS) is one of the graduate schools of Harvard University and currently the #1 medical school in America as ranked by U As per the discussion in the Talk page there has been no consensus as to using the American (gynecology or British (gynaecology spelling for this article BUT John Rock may refer to John Rock (American scientist John Rock (Abolitionist John Rock (ASUI Senator Brigham and Women's Hospital (BWH is the largest Hospital of Longwood Medical and Academic Area, in the Boston, Massachusetts neighborhood of Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. At a scientific conference in 1952, Pincus and Rock, who had known each other for many years, discovered they were using similar approaches to achieve opposite goals. In 1952, Rock induced a three-month anovulatory "pseudo-pregnancy" state in eighty of his infertility patients with continuous gradually increasing oral doses of estrogen (diethylstilbestrol 5 – 30 mg/day) and progesterone (50 – 300 mg/day) and within the following four months an encouraging 15% became pregnant. An anovulatory cycle is a cycle during which the ovaries fail to release an oocyte Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Diethylstilbestrol ( DES) is a drug, an orally active synthetic nonsteroidal Estrogen that was first synthesized in 1938 ^[16][17][25]

In 1953, at Pincus' suggestion, Rock induced a three-month anovulatory "pseudo-pregnancy" state in twenty-seven of his infertility patients with an oral 300 mg/day progesterone-only regimen for 20 days from cycle days 5 – 24 followed by pill-free days to produce withdrawal bleeding. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the This produced the same encouraging 15% pregnancy rate during the following four months without the troubling amenorrhea of the previous continuous estrogen and progesterone regimen. Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age But 20% of the women experienced breakthrough bleeding and in the first cycle ovulation was suppressed in only 85% of the women, indicating that even higher and more expensive oral doses of progesterone would be needed to initially consistently suppress ovulation. Breakthrough bleeding is Bleeding while taking the active pills of combined oral contraceptives, or other hormonal contraceptives ^[26]

Studies of progestins to prevent ovulation

Pincus asked his contacts at pharmaceutical companies to send him chemical compounds with progestogenic activity. Chang screened nearly 200 chemical compounds in animals and found the three most promising were Syntex's norethindrone and Searle's norethynodrel and norethandrolone. Norethisterone (or norethindrone) (or 19-nor-17α-ethynyltestosterone is a molecule used in some Combined oral contraceptive pills and in some Progestogen only Norethynodrel was the Progestin used in Enovid, the first oral contraceptive. Norethandrolone is an Anabolic steroid.CAS# 52-78-8 ^[27]

Chemists Carl Djerassi, Luis Miramontes, and George Rosenkranz at Syntex in Mexico City had synthesized the first orally highly active progestin norethindrone in 1951. Carl Djerassi (born October 29, 1923 in Vienna, Austria) is a chemist, Novelist, and Playwright best known Luis Ernesto Miramontes Cárdenas ( March 16 1925, in Tepic, Nayarit &ndash September 13 2004, in Mexico City George Rosenkranz (born as György Rosenkranz, August 20, 1916, in Budapest) is a Mexican Ph Chemist Frank B. Colton at Searle in Skokie, Illinois had synthesized the orally highly active progestins norethynodrel (an isomer of norethindrone) in 1952 and norethandrolone in 1953. Frank Benjamin Colton ( March 3, 1923 &ndash November 25, 2003) American chemist who first synthesized Norethynodrel, the Skokie (formerly Niles Center is a Village in Cook County, Illinois, United States. ^[11]

In December 1954, Rock began the first studies of the ovulation-suppressing potential of 5 – 50 mg doses of the three oral progestins for three months (for 21 days per cycle — days 5 – 25 followed by pill-free days to produce withdrawal bleeding) in fifty of his infertility patients in Brookline, Massachusetts. Brookline is a town in Norfolk County, Massachusetts, United States, which borders on the cities of Boston and Newton. 5 mg doses of norethindrone or norethynodrel and all doses of norethandrolone suppressed ovulation but caused breakthrough bleeding, but 10 mg and higher doses of norethindrone or norethynodrel suppressed ovulation without breakthrough bleeding and led to a 14% pregnancy rate in the following five months. Pincus and Rock selected Searle's norethynodrel for the first contraceptive trials in women citing its total lack of androgenicity versus Syntex's norethindrone's very slight androgenicity in animal tests. ^[28][29]

Development of an effective combined oral contraceptive

Norethynodrel (and norethindrone) were subsequently discovered to be contaminated with a small percentage of the estrogen mestranol (an intermediate in their synthesis), with the norethynodrel in Rock's 1954-5 study containing 4-7% mestranol. Mestranol is the 3- Methyl Ether of Ethinylestradiol. It was the Estrogen used in many of the first oral contraceptives. When further purifying norethynodrel to contain less than 1% mestranol led to breakthrough bleeding, it was decided to intentionally incorporate 2. 2% mestranol, a percentage that was not associated with breakthrough bleeding, in the first contraceptive trials in women in 1956. The norethynodrel and mestranol combination was given the proprietary name Enovid. ^[29][30]

