«Mum, I want the pill»
Linda has been taking the pill since she was 16 and has had a steady boyfriend. Getting pregnant is out of the question for the high school student at the moment. The 17-year-old also suffers from severe abdominal pain during her period. She could easily do without her monthly periods. A new pill could now help the schoolgirl. Since this year, a pill with a long cycle has been available in Switzerland for the first time, which is taken without interruption and only leads to four periods per year. The question is how suitable this pill is for young women. Gabriele Merki is head of the contraception clinic at the gynaecological clinic at Zurich University Hospital. In a study conducted by the doctor in 2014, 57 per cent of girls aged between 15 and 19 stated that they found their periods difficult. Around 80 per cent of the girls surveyed would prefer their periods to be less than monthly or not at all.
Menstruation yesterday and today
Is there even a need for monthly hormone withdrawal or cancellation bleeding, as is the case with conventional pills? Sibil Tschudin, Head Physician at the Women's Clinic of the University Hospital Basel, explains: «From a medical point of view, regular bleeding when taking the pill is not necessary for your health.» Today, women have the choice of reducing the number of their periods with a patch or hormone ring in addition to the pill.
«From a medical point of view, regular bleeding is not necessary.»
Frequent bleeding is a phenomenon of modern times. Around 100 years ago, women only had an average of around 160 periods in the course of their lives, firstly because they got their periods later, secondly because they became pregnant 10 to 15 times, gave birth to 10 children and breastfed the 7 or 8 survivors for around two years. In other words, menstruation used to be prevented for a long time by numerous pregnancies and long periods of breastfeeding. Today, women menstruate an average of 450 times in their lifetime because they only give birth to 1 or 2 children and half of mothers stop breastfeeding after just 3 months.
Young women rely on the pill
According to the latest health survey conducted by the Federal Statistical Office in 2012, young women between the ages of 15 and 24 are the most likely to use the pill for contraception. In this age group, around 64 per cent of women rely on reliable protection. Three quarters of the girls in Linda's class also take the pill. Most of them expect other benefits in addition to contraceptive protection. Sarah, 16, appreciates the fact that she gets her period regularly and has a lighter period thanks to the pill. Pia, 16, takes the pill because she has suffered from severe acne since the beginning of puberty. «My skin has improved significantly since I started taking the pill,» she says. Sibil Tschudin from the University Hospital Basel knows: «These positive side effects are not equally noticeable in all adolescents. The pill is not a miracle cure, and girls need to be aware that it is a medication.»
Pills with low risk
Young women are not allowed to be prescribed the pill without their parents' consent before the age of 14. Gabriele Merki explains: «We only prescribe the pill to a fourteen-year-old girl who comes to the consultation alone and wants to use contraception if she is mature enough to make such a decision.» A detailed consultation is extremely important for every first prescription (see box at the end of the article). Since the introduction of the first contraceptive pill in the 1960s, countless products have come onto the market. But which pills are suitable for girls who want to use contraception for the first time? «I most often prescribe second-generation products to young women, as they have the best risk-benefit profile,» explains Gabriele Merki. These combination preparations, which contain the progestogen levonorgestrel and the oestrogen ethinylestradiol, have the lowest risk of thrombosis.
Complications are rare, side effects such as depressive moods are possible.
Expressed in figures, this means that While two to three healthy women in every 10,000 who do not take the pill will develop a thrombosis, with second-generation combined oral contraceptive pills it is four to six women during a year of use. The risk is influenced in particular by family history, but also by obesity, smoking and age. With third and fourth generation pills, the risk is six to ten in 10,000. Even though the pill is well tolerated by the vast majority of women and complications such as thrombosis rarely occur, side effects are possible, for example depressive moods, weight gain and loss of libido. Undesirable effects usually become noticeable in the three months after taking the pill for the first time. Gabriele Merki therefore recommends arranging an initial check-up after this time. If side effects occur, it may be advisable to switch to a different preparation.
