Rx-the Pill

H.2010.05.04 - the Pill

The other side of the Pill
By Eveline Gan, TODAY | Posted: 04 May 2010 0811 hrs
SINGAPORE : Most people slap on pimple cream or wash their faces with special soaps to manage their acne problems.

But 27-year-old Val D, who is prone to regular acne outbreaks, does none of those things. Instead, she pops a contraceptive pill.

"I've been taking the Pill intermittently for my skin problems for the past five years. It's definitely not for birth control. I find that it improves my bad skin," said the regional product manager, who is currently single.

While you may find it strange, women's health experts TODAY spoke to said besides its birth control purpose, the modern Pill is also "an all-in-one package of health benefits". Its anti-acne benefit is one of them.

Professor P C Wong, head and senior consultant at the National University Hospital's division of reproductive endocrinology and infertility, department of obstetrics and gynaecology, noted that although it has been around for the past 50 years, that there is still a huge wall of resistance to taking the Pill. He said that it was largely due to misconceptions and a lack of awareness about the non-contraceptive benefit of the Pill.

A public forum, where experts will dispel myths surrounding the Pill, will be held on June 19 at National Library Board. (Visit nuh.com.sg for details.)

Said Prof Wong: "When the first Pill was introduced in Singapore in the 1960s as part of the Family Planning Programme, women welcomed it as a less invasive alternative to the Intrauterine Device (a small device that is inserted through the cervix and placed in the uterus to prevent pregnancy). However, due to the high dosage of ethinyl estradiol in the early pills, there soon emerged many reports of unpleasant side effects such as headaches and vomiting.

"The women's fears were passed down to the younger generation. The aim of our public education outreach is to debunk the myths associated with the Pill."

According to Prof Wong, the Pill usually contains two hormones - oestrogen and progestyerone - which act by preventing ovulation.

In the 1960s, the first oral contraceptives available on the market contained about 50mcg of ethinyl estradiol, a synthetic form of oestrogen. Besides the unpleasant side effects mentioned by Prof Wong, high doses of ethinyl estradiol can also result in weight gain and irregular bleeding.

Fewer side effects, more benefits

These days, the Pill contains a lower-dosage of ethinyl estradiol and this means that women who take them not only grapple with fewer side effects, but may enjoy other non-contraceptive advantages as well, said Prof Wong.

Several studies have found that the Pill may potentially protect against several women-related cancers. Research findings by Oxford University epidemiologists, published in 2008, concluded that using contraceptive pills substantially reduces a woman's risk of ovarian cancer by 20 per cent for every five years that she has been on the Pill. Those who take it for 15 years cut their risk by half.

According to Dr Anupriya Agarwal, an associate consultant at NUH's department of obstetrics and gynaecology, the Pill may help those who are suffering from menstrual woes.

Dr Anupriya was the principal investigator in a local study on menstrual disorders, published last December in the Journal of Paediatric and Adolescent Gynaecology.

The study of more than 5,500 adolescent girls found that menstrual problems such as bloatedness, and irregular or painful menses were common. More than 23 per cent and a whopping 83 per cent of participants reported regular and painful menstruation, respectively. About a quarter reported that they have been absent from school because of their menstrual problems.

Dr Anupriya said menstrual problems occur because "hormonal imbalances which can be due to various reasons such as being over- or underweight or stress". She said oestrogen and progesterone in the Pill can help balance hormones which cause these problems.

However, not everyone shares the same mindset.

Not for everyone?

Dr Wong Wei Mon, a physician leader of Raffles Medical Group, said with the exception of acne that flares up during the woman's menses, he would not consider the use of the Pill as the first line of treatment for non-contraceptive problems.

"Oral contraceptives may not be the right choice for everyone. Artificially tweaking the hormones can result in hormonal imbalance and other problems. There is controversy among some health care professionals about using synthetic hormones for these purposes when other treatment options exist, especially if the use of the pill is for 'lifestyle' reasons," said Dr Wong.

He said that menstrual problems such as bloating and water retention may be a sign of "oestrogen dominance" - when the woman has excess oestrogen relative to progesterone levels.

Dr Wong explained that in some cases, oestrogen dominance can be caused by one's lifestyle.

What many people don't know is that certain chemicals, foods and plants can mimic the action of oestrogen and alter the body's hormonal activity, he said.

"We are constantly assaulted by estrogens in our environment from the food we eat and the chemicals we use. These compounds are generally weak estrogens, but in a body that is already experiencing an estrogen imbalance, adding more will contribute to the problem," said Dr Wong.

Oestrogen mimickers can be found in canned foods, styrofoam cups, plastics, pesticides, paints, and even foods such as soy and flaxseeds.

Dr Wong's advice to patients is to discuss your medical history with your doctor if you're thinking of going on the Pill for reproductive health problems.

"It is best to have the hormonal profile ascertained before using the pill. And instead of using hormones with a "one size fits all" mentality, a personally "tailored" dose, with certain lifestyle modification, may be a better choice," he said.

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