The first contraceptive trial of Enovid led by Edris Rice-Wray began in April 1956 in Río Piedras, Puerto Rico. Edris Rice-Wray Carson, MD attended Cornell University where she was a member of the Alpha Phi sorority Río Piedras is the largest district of the city of San Juan Puerto Rico. ^[31][32][33] A second contraceptive trial of Enovid (and norethindrone) led by Edward T. Tyler began in June 1956 in Los Angeles. Los Angeles (lɑˈsændʒələs los ˈaŋxeles in Spanish) is the largest City in the state of California and the American West ^[14][34] On January 23, 1957, Searle held a symposium reviewing gynecologic and contraceptive research on Enovid through 1956 and concluded Enovid's estrogen content could be reduced by 33% to lower the incidence of estrogenic gastrointestinal side effects without significantly increasing the incidence of breakthrough bleeding. ^[35]

Public availability

United States

On June 10, 1957, the FDA approved Enovid 10 mg (9. 85 mg norethynodrel and 150 µg mestranol) for menstrual disorders based on data from its use by more than 600 women. Numerous additional contraceptive trials showed Enovid at 10, 5, and 2. 5 mg doses to be highly effective. On July 23, 1959, Searle filed a supplemental application to add contraception as an approved indication for 10, 5 and 2. 5 mg doses of Enovid. The FDA refused to consider the application until Searle agreed to withdraw the lower dosage forms from the application. On May 9, 1960, the FDA announced it would approve Enovid 10 mg for contraceptive use, which it did on June 23, 1960, by which time Enovid 10 mg had been in general use for three years during which time, by conservative estimate, at least half a million women had used it. ^[18][31][36]

Although FDA-approved for contraceptive use, Searle never marketed Enovid 10 mg as a contraceptive. Eight months later, on February 15, 1961, the FDA approved Enovid 5 mg for contraceptive use. In July 1961, Searle finally began marketing Enovid 5 mg (5 mg norethynodrel and 75 µg mestranol) to physicians as a contraceptive. ^[18][19]

Although the FDA approved the first oral contraceptive in 1960, contraceptives were not available to married women in all states until Griswold v. Connecticut in 1965 and were not available to unmarried women in all states until Eisenstadt v. Baird in 1972. Griswold v Connecticut, 381 US 479 ( 1965) was a Landmark case in which the Supreme Court of the United States ruled that the Eisenstadt v Baird,, was an important United States Supreme Court case that established the right of unmarried people to possess contraception on the same basis ^[15][19]

The first published case report of a blood clot and pulmonary embolism in a woman using Enavid (Enovid 10 mg in the U. A thrombus, or blood clot, is the final product of the Blood coagulation step in Hemostasis. Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein S. ) at a dose of 20 mg/day did not appear until November 1961, four years after its approval, by which time it had been used by over one million women. ^[31][37][38] It would take almost a decade of epidemiological studies to conclusively establish an increased risk of venous thrombosis in oral contraceptive users and an increased risk of stroke and myocardial infarction in oral contraceptive users who smoke or have high blood pressure or other cardiovascular or cerebrovascular risk factors. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the A venous thrombosis is a Blood clot that forms within a Vein. A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated ^[18] These risks of oral contraceptives were dramatized in the 1969 book The Doctors' Case Against the Pill by feminist journalist Barbara Seaman who helped arrange the 1970 Nelson Pill Hearings called by Senator Gaylord Nelson. Barbara Seaman ( September 11 1935 &ndash February 27 2008) was an American author activist and journalist and a principal founder of In 1970 Barbara Seaman brought the dangers of Combined oral contraceptive pill use to the attention of Senator Gaylord Nelson with her book The Doctors Case Gaylord Anton Nelson ( June 4, 1916 July 3, 2005) was an American Democratic politician from Wisconsin. ^[39] The hearings were conducted by Senators who were all men and the witnesses in the first round of hearings were all men, leading Alice Wolfson and other feminists to protest the hearings and generate media attention. Alice Wolfson, a Barnard graduate and former Fulbright Scholar, is a veteran political activist in women's reproductive health issues a lawyer and a co-founder of ^[19] Their work led to mandating the inclusion of patient package inserts with oral contraceptives to explain their possible side effects and risks to help facilitate informed consent. A package insert or prescribing information (in Europe Patient Information Leaflet for human medicines or Package Leaflet for veterinary medicines is Informed consent is a legal condition whereby a person can be said to have given Consent based upon an appreciation and understanding of the facts implications ^[40][41][42] Today's standard dose oral contraceptives contain an estrogen dose that is one third lower than the first marketed oral contraceptive and contain lower doses of different, more potent progestins in a variety of formulations. ^[18][19][20]

