Misplaced Pages

This discussion seems to have reviewed the literature fairly thoroughly, and refers specifically to all the studies Jdbrown added as a references in support of extrauterine vs. intrauterine pregnancies being caused directly by combined oral contraceptives. It comments that "The letter by Job-Spira et al seems to represent the same data set of 279 cases and controls as the study by Coste et al." The meta-analysis by Mol apparently includes that study. So just one study is effectively being refered to three times; though the meta-analysis does include other studes which apparently (per edits by Davidruben) contradict the assertation of increased extrauterine pregnancy. The Polycarp Research Institute paper also discounts the WHO study as including women taking progesterine-only pills, which are commonly accepted as directly increasing the risk of extrauterine vs. intrauterine pregnancies. (In addition to that assumption in the Polycarp paper, a Google search for extrauterine pregnancy pill come up mostly with references to the mini-pill.)

While I unfortunately do not have access to the full text of these studies, I question how well STDs were controlled for. With study titles such as "Risk of chlamydial PID and oral contraceptives," STDs were obviously a factor in the ectopic pregnancies. Because women who choose to take COCs are more likely to engage in behavoir that puts them at risk of STDs, that population is going to have a higher ectopic pregnancy rate than the population of women who choose other forms of birth control. Not because of the hormones they are taking, but because of their behavoir.

The increased rate of ectopic pregnancy in COC users would seem to have an explanation in their increased STD rate, not in a postfertilization effect of the COCs. I would be very interested if someone with access to the studies explained how this confounding factor was taken into account when calculating the increased risk of extrauterine pregnancy due directly to COC use.Lyrl 22:19, 19 May 2006 (UTC)

OT question by younger user

--71.230.248.74 00:43, 31 May 2006 (UTC)OK, so my mom seems to think that taking this thing would be dangerous give me migranes, etc. There is the age factor (i'm 14) but still according to there commercial it reduces the amount of periods by 8 each year. Can someone get some statistics on the side effects maybe related to age that i could show her, or a list of all the pros and cons as stated by each side? Like a sort of summay of the article? Also, i seem to be getting the impresson that maybe she had a bad experience, so does genetcs contribtute to occurence of side effects? (sorry my keyboard is sticking today)--71.230.248.74 00:43, 31 May 2006 (UTC)

You're right that this is the wrong place, but you might want to look at the Planned Parenthood web site. It's generally a good source of reliable, objective medical information on contraception. Al 00:44, 31 May 2006 (UTC)

While we're talking about side effects, do we know why they occur? Some of them are similar to the symptoms of pregnancy and I was told by my mother (not a verifiable source by a long shot) that it was because the hormone increase was similiar that of pregnancy on a lesser scale (this was in a discussion about nausea, I've been rather ill riding in cars since I started a few days ago). Info like that could be helpful as many teens are coming here before PP for information... Kuronue 00:55, 3 June 2006 (UTC)

Estrogen and progesterone are both high during the luteal phase (time between ovulation and menstruation). They remain high during pregnancy. Many "pregnancy" symptoms are identical to PMS symptoms, and are caused by the high levels of estrogen and/or progesterone that occur both during the luteal phase and during pregnancy, rather than from any direct action of the embryo or fetus. As hormonal contraception consists of estrogen and progesterone, it is not surprising that it causes various PMS-like or pregnancy-like symptoms. I believe all women will have side effects from hormonal contraception; the type and severity of the effects varies widely between brands and between women. A few side effects, such as breast tenderness and nausea, tend to go away by the third month on the pill. As this information is all anecdotal from my experience and reading, I'm not sure it could be incorporated into the Wiki article - that generally requires sources. Lyrl 03:36, 3 June 2006 (UTC)

Most women don't get morning sickness or nausea during their periods; the first month or so on The Pill and the duration of pregnancy obviously cause nausea (I'm told it goes away wwhen you get used to The Pill). What I was asking was does anyone have a good source we can add to the encyclopedia from, since people like me might look for this kind of info and not check the antecdotal evidence on the talk page Kuronue 03:53, 3 June 2006 (UTC)