New pill prolongs cycle
But how suitable is the new pill for teenagers? In terms of composition, it is no different from the conventional second-generation pills. The pill was launched in the USA in 2006 and has been available in Austria for two years; it has been authorised by Swissmedic for both young girls and women. Experts do not see any disadvantages compared to conventional second-generation preparations. The fact that there is no break between pills due to continuous use reduces the risk of a woman starting the next pack late and thus of an unwanted pregnancy. In addition, the bleeding time is reduced to around three days, which many users are also likely to be pleased about. On the other hand, a long-term pill could make it more difficult to get used to the natural monthly menstruation after stopping the pill. If a daughter wants to take the pill, some parents worry whether this will affect her fertility in the long term. Sibil Tschudin: «Reproductive capacity is not affected by taking the pill, even if it is taken in a long cycle.» After stopping the combined pill, regardless of whether it was taken in a monthly or long cycle, the cycle usually resumes immediately.
Photo: iStock
Signs of complications
The Swiss Society of Gynaecology and Obstetrics has compiled a checklist to help recognise signs of complications at an early stage. A woman should contact her gynaecologist if:
- sie unter Pilleneinnahme erstmalig Migräne hat, diese stärker auftritt oder sie häufig an ungewohnt starken Kopfschmerzen leidet;
- sie plötzliche Seh-, Hör- oder sonstige Wahrnehmungsstörungen hat;
- sie erste Anzeichen thrombo-embolischer Erscheinungen hat, insbesondere Atemnot, unklare Thoraxschmerzen oder Husten unklarer Ursache;
- sie unklare Schmerzen in einer Extremität und/oder Schwellung eines Beines hat, vor allem nach Flug- und Busreisen;
- sie sich einer geplanten Operation unterziehen muss (mindestens vier Wochen im Voraus) oder sich nach einem Unfall oder einer Operation kaum bewegen kann – falls dies nicht möglich ist, ist eine gezielte Thromboseprophylaxe notwendig;
- ihr Blutdruck plötzlich erhöht ist (bei wiederholter Messung);
- Verdacht auf Herzinfarkt oder koronare Herzkrankheit besteht;
- Verdacht auf Schlaganfall besteht;
- sie an Gelbsucht, Hepatitis oder Juckreiz am ganzen Körper leidet;
- starke Oberbauchschmerzen oder Lebervergrösserung auftreten;
- sie schwanger ist oder Verdacht auf Schwangerschaft besteht.
What the gynaecologist should ask your daughter
- Do you feel ready for sexual intercourse or does the desire come from your boyfriend? How old is your boyfriend?
- Are you aware that the pill reliably protects against pregnancy when taken correctly, but not against STIs? Only the condom protects against sexually transmitted diseases.
- Did you know that the pill is well tolerated by most women, but that complications and side effects can also occur?
- On the risk of thrombosis:
- Has anyone in your family ever suffered a thrombosis, pulmonary embolism, heart attack or stroke?
- Do you smoke?
- Do you or anyone in your family suffer from high blood pressure, diabetes, a lipometabolic disorder, blood disorders, liver disease, oestrogen-dependent carcinoma?
- Do you suffer from neurological diseases, epilepsy or migraines?
- Do you know that being overweight increases the risk of thrombosis?
- What do you need to know if you forget to take the pill, take it too late or have diarrhoea? If you have had sexual intercourse despite forgetting to take the pill, the morning-after pill can protect you from pregnancy.
Taking the pill
The maturation of the follicle and ovulation are only reliably prevented if the pill is taken regularly. Some people use an app to help them remember to take the pill (e.g. Lady Pill Reminder, myPill Reminder). With the second-generation combined pill, contraception is guaranteed for a maximum of 12 hours if you take it late. After that, there is no more reliable protection. With monthly cycle pills, there is a break of 7 or 4 days after taking the pill for 21 or 24 days respectively. With the long-cycle pill, the pill is taken without a break for 91 days. 84 tablets contain the progestogen-oestrogen combination, the last 7 tablets contain a low dose of oestrogen. There is no pill break after the end of the pack.