Luis E. Miramontes signed laboratory notebook. October 15, 1951

Australia

The first oral contraceptive introduced outside the United States was Schering's Anovlar (norethindrone acetate 4 mg + ethinyl estradiol 50 µg) on January 1, 1961 in Australia. Schering AG was a research-centered German Pharmaceutical company. Norethindrone acetate is a Progestin used in Contraception. See also Norethindrone Ethinylestradiol, also ethinyl estradiol (EE is a Derivative of Estradiol. For a topic outline on this subject see List of basic Australia topics. ^[43]

Germany

The first oral contraceptive introduced in Europe was Schering's Anovlar on June 1, 1961 in West Germany. West Germany ( Inf German: Westdeutschland or West-Deutschland) was the common English name for the Federal Republic of Germany ( ^[43]

Britain

Before the mid-1960s, the U.K. did not require pre-marketing approval of drugs. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The British Family Planning Association (FPA) through its clinics was then the primary provider of family planning services in Britain and only provided contraceptives that were on its Approved List of Contraceptives (established in 1934). The Family Planning Association, also known as fpa, is a UK registered charity (number 250187 working to promote sexual health. In 1957, Searle began marketing Enavid (Enovid 10 mg in the U. S. ) for menstrual disorders. Also in 1957, the FPA established a Council for the Investigation of Fertility Control (CIFC) to test and monitor oral contraceptives which began animal testing of oral contraceptives and in 1960 and 1961 began three large clinical trials in Birmingham, Slough, and London. Birmingham ( ˈbɜːmɪŋəm Ber -ming-um Slough ( ˈslaʊ is a Borough and Unitary authority within the ceremonial county of Berkshire, England. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. ^[31][44]

In March 1960, the Birmingham FPA began trials of norethynodrel 2. 5 mg + mestranol 50 µg, but a high pregnancy rate initially occurred when the pills accidentally contained only 36 µg of mestranol--the trials were continued with norethynodrel 5 mg + mestranol 75 µg (Conovid in Britain, Enovid 5 mg in the U. S. ). ^[45] In August 1960, the Slough FPA began trials of norethynodrel 2. 5 mg + mestranol 100 µg (Conovid-E in Britain, Enovid-E in the U. S. ). ^[46] In May 1961, the London FPA began trials of Schering's Anovlar. ^[47]

In October 1961, at the recommendation of the Medical Advisory Council of its CIFC, the FPA added Searle's Conovid to its Approved List of Contraceptives. ^[48] On December 4, 1961, Enoch Powell, then Minister of Health, announced that the oral contraceptive pill Conovid could be prescribed through the NHS at a subsidized price of 2s per month. Brigadier John Enoch Powell, MBE ( June 16 1912 &ndash February 8 1998) was a British Politician, Secretary of State for Health is a UK cabinet position responsible for the Department of Health. The National Health Service is the name commonly used to refer to the four Publicly-funded healthcare systems of the United Kingdom collectively or individually (although The shilling is a unit of Currency used in current and former Commonwealth countries and was continued to be used in countries that left the commonwealth ^[49] In 1962, Schering's Anovlar and Searle's Conovid-E were added to the FPA's Approved List of Contraceptives. ^[31][46][47]

France

On December 28, 1967, the Neuwirth Law legalized contraception in France, including the pill. ^[50] The pill is the most popular form of contraception in France, especially among young women. The abortion rate has remained stable since the introduction of the pill. ^[51]

Japan

In Japan, lobbying from the Japan Medical Association prevented the Pill from being approved for nearly 40 years. For a topic outline on this subject see List of basic Japan topics. Two main objections raised by the association were safety concerns over long-term use of the Pill, and concerns that the Pill use would lead to diminished use of condoms and thereby potentially increase sexually transmitted infection (STI) rates. A sexually transmitted disease ( STD) or venereal disease ( VD) is an illness that has a significant probability of transmission between Humans ^[52] As of 2004, condoms accounted for 80% of birth control use in Japan, and this may explain Japan's comparably low rates of AIDS. ^[6]

The Pill was approved for use in September 1999; the Pill prescription guidelines the government endorsed require Pill users to visit a doctor every three months for pelvic examinations and undergo tests for sexually transmitted diseases and uterine cancer. Year 1999 ( MCMXCIX) was a Common year starting on Friday (link will display full 1999 Gregorian calendar) In the United States and Europe, in contrast, an annual or bi-annual clinic visit is standard for Pill users. ^[6]

Use and packaging

Half-used blister pack of Levlen®ED

Combined oral contraceptive pills should be taken at the same time each day. If one or more tablets are forgotten for more than 12 hours, contraceptive protection will be reduced. ^[53] Most brands of combined pills are packaged in one of two different packet sizes, with days marked off for a 28 day cycle. For the 21-pill packet, a pill is consumed daily for three weeks, followed by a week of no pills. For the 28-pill packet, 21 pills are taken, followed by week of placebo or sugar pills. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity A woman on the pill will have a withdrawal bleed sometime during the placebo week, and is still protected from pregnancy during this week.