Oral contraceptive vs. Hormonal contraception

Hormonal contraception is currently a stub. But it seems like it should be a higher-level article than this one, since it encompasses all the delivery mechanisms of combined or progesterone-only contraception. And that this article should focus on the unique aspects of taking the hormones orally (such as "use" and "packaging") rather than on the actions of the hormones themselves. Would moving some of the sub-topics of this article (such as "principles," "mechanism of action," "effectiveness," "drug interactions," etc. to the hormonal contraception article? Lyrl 16:17, 10 June 2006 (UTC)

I agree. Fundamentally, whether you take it as a pill or through a patch or a ring, the key is that it's hormonal, so that should be the main article. At that point, oral contraceptive should either redirect to hormononal contraception, unles there is sufficient material to justify its existence. Al 23:55, 10 June 2006 (UTC)

• Disagree (but with sympathy, and agreeing some changes to some of the articles is needed) - I agree as a discussion of categorisation this is correct, but:
• Remember hormonal also includes injected progesterone (Depo Provera), and the coated 'coil' of IntraUterine System
• I fear we risk fragmenting into too many pages. We already have as the top level, Birth control, which sets out the classification scheme and effectively bypass Hormonal contraception entirely (calling it 'Chemical methods')
  • Perhaps that 'Chemical methods' header needs to be reworded to Hormonal contraception
  • If Hormonal contraception is to discuss most of the effects of oestrogens & progesterones, it will be significantly larger than current Oral Contraceptive, as Progesterone only pill would also get included, along with Depo Provera, IUS and the various progesterone-implants.
  • Personally I would leave Hormonal contraception as a short descriptive/comparative piece with the greater details in the specific articles, or possibly just having a brief outline of the two groups of hormones and transfer this articles main history section there.
  • Oral contraceptive is current written mostly about the combined oestrogen & progesterone pill history, controversy, effects & side-effects (progesterone-only pills covers these topics it its own article). I would change this article to a redirection page to Combined Oral Contraceptive Pill and Progesterone Only Pill
  • Discussion of the risks of oestrogens (e.g. DVTs) really has no place in the main Hormonal contraception article in any great depth, as it is better suited to this article in discussing differences in risks of 2nd & 3rd generation COCP.
• When it comes to how the reader might wish to browse & read through the various pages, having every possible level of the contraceptive classification with its own page will be a poorer experience. All my patients consider the options (amongst others) as 'the pill' (which includes both COCP & POP), 'the injection' and 'the coil' (meaning IUD & IUS). 'Hormonal contraception' whilst a technically correct term and one us contributing editors are familiar with, is not a phrase used by the general reader. Instead they will look for 'birth control' (or 'contraception') and then expect to jump to specific methods ('Hormonal', I guess, means little to the wider readership).

David Ruben 00:41, 11 June 2006 (UTC)

Good point about hormonal contraception being so broad. That might actually need to be a disambiguation page instead of its own article. Maybe instead of hormonal contraception as a top-level article, there could be an article on Combined estrogen and progesterone contraceptive. Hmm. That's very ackward sounding. But it sure would be nice to combine the pill, patch, and NuvaRing pages somehow. And more fully seperate the combined pill page from the mini-pill page. Lyrl 17:26, 11 June 2006 (UTC)

Indeed these were my intensions (PS in UK, doctors do talk about COCP & POP or their expanded equivalents). Given that the Oral contraceptive would become the place readers might search out, it would then disambig to specific pages for COCP & POP, I think these should have the proper technical names (POP already exists of course, COCP currently redirects here). So:

• Birth control (Contraception redirects there) currently sets out the classification scheme
• Hormonal contraception acts as a brief overview of oestrogens & progesterones, and disambigs to the various delivery articles.
• Oral contraceptive (this page) becomes a similar (but even briefer) outline paragraph of use oestrogens and progesterones and is then mostly then to act as a disambig to:
• Combined Oral Contraceptive Pill (which currently redirects here) instead becomes most of the current Oral contraceptive article.
• Progesterone Only Pill (already exists) stays as it is with any relevant progesterone-only pill stuff transfered out of the current Oral contraceptive article as it is moved to the Combined Oral Contraceptive Pill page.
• Depo Provera, intraUterine System, Norplant etc already exist and essentially remain as they are.

