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UPPER DIVISION COLLEGE Voi. 2 November 25, 1974 There Has To Be A Morning After By GEORGE L. WALTERS Birth control is as old as mankind. In the unending quest for some individuals to populate this “ tired old earth” , there have been other in dividuals interested in preventing this natural oc currence. Aristotle was the first Greek to mention con traception. He suggested in fusion of the vagina with oil of cedar or frankincense com mingled with olive oil. While the Japanese men of olden times were using condoms made of hard leather, shell, and horn. Up until the early 1960’s birth control remained in the dark ages. Birth control was more in the hands of soothsayers than that of science. - A step up from the depths of ignorance is a device called a diaphragm. A diaphragm is a thin, saucer shaped, rubber cap which fits over the cervix closing off the uterus from the vagina. A patient must be measured and fitted for one by her physician. The diaphragm is used with vaginal creams or jellies so that it blocks sperm both physically and chemically. The diaphragm can be inserted up to three hours ahead of expected use. Six hours must elapse after intercourse before the diaphragm can be removed. Proponents of this method state that the diaphragm is extraordinarily effective if used correctly. A device that revolutionized birth control during the 1960’s is known as the IUD (in trauterine device). The principle of intrauterine contraception is old. In the Middle East, nomads used to place stones in the uteruses of female camels to prevent pregnancy on long desert treks. Insertion of objects into the uterus was tried in the nineteenth and early twentieth centuries for human con traception but then abandoned because infection and pelvic inflammation were frequent results. The original modern device had a twenty per cent failure rate. IUD’s with chemical adjuncts have proved more effective. These newer IUD’s are made of inert plastics or metals and come in a variety of shapes and names, such as: Copper-T, Saf- T-Coil, Daikon Shield, and Lippes Loop. Just how the IUD’s work is not known. One theory proposes that the IUD’s produce a mild inflammatory reaction that kills sperm or prevents implantation of the fertilized egg. Some 75 devices are on the market or under development, and are used by some three million women. Federal regulation is lacking for IUD’s. The Food and Drug Administration can ban a device if they later find a device that is hazardous to health. Oral contraceptives must be approved by the F.D.A. Most IUD’s are con sidered devices rather than drugs. Some hazards reported by gynecologists are per foration of the uterus, pelvic infection, spontaneous ex pulsion, and excessive men strual bleeding. Perforation occurs in about four per ten thousand IUD insertions. Serious infections are “ very rare” and have decreased since the introduction of sterile packaging for the devices. The risk of death with the IUD is less than 2 per 100,000 as compared with nearly three for oral contraceptives. The average preganancy rate among IUD users is 3 per cent, as compared with .1 per cent for those on oral con traceptives. Failures were most frequent among younger women and decreased sharply with age. About half of pregnancies occurring with the IUD in place result in spon taneous abortion, and most of the rest proceed uneventfully to term. The F.D.A. has banned use of the “ Majzlin Spring” , a device that had been distributed to some 100,000 women since 1968. The banning was prompted by reports that it caused intense pain and perforation through excessive pressure on the uterine wall, in some cases necessitating hysterectomies. The F.D.A. has already classified the “ Copper-T” as a drug on the grounds that the metal itself is an active ingredient in its contraceptive properties. An advantage to the IUD is that the body’s natural hor mone balance is not affected. While still safer than oral contraceptives, IUD’s pose potentially serious hazards of their own. Side effects such as cramping and excessive or irregular bleeding have been reported. They are also not well tolerated by women who had never had a baby. Also, one-third of all women that try the IUD form of contraception cannot retain it. Larger IUD’s provide a better protection against pregnancy and tend to be better retained by the uterus than the small ones. Small devices, on the other hand produce less cramping and bleeding. It has been found that the “ Copper-T” produces less cramping and bleeding, par- ticulary in women who have not borne children. The form of contraception that has received more publicity than any other is the oral contraceptive, otherwise known as the “ pill” . The pill, which is used by over 8 million women, was introduced in the early 1960’s. Oral con traceptives, when used properly, produce virtually 100 per cent inhibition of female fertility. There are basically two different types of pills. The first type contains hormones called estrogen and progestogen. These hormones act primarily by inhibiting the monthly release of the egg from the ovary. The second type, the “ mini-pill” , contains only a progestogen roughly one-third or less that of the first type. This low concentration of progestogen apparently prevents the sperm from reaching the oviducts, where fertilization occurs, by m aintaining the mucus 4lt the opening to the uterus in a condition that hinders sperm migration. But risk of pregnancy when using the mini-pill is almost three per cent higher than that of the pill containing both estrogen and progestogen. The sequential type pill contains estrogen in the first 15 or 16 pills and both estrogen and progesterone in the last five. Most pills are taken once a day for 20 or 21 days. Sometime during die next 3 to 7 days menstruation occurs. One very positive advantage to the low and no estrogen preparations are that they allow women to take oral contraceptives who previously have not been able to do so because the higher estrogen doses produced such side ef fects as weight gain and swelling. In some women soreness of the breasts occurs. However, when estrogen dosage is decreased, some women increase their chance of pregnancy, and some menstrual irregularity has been reported. Other discomforts range from merely uncomfortable nausea, excess water reten tion, fatigue, vomiting, headaches, spotty darkening of the skin usually on the face, b r e a k t h r o u g h v a g in a l bleeding, loss of hair from your head, more body hair, increase or decrease in sexual appetite. More potentially dangerous is a high incidence of abnormal blood clots in the veins that can lodge in the lungs with deadly results. This is known as a thrombotic stroke. In a study reported by the New England Journal of Medicine the risk of suffering a thrombotic stroke turned out to be nine times greater among pill users. It had also shown that a high proportion of the stroke vic tims were, or had been, cigarette smokers, suggesting that smoking adds to the pills deleterious effects on clotting mechanisms. Another type of stroke is the hemorrhagic stroke. The same study showed that the risk of suffering a hemorrhagic stroke turned out to be double among pill users. A hemorrhagic stroke is a rupture of a cerebral blood vessel. The reason suggested that might explain the increase is that the estrogen in oral contraceptives may increase the blood pressure in some women. If you want to stop, and become pregnant, your doctor will take you off the pill several months ahead of the planned launching. With some women it may take up to a year. You may ask; how long can you take the pill? No one really knows because the pill hasn’t been around long enough. Most doctors agree that when a woman is 45 it is time to switch to another form of con traception. Your fertility is lower by then and you' don’t have to kill a fly with a sledge hammer. A new type of pill that has given rise to interest recently is the “ morning after pill” . The morning after pill uses a controversial synthetic estrogen, diethylstilbestrol (DES). DES has been 95 per cent effective, it has also been linked with the occurrence of a rare type of vaginal cancer in the daughters of women who took the drug during pregnancy to prevent miscarriages. The F.D.A. has approved its use only in emergencies. The F.D.A. has classified rape and incest as the only emergency situations. Also, a possible prior pregnancy must be ruled out by a pregnancy test. If then, the drug is used it must be used within 72 hours (preferably 24 hours) of exposure, and then taken for five days. If your family has a history of breast or genital cancer, exposure to DES would increase an already indicated risk; and that in dividual should not take the drug. The F.D.A. also said abortion should be seriously considered if pregnancy does occur after taking the pill. more