Placebo pills

The purpose of the placebo pills is that the user can take a pill on every day of her menstrual cycle, remaining in this daily habit even during the week without hormones. Placebo pills may contain an iron supplement, as iron requirements increase during menstruation. Iron (ˈаɪɚn is a Chemical element with the symbol Fe (ferrum and Atomic number 26

Failure to take pills during the placebo week has no effect on the effectiveness of the pill provided that daily ingestion of active pills is resumed at the end of the week.

The presence of placebo pills is thought to be comforting, as menstruation is a physical confirmation of not being pregnant. The 28-day pill package also simulates the average menstrual cycle, though the hormonal events during a pill cycle are completely different from those of a normal ovulatory menstrual cycle, and the bleeding is triggered by different hormonal cues. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Breakthrough bleeding also becomes a more common side effect as a woman attempts to go longer periods of time between menstrual periods.

Less frequent placebos

Main article: Extended cycle combined oral contraceptive pill

If the pill formulation is monophasic, it is possible to skip menstruation and still remain protected against conception by skipping the placebo pills and starting directly with the next packet. Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. Breakthrough bleeding is Bleeding while taking the active pills of combined oral contraceptives, or other hormonal contraceptives It will not, however, increase the risk of getting pregnant.

Starting in 2003, women have also been able to use a three-month version of the Pill. ^[54] Similar to the effect of using a constant-dosage formulation and skipping the placebo weeks for three months, Seasonale gives the benefit of less frequent periods, at the potential drawback of breakthrough bleeding. Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen.

A version of the combined pill has also been packaged to completely eliminate placebo pills and withdrawal bleeds. Marketed as Anya or Lybrel, studies have shown that after seven months 71% of users no longer had any breakthrough bleeding, the most common side effect of going longer periods of time without breaks from active pills. ^[55]

Effectiveness

The effectiveness of COCPs, as of most forms of contraception, can be assessed two ways. Birth control, sometimes synonymous with contraception, is a regimen of one or more actions devices or Medications followed in order to deliberately prevent Perfect use or method effectiveness rates only include people who take the pills consistently and correctly. Actual use, or typical use effectiveness rates are of all COCP users, including those who take the pills incorrectly, inconsistently, or both. Rates are generally presented for the first year of use. ^[2] Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables. The Pearl Index, also called the Pearl rate, is the most common technique used in Clinical trials for reporting the effectiveness of a Birth control method Decrement tables, also called life table methods, are used to calculate the probability of certain events ^[56]

The typical use pregnancy rate among COCP users varies depending on the population being studied, ranging from 2-8% per year. The perfect use pregnancy rate of COCPs is 0. 3% per year. ^[2]

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the user
• conscious user non-compliance with instructions.

For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription.

COCPs provide effective contraception from the very first pill if started within five days of the beginning of the menstrual cycle (within five days of the first day of menstruation). The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. If started at any other time in the menstrual cycle, COCPs provide effective contraception only after 7 consecutive days use of active pills, so a backup method of contraception must be used until active pills have been taken for 7 consecutive days. COCPs should be taken at approximately the same time every day. ^[20][57]

Contraceptive efficacy may be impaired by: 1) missing more than one active pill in a packet, 2) delay in starting the next packet of active pills (i. e. extending the pill-free, inactive or placebo pill period beyond 7 days), 3) intestinal malabsorption of active pills due to vomiting or diarrhea, 4) drug interactions with active pills that decrease contraceptive estrogen or progestogen levels. In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea ^[20]

Mechanism of action

Combined oral contraceptive pills were developed to prevent ovulation by progestogenic and estrogenic suppression of gonadotropin release. Note This article deals primarily with Human ovulation nonhuman Animal ovulation is touched on briefly at the conclusion Gonadotropins are Protein Hormones secreted by Gonadotrope cells of the Pituitary gland of Vertebrates Gonadotropin is sometimes Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as their primary mechanism of action. The follicular phase (or proliferative phase) is the phase of the Estrous cycle, (or in humans and Great apes the Menstrual cycle) during ^{[2][20][58][59][60]}