I've just created Template:BirthControl, let me know what you think and then I shall add it to the various articles. David Ruben 22:31, 11 June 2006 (UTC)

That all sounds good. On the template, coitus interruptus is considered a form of masturbation by the Catholic Church, and is not part of NFP. Everything else I really like. Lyrl 00:09, 12 June 2006 (UTC)

Ah... Need alternative heading then in the templates 1st line, How about 'Natural' (meaning as opposed to products or medical). 'Self-administered' or 'User' seem awkward. 'Non-medical' might then imply Condoms are medical, which clearly they are not. David Ruben 01:50, 12 June 2006 (UTC)

I've copied last 2 postings across to Template talk:BirthControl, where perhaps more relevant to discuss further :-) David Ruben 02:05, 12 June 2006 (UTC)

Beginning of pregnancy controversy - implantation vs. fertilization, in vitro

The medical consensus is that pregnancy starts with implantation, not fertilization. This definition of pregnancy did not start until the advent of in vitro fertilization — having eggs fertilized in a laboratory is not generally accepted to make a woman pregnant. Many sources do still define pregnancy as beginning with fertilization. Therefore, the determination of whether oral contraceptives are abortificants depends largely on a person's individual definition of pregnancy.

This paragraph probably needs to be rewritten. For starters, the beginning of pregnancy controversy mentions in vitro fertilisation but doesn't say it was the cause of pregnancy being defined as beginning at implantation. It doesn't discuss when and why there was a change, if there was a change (and it wasn't just a pre-existing but probably largely ignored difference in terminology). Secondly the 'many sources' part is a bit of a weasel word IMHO in this context. How many is many? It would be better to say some medical sources or something of that sort maybe. Finally, the bit about "determination of oral... depends..... person's invididual...." is a bit confusing. This article already establishs that no one really know whether oral contraceptives do interfer in implantation. If they don't personal believes on the beginning of pregnancy is irrelevant to the issue at hand. Nil Einne 12:42, 17 June 2006 (UTC)

Well I decided just to be bold. My new paragraph is as below

The medical consensus is that pregnancy starts with implantation, not fertilization. However some medical sources do still define pregnancy as beginning with fertilization. Therefore, if oral contraceptives do interfer with implantation, the determination of whether oral contraceptives are abortificants depends largely on a person's individual definition of pregnancy. See Beginning of pregnancy controversy for more information

As you can see, I removed the unsourced bit about the origins of the definition, I've changed the weasel word many and I've made it clear the issue is only relevant ir oral contraceptives do interfer with implanation which we don't know. See my discussion above for more info on why I made my changes. I also added a link to the beginning of pregancy controversy since it should be the primary article. I'm not particularly good at style so maybe it should be mentioned in a different way but at least it's mentioned Nil Einne 12:45, 17 June 2006 (UTC)

Safety of pills vs. pregnancy

A common example is blood clots. Women on combined hormonal contraceptives are at increased risk of blood clots compared to non-pregnant women not using the drugs (3-6 per 30,000 for pill users vs. 1 per 30000 for non-pregnant non-pill users). However, pills protect from pregnancy and the much higher risk of blood clots associated with pregnancy (30 per 30,000).

These facts have been verified by multiple studies, and I have no problem say knowledge of them is "commonly held" in the medical community. Lyrl _Contribs 12:53, 23 July 2006 (UTC)

Okay, so there is absolutely NO WAY in which pregnancy is safer than the pill? No area? I really think that this is false...but I don't know for sure.

Chooserr 16:08, 23 July 2006 (UTC)

Pregnancy is dangerous. Increased risk not only of blood clots, but of aneurysms and strokes. It does permanent damage to the pelvic floor, risk of gestational diabetes (which can turn into permanent diabetes), pre-eclampsia and HELLP syndrome... I can keep going if you want.