Progestagen negative feedback decreases the pulse frequency of gonadotropin-releasing hormone (GnRH) release by the hypothalamus, which decreases the release of follicle-stimulating hormone (FSH) and greatly decreases the release of luteinizing hormone (LH) by the anterior pituitary. Negative Feedback feeds part of a System 's output inverted into the system's input generally with the result that fluctuations are attenuated Gonadotropin-releasing hormone ( GNRH) also known as Luteinizing-hormone releasing hormone ( LHRH) is a tropic Peptide Hormone The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis Follicle-stimulating hormone ( FSH) is a Hormone synthesized and secreted by Gonadotropes in the Anterior pituitary gland. Luteinizing hormone ( LH, also known as lutropin) is a Hormone produced by the Anterior pituitary gland. The anterior pituitary (also called the adenohypophysis, from Greek adeno, "gland" hypo, "under" physis, "growth" Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels. Estradiol (17β-estradiol (also oestradiol) is a Sex hormone. Progestagen negative feedback and the lack of estrogen positive feedback on LH release prevent a mid-cycle LH surge. Positive feedback, sometimes referred to as "cumulative causation" is a Feedback loop system in which the system responds to perturbation in the same direction The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Inhibition of follicular development and the absence of a LH surge prevent ovulation. ^[2][20][58]

Estrogen was originally included in oral contraceptives for better cycle control (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding), but was also found to inhibit follicular development and help prevent ovulation. Estrogen negative feedback on the anterior pituitary greatly decreases the release of FSH, which inhibits follicular development and helps prevent ovulation. ^[2][20][58]

A secondary mechanism of action of all progestagen-containing contraceptives is inhibition of sperm penetration through the cervix into the upper genital tract (uterus and fallopian tubes) by decreasing the amount of and increasing the viscosity of the cervical mucus. A spermatozoon or spermatozoan ( pl spermatozoa) from the Ancient Greek σπέρμα (seed and ζῷον (living being and more commonly known The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges ( singular salpinx) are two very fine tubes lined with ciliated Viscosity is a measure of the resistance of a Fluid which is being deformed by either Shear stress or Extensional stress. The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. ^[60]

Other secondary mechanisms have been hypothesized. One example is endometrial effects that prevent implantation of an embryo in the uterus. The endometrium is the inner membrane of the Mammalian Uterus. Pro-life groups consider such a mechanism to be abortifacient, and the existence of postfertilization mechanisms is a controversial topic. An abortifacient is a substance that induces Abortion. Abortifacients for Animals that have mated undesirably are known as Mismating shots Some scientists point out that the possibility of fertilization during COCP use is very small. From this, they conclude that endometrial changes are unlikely to play an important role, if any, in the observed effectiveness of COCPs. ^[60] Others make more complex arguments against the existence of these mechanisms ^[61], while yet other scientists argue the existing data supports such mechanisms. ^[62] The controversy is currently unresolved.

Drug interactions

Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or increased chance of pregnancy. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Breakthrough bleeding is Bleeding while taking the active pills of combined oral contraceptives, or other hormonal contraceptives These include drugs such as rifampicin, barbiturates, phenytoin and carbamazepine. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation Phenytoin sodium is a commonly used Antiepileptic. Phenytoin acts to dampen the unwanted runaway brain activity seen in seizure by reducing electrical conductance among brain Carbamazepine ("CBZ" is an Anticonvulsant and mood stabilizing drug used primarily in the treatment of Epilepsy and Bipolar disorder In addition cautions are given about broad spectrum antibiotics, such as ampicillin and doxycycline, which may cause problems "by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel" (BNF 2003). Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 Doxycycline ( INN) (ˌdɒksɪˈsaɪkliːn is a member of the Tetracycline antibiotics group and is commonly used to treat a variety of Infections Doxycycline The human flora is the Microrganisms that constantly inhabit the Human body. Ethinylestradiol, also ethinyl estradiol (EE is a Derivative of Estradiol. The British National Formulary (BNF contains a wide spectrum of information on prescribing and Pharmacology, among others indications Side effects and ^[63]

The traditional medicinal herb St John's Wort has also been implicated due to its upregulation of the P450 system in the liver. St John's wort (pronounced) used alone refers to the species Hypericum perforatum, also known as Tipton's Weed or Klamath weed, but with qualifiers is Cytochrome P450 (abbreviated CYP, P450, infrequently CYP450) is a very large and diverse superfamily of Hemoproteins found in all Domains The liver is a vital organ in the human body and is present in Vertebrates and some other animals

Side-effects

Different sources note different incidences of side effects. A University of New Mexico Student Health Center webpage says the majority (about 60%) of women report no side effects at all, and the vast majority of those who do, have only minor effects. The University of New Mexico ( UNM) is a Public University in Albuquerque, New Mexico. ^[64] A 1992 French review article said that as many as 50% of new first-time users discontinue the Pill before the end of the first year because of nuisance bleeding irregularity side effects such as breakthrough bleeding and amenorrhea. Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age ^[65]