Pregnancy does provide long-term protection from breast and ovarian cancer - but I've never seen anyone say a woman should get pregnant for the sole reason of protecting herself from those two forms of cancer. Lyrl _Contribs 18:15, 23 July 2006 (UTC)

Do you have a source for the protection from breast cancer statement? Because pregnancy increases hormones and hormones increase risk-- or is that totally outdated? IMFromKathlene 03:56, 31 August 2006 (UTC)

On ovarian cancer, a woman who has her last child when older than 35 decreases her risk of ovarian cancer by about 50% .

On breast cancer, a recent study in Nigeria found that delaying first pregnancy until after 20 years of age increases a woman's risk of breast cancer by 32% . This one from Italy seems to say that having a first child after 30 versus at younger than 20 increases breast cancer risk by 431% (odds ratio 5.31, that's 431%, right?)

Increased hormones are not the only changes that occur during pregnancy - this article explains some of the theories about why pregnancy protects from breast cancer. Lyrl _Contribs 00:56, 1 September 2006 (UTC)

Why was this statement (In general, the health risks of oral contraceptives are far lower than those from pregnancy and birth) removed in recent edits? Inappropriate comparison or not, it is a high-visibility claim made by the medical community and drug manufacturers that deserves to be addressed in this article. Lyrl _Contribs 23:15, 7 September 2006 (UTC)

...1) we could compare any method of bc to pregnancy; it's not unique to the pill. 2) it posits pregnancy only as "unwanted pregnancy"--in a wanted pregnancy, women get something out of pregnancy they don't get out of bc--in a risk/benefit calculation, women make different calculations for bc and pregnancy. 3. pregnancy is sui generis--we could compare two forms of bc, but what is comparable to pregnancy?

i think the whole comparison of pregnancy/the pill is weirdly selectively contructed/a logical fallacy. two things which are on par/alike can be compared. (there's a whole discussion viz abortion and appropriate comparisons--an appropriate comparison was determined to be: two forms of abortion available at 8 weeks gestation. comparing one form of abortion at 8wks gestation to forms of abortion at later gestation, pregnancy, and other drugs was stricken.) Cindery 23:31, 7 September 2006 (UTC)

Those points can certainly be discussed in the article. But the comparison was in my pill inserts, has been made by doctors on this site, is on numerous websites that discuss the safely of hormonal contraceptives, and is in the very popular book originally used as a source by this article. It is a high-visibility statement that should be addressed. Lyrl _Contribs 22:13, 8 September 2006 (UTC)

elevating the comparison of the pill to pregnancy to the status of a high-visibility controversy is not supported by any evidence i have seen...controversies should be selectively reported on in accordance to their importance. ( the important controversy that has been excluded if any i think is the controversy re cancer risk v. the pill-- doctors are taught in medical school that in a risk/benefit analysis, the benefits outweigh the risks/feminist orgs like the national women's health network counter that the risk/benefit analysis concept was developed to analyze drugs with serious side effects which are given to sick people, not drugs given long-term to perfectly healthy people.) but that's a separate topic. i don't think pill/pregnancy is a high-visibility statement, i think it's just a claim that's been bandied about. not unlike: the pill is revolutionary! etc. not every statement that's ever been made about the pill can be included here and analyzed in depth--it's already a sprawling piece. comparison between pregnancy and <fill in the blank> birth control method are not standard on wikipedia... Cindery 22:43, 8 September 2006 (UTC)

Pill-related polution and human male fertility

It seems there has been some speculation that the pollution of drinking water with synthetic estrogen is affecting human male fertility. However, there appears to have been no research to support this speculation, and even serious discussions of declining male fertility (like here) dismiss the pill hormone-male fertility theory as "extreme." Lyrl _Contribs 18:30, 23 July 2006 (UTC)

I didn't see them adress the pill hormone-male fertility theory, only the laptop theory, and it even said that it was possible. It just said that something else at work BESIDES the laptop theory is at work. So I wouldn't go saying that this is extreme.

I'm currently searching for more information about the pill hormone-male fertility theory, and will (god willing) come back with some more information.