Weight

The same 1992 French review article noted that in the subgroup of adolescents 15–19 years of age in the 1982 National Survey of Family Growth (NSFG) who had stopped taking the Pill, 20–25% reported they stopped taking the Pill because of either acne or weight gain, and another 25% stopped because of fear of cancer. National Center for Health Statistics ( NCHS) is part of the Centers for Disease Control and Prevention (CDC which is part of the United States Department of Acne vulgaris (commonly called acne) is a Skin disease caused by changes in the Pilosebaceous units (skin structures consisting of a Hair follicle ^[65] A 1986 Hungarian study comparing two high-dose estrogen (both 50 µg ethinyl estradiol) pills found that women using a lower-dose biphasic levonorgestrel formulation (50 µg levonorgestrel x 10 days + 125 µg levonorgestrel x 11 days) reported a significantly lower incidence of weight gain compared to women using a higher-dose monophasic levonorgestrel formulation (250 µg levonorgestrel x 21 days). ^[66]

Many clinicians consider the public perception of weight gain on the Pill to be inaccurate and dangerous. The aforementioned 1992 French review article noted that one unpublished 1989 study by Professor Elizabeth Connell at Emory University of 550 women found that 23% of the 6% of women who discontinued the Pill because of poor cycle control experienced subsequent unwanted pregnancies. Emory University is a Private university located in the metropolitan area of the city of Atlanta and in western unincorporated DeKalb County, ^[65] A 2000 British review article concluded there is no evidence that modern low-dose pills cause weight gain, but that fear of weight gain contributed to poor compliance in taking the Pill and subsequent unintended pregnancy, especially among adolescents. ^[67]

Sexuality

The Pill may have a positive effect on a woman's sexuality. Because neither the woman (who uses the Pill) nor her partner need take any special action before or during intercourse, it makes birth control "invisible" and sex spontaneous, more natural, or both.

However, some say the Pill can also have a negative effect on a woman's sexuality. Dr. John Bancroft (a senior research fellow at the Kinsey Institute at Indiana University) estimates that one in four women on the pill experience some negative sexual effect. These effects may include a decreased frequency of sexual thoughts, increased difficulty in becoming aroused, or decreased lubrication, which can make sex painful. Recent research co-authored by Dr. Irwin Goldstein (a urologist in Boston) suggests such effects may continue for up to four months after a woman stops taking the Pill. ^[68]

Depression

Low levels of serotonin, a neurotransmitter in the brain, have been linked to depression. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression High levels of estrogen, as in first-generation COCPs, and progestin, as in some progestin-only contraceptives, have been shown to promote the lowering of brain serotonin levels by increasing the concentration of a brain enzyme that reduces serotonin. ^[2] Progestin-only contraceptives are known to worsen the condition of women who are already depressed. ^[69]

Current medical reference textbooks on contraception^[20] and major organizations such as the American ACOG,^[70] the WHO,^[71] and the United Kingdom's RCOG^[72] agree that current evidence indicates low-dose oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women who are currently depressed. The American College of Obstetricians and Gynecologists ( ACOG) is a Professional association of Medical doctors specializing in Obstetrics and The Royal College of Obstetricians and Gynaecologists (RCOG is a professional association based in the UK. Contraceptive Technology states that low-dose COCPs have not been implicated in disruptions of serotonin or tryptophan. Tryptophan (abbreviated as Trp or W) is one of the 20 standard amino acids, as well as an Essential amino acid in the Human diet ^[2]

However, a recent study found that women taking the oral contraceptive pill are almost twice as likely to be depressed than those not on the Pill. Professor Jayashri Kulkarni from the School of Psychology, Psychiatry and Psychological Medicine at Monash University conducted a study with 62 women. In the study depression symptom scores between users and non-users of combined oral contraceptives were compared. Those that used the Pill had an average depression rating scale score that was 17. 6, compared with 9. 8 for the non-users. Women in the survey were aged over 18 years, were not pregnant or lactating, had no history of clinical depression and had not used anti-depressant medication for the previous 12 months. The relationship to depression and the Pill in the is study has been described as significant by the researcher. ^[73]

Other effects

Other possible side effects are: vaginal discharge, changes in menstrual flow, breakthrough bleeding, nausea, vomiting, headaches, changes in the breasts, changes in blood pressure, loss of scalp hair, skin problems and skin improvements. See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Breakthrough bleeding is Bleeding while taking the active pills of combined oral contraceptives, or other hormonal contraceptives Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Dermatology (from Greek grc δέρμα derma, "skin" and grc -λογία -logia) is a branch of Medicine dealing with The insert included with each pill packet usually has a more extensive list of recognized side effects.