Chooserr 19:01, 23 July 2006 (UTC)

Hmmm...I found a rather interesting summary just after posting that, which while not concerning synthetic estrogen from the Pill talks about its effect in general, and highlights some chemicals which cause it (including DDT) - its here if you want to have a look. Maybe this deserves its own article? Chooserr 19:10, 23 July 2006 (UTC)

Well I found some other links but they can hardly be considered more reliable (one is from Jivemagazine). None of them are really from the study. But I'll give it another look. Chooserr 19:59, 27 July 2006 (UTC)

Source Problems

Sources 7 & 8 listed in this article do not appear to be in the correct place. The article referenced in source 7, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4052920 , only claims an increase in ectopic pregnancy for IUD users, not oral contraceptive users (which it did not find any significant change to). Source 8 has two problems: first, its link does not directly link to the article; a second link must be followed. Secondly, the article, at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2293688&itool=pubmed_Abstract , does not deal with ectopic pregnancies at all; indeed, it appears the risk for PID (a risk factor for ectopic pregnancy) is reduced by using the Pill. --Chiapr 15:37, 24 July 2006 (UTC)

I had other problems with that whole section when it was put in (see discussion section #Lyrl-edits of 18 May 06), but I didn't want to get into a revert war at the time and then forgot about it. If you want to clean that section up, please do. Lyrl _Contribs 21:29, 24 July 2006 (UTC)

Removed paragraph - "'married women'... 'indisputable effectiveness'"

"Further, married women had control over their family size, even if their belief was that the woman was obligated to submit to her husband's sexual desires — regardless of her interest — which had been a prevailing view in many cultures. For women with abusive husbands or women who had had high risk pregnancies, this control was potentially lifesaving; however, it did lead to the conflict of obtaining medication without fully informing the husband.

In time, however, as society adjusted to these new facts, the Pill largely regained its reputation, due to its indisputable effectiveness and convenience. According to some sources, 80 percent of American women use the Pill at some point in their lives."

this is ungrammatical and makes no sense in a number of places, but i think some of the ideas may be worth saving/rephrasing.

for example, i don't see how the pill could be lifesaving for a woman with an abusive husband. ? or how the pill could be lifesaving in a high-risk pregnancy. (access to contraception could prevent a high-risk pregnancy in a woman likely to have one due to health conditions, but the pill itself has no effect on a high risk pregnancy...)

also, i'm not sure that the pill "regained its reputation"--the WHO/IARC recently upgraded it from a possible carcinogen to definitely carcinogenic to humans. it *is* certainly popular, but its reputation viz breast cancer shouldn't be treated as though all concern is gone. and a claim of %80 is rather high (and would need a source other than ortho-tricyclen, even if that link worked...) Cindery 03:00, 5 September 2006 (UTC)

Breast enlargement via the pill

I see that the statement about women going on the pill to increase their breast size has been marked as needing references. I have no doubt that this is true. If you search various internet forums you can certainly find this subject being discussed. What is more relevant is the fact that it doesn't necessarily work. In particular, low-estrogen pills often cause breast volume reduction due to their progestin content. It'd be nice if we could find some reliable statistics on that. -- Kiral 10:03, 5 September 2006 (UTC)

it's specifically the statement "many women..." that needs a citation, i think. a source. a survey or study. some numbers. but you're right that it needs citations in general, if it's going to be mentioned included. (*does* it need to be included? if so, maybe it should be in side effects? "pill can sometimes increase or decrease breast size" etc? Cindery 16:57, 5 September 2006 (UTC)

Effects on sexuality

The effect of the Pill on a woman’s sexuality are difficult to judge; depending on the individual and the particular formula, the Pill may enhance or disrupt a woman’s (or couple’s) sex life. 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. When combined with the Pill’s high degree of effectiveness, this may enable the couple, and especially the woman, to relax more easily during sex. Masters and Johnson, among others, reported more than one woman who experienced her first orgasm during intercourse shortly after going on the Pill.