Formulations

Main article: oral contraceptive formulations

Oral contraceptives come in a variety of formulations. Oral contraceptives come in a variety of formulations The main division is between Combined oral contraceptive pills containing both Estrogen and synthetic Progestogens The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, A progestin is a synthetic progestagen that has progestinic effects similar to Progesterone. Progestogen Only Pills or Progestin Only Pills ( POP) are Contraceptive Pills that only contain synthetic Progestogens ( Progestins Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestin changes from week to week.

Cautions and contraindications

Oral contraceptives may influence coagulation, increasing the risk of deep venous thrombosis (DVT) and pulmonary embolism, stroke and myocardial infarction (heart attack). Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Combined oral contraceptives are generally accepted to be contraindicated in women with pre-existing cardiovascular disease, in women who have a familial tendency to form blood clots (such as familial factor V Leiden), women with severe obesity and/or hypercholesterolaemia (high cholesterol level), and in smokers over age 35. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Factor V Leiden (sometimes Factor VLeiden) is the name given to a variant of human Factor V that causes a hypercoagulability disorder Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Hypercholesterolemia (literally high blood cholesterol is the presence of high levels of Cholesterol in the blood. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette.

Research into the relationship between breast cancer risk and hormonal contraception is complex and seemingly contradictory. Breast cancer is a Cancer that starts in the cells of the Breast in women and men Hormonal contraception refers to Birth control methods that act on the hormonal system ^[74] The large 1996 collaborative reanalysis of individual data on over 150,000 women in 54 studies of breast cancer found that: "The results provide strong evidence for two main conclusions. First, while women are taking combined oral contraceptives and in the 10 years after stopping there is a small increase in the relative risk of having breast cancer diagnosed. Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use. The cancers diagnosed in women who had used combined oral contraceptives were less advanced clinically than those diagnosed in women who had never used these contraceptives. "^[75] This data has been interpreted to suggest that oral contraceptives have little or no biological effect on breast cancer development, but that women who seek gynecologic care to obtain contraceptives have more early breast cancers detected through screening. ^[76][77]

It is generally accepted by medical authorities that the health risks of oral contraceptives are lower than those from pregnancy and birth,^[78] and "the health benefits of any method of contraception are far greater than any risks from the method". ^[79] Some organizations have argued that comparing a contraceptive method to no method (pregnancy) is not relevant - instead, the comparison of safety should be among available methods of contraception. ^[80]

Non-contraceptive uses

The hormones in "the Pill" can be used to treat some medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, anemia related to menstruation, and painful menstruation (dysmenorrhea). Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the Uterus) within the myometrium (the Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe Uterine Pain during Menstruation. In addition, oral contraceptives are often prescribed as medication for mild or moderate acne. ^[81] The pill can also induce menstruation on a regular schedule for women bothered by irregular menstrual cycles and certain disorders where there is dysfunctional uterine bleeding. Dysfunctional Uterine Bleeding (DUB is the most common cause of functional abnormal uterine bleeding which is abnormal genital tract bleeding based in the Uterus

Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to never users. Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Endometrial cancer refers to several types of malignancy which arise from the Endometrium, or lining of the Uterus. The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. The risk reduction for both ovarian and endometrial cancer persists for at least 20 years. ^[20]

Social and cultural impact

While the Pill was approved by the FDA in the early 1960s, its use was limited to married women. It was only in the early 1970s, when the "age of majority" legally changed from 21 to 18, that the Pill truly became widespread. As its use diffused to even those young and non-married women, it generated an enormous social impact. In the first place, it was far more effective than any previous method of birth control, giving women unprecedented control over their fertility. Its use was separate from intercourse, requiring no special preparations at the time of sexual activity that might interfere with spontaneity or sensation, and the choice to take the Pill was a private one. This combination of factors served to make the Pill immensely popular within a few years of its introduction. ^[12][19] Claudia Goldin, among others, argue that this new contraceptive technology was a key player in forming women's modern economic role, in that it prolonged the age at which women first married allowing them to invest in education and other forms of human capital as well as generally become more career-oriented.

Because the Pill was so effective, and soon so widespread, it also heightened the debate about the moral and health consequences of pre-marital sex and promiscuity. Fornication, or simple fornication is a term which refers to voluntary Sexual intercourse between persons not married to each other Never before had sexual activity been so divorced from reproduction. For a couple using the Pill, intercourse became purely an expression of love, or a means of physical pleasure, or both; but it was no longer a means of reproduction. While this was true of previous contraceptives, their relatively high failure rates and their less widespread use failed to emphasize this distinction as clearly as did the Pill. The spread of oral contraceptive use thus led many religious figures and institutions to debate the proper role of sexuality and its relationship to procreation. The Roman Catholic Church in particular, after studying the phenomenon of oral contraceptives, re-emphasized traditional Catholic teaching on birth control in the 1968 papal encyclical Humanae Vitae. Year 1968 ( MCMLXVIII) was a Leap year starting on Monday (link will display full calendar of the Gregorian calendar. Humanae Vitae ( Latin "Of Human Life" is an Encyclical written by Pope Paul VI and promulgated on July 25, 1968 The encyclical reiterated the traditional Catholic teaching that artificial contraception distorted the nature and purpose of sex. ^[82]

A backlash against oral contraceptives occurred in the early and mid-1970s, when reports and speculations appeared that linked the use of the Pill to breast cancer. Breast cancer is a Cancer that starts in the cells of the Breast in women and men Until then, many women in the feminist movement had hailed the Pill as an "equalizer" that had given them the same sexual freedom as men had traditionally enjoyed. Feminism is a discourse that involves various movements theories, and Philosophies which are concerned with the issue of Gender difference, advocate This new development, however, caused many of them to denounce oral contraceptives as a male invention designed to facilitate male sexual freedom with women at the cost of health risk to women. ^[83] At the same time, society was beginning to take note of the impact of the Pill on traditional gender roles. Women now did not have to choose between a relationship and a career; singer Loretta Lynn commented on this in her 1974 album with a song entitled "The Pill," which told the story of a married woman's use of the drug to liberate herself from her traditional role as wife and mother. Loretta Lynn (born Loretta Webb on April 14, 1934) is an American Country music Singer-songwriter; she was one of the leading " The Pill " is a 1975 Country music song written and recorded by Loretta Lynn.

Two Supreme Court cases, Griswold v. Connecticut in 1965 and Eisenstadt v. Baird in 1972, guaranteed access to the contraceptive pill for all. Griswold v Connecticut, 381 US 479 ( 1965) was a Landmark case in which the Supreme Court of the United States ruled that the Eisenstadt v Baird,, was an important United States Supreme Court case that established the right of unmarried people to possess contraception on the same basis ^[84]

Environmental impact

Human excretion in urine and feces of the natural estrogens estrone and estradiol and excretion of the synthetic estrogen ethinylestradiol by women using COCPs are likely to play a role in causing endocrine disruption in wild fish populations in some segments of streams contaminated by treated sewage effluents. Excretion is the process of eliminating waste products of Metabolism and other non-useful materials Human Feces (also faeces &mdash see spelling differences) also known as stools, is the waste product of the human digestive system and varies significantly Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Estrone (also oestrone) is an Estrogenic Hormone secreted by the Ovary. Estradiol (17β-estradiol (also oestradiol) is a Sex hormone. Ethinylestradiol, also ethinyl estradiol (EE is a Derivative of Estradiol. Endocrine disruptors (sometimes also referred to as hormonally active agents) are Exogenous substances that act like Hormones in the Endocrine system Fish are aquatic Vertebrate animals that are typically ectothermic (previously Cold-blooded) covered with scales, and equipped with two A stream is a body of Water with a current, confined within a bed and stream-banks Sewage treatment, or domestic wastewater treatment, is the process of removing Contaminants from Wastewater, both Runoff ( Effluents Effluent is an outflowing of water from a natural body of water or from a man-made structure ^[85][86] A review of activated sludge plant performance found estrogen removal rates varied considerably but averaged 78% for estrone, 91% for estradiol, and 76% for ethinylestradiol (estriol effluent concentrations are between those of estrone and estradiol, but estriol is a much less potent endocrine disruptor to fish). Activated sludge is a process dealing with the treatment of Sewage and industrial wastewaters. Estriol (also oestriol) is one of the three main Estrogens produced by the human body ^[87] Effluent concentrations of ethinylestradiol are lower than estradiol which are lower than estrone, but ethinylestradiol is more potent than estradiol which is more potent than estrone in the induction of intersex fish and synthesis of vitellogenin in male fish. Vitellogenin (VTG or less popularly known as VG (from Latin vitellus = yolk and gener = to produce is a synonymous term for the gene and the expressed Protein. ^[88]

Footnotes

External links

• The Birth Control Pill CBC Digital Archives
• The Pill. American Experience. Public Broadcasting Service. The Public Broadcasting Service ( PBS) is a Non-profit Public broadcasting Television service with 354 member TV stations in the Retrieved on 2006-08-14. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 1183 - Taira no Munemori and the Taira clan take the young Emperor Antoku and the three sacred treasures
• FDA Approves first contraceptive pill. On This Day, May 9. findingDulcinea. Retrieved on 2008-06-12. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1381 - Peasants' Revolt: in England, rebels arrive at Blackheath.

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