On the other hand, the Pill’s various side effects may prove disruptive on a physiological or even a psychological level. The hormonal disruption caused by the Pill may result in mood swings, lower libido, excessive or insufficient vaginal lubrication during intercourse, and possibly an injured self-image due to weight gain. Some women who use the Pill despite the teachings of their religious traditions may feel conscious or unconscious guilt; others may not fully trust an "invisible" method of birth control. This wide range of variables makes prediction of the Pill's effect on sexuality difficult, but the fact that the Pill can and does have an impact in this area, for good or for ill, is well-documented.

...i moved this here for now because it doesn't cite a single ref. no doubt some of these assertions are valuable and can be backed up, but the style is editorial/subjective in addition to citing no refs. whole thing should be rewritten/restyled/sourced. Cindery 20:34, 7 September 2006 (UTC)

Side effects

I was wondering about the rate of weight gain and weight loss. It says 50% for both, but I don't think that can be correct. I found a source saying that about 40% of women report side effects - meaning that 60% don't. And 50% can't report weight gain if 60% report nothing.

Also, I think the side effects section should be expanded with some percentages and actual numbers. Fresheneesz 20:51, 11 September 2006 (UTC)

I imagine the prevalence of side effects is largely dependent on what is categorized as a side effect, how the questions are asked, and when they is asked. I can't tell you how many posts I've seen from women who quit bcp and were amazed at how much less moody, more happy, and more interested in sex they were. But these effects often begin gradually and are not immediately noticed to be caused by the hormones. If these women were interviewed while they were still taking the drugs, they would not have known they were experiencing side effects.

Also realize that many women quit because of side effects. If a side effect study is done on women who have been taking the pill for a year, for example, the ones experiencing major side effects will not show up - because they are no longer taking the hormones.

Fresheneesz's idea for expansion sounds good. I'd be happy to see more information and citations in that section. Lyrl _Contribs 23:52, 11 September 2006 (UTC)

Interesting perspective. I have no experience in that, but if you can source that information, I think it would be a good addition to that section. Especially on the gradual onset of side effects. Fresheneesz 03:37, 12 September 2006 (UTC)

Most of my information is anecdotal. I'd be starting at square one with research for verifiable information to put in the Misplaced Pages article. I did a search today and found this article on the pill and depression (it references this research study). Lyrl _Contribs 23:29, 12 September 2006 (UTC)

Extrauterine pregnancies

Source problem: "The theory that the pill has postfertilization effects is also based on some studies that found the ratio of extrauterine to intrauterine ratio of pregnancies increases by 70–1390% in women using the pill". 13,14 and 15 is listed as sources, but none of them (14 was a comment/letter that was not available) seems to reach the conclusion stated in this sentence. The article listed as source nr 13 ("A multinational case-control study of ectopic pregnancy...") in fact states that there was NO connection between XU-pregancies and OC. Number 15 ("Risk factors for ectopic pregnancy: a case-control study in France, with special focus on infectious factors.") states some connection between contraceptives, but does not discriminate between IUD and OC- which of course makes a huge difference in this context. -J-

See #Lyrl-edits of 18 May 06 and #Source Problems for prior discussion. I would be happy to see cleanup of that section. Lyrl _Contribs 13:00, 28 September 2006 (UTC)

Djerassi is Austrian, not Bulgarian

The "History" section says: "Carl Djerassi, a young Bulgarian chemist, . Djerassi was born in Vienna, Austria in 1923. While escaping Nazi persecution, he spent 2 years in Bulgaria (1939-1941) before fleeing to the United States. Djerassi is Austrian, not Bulgarian.— Preceding unsigned comment added by AdderUser (talk • contribs)

Djerassi is American. His Viennese mother and Bulgarian father met in medical school at the University of Vienna, married and moved to Sofia, Bulgaria. His mother returned to Vienna for two months for the birth of her only child. Djerassi lived in Bulgaria with his parents until he was five. He and his mother then moved to Vienna where he attended a Realgymnasium until age fourteen, spending summers in Bulgaria with his father who had divorced his mother. After the Anschluss, his father briefly remarried his mother to allow Djerassi to escape to Bulgaria in 1938 where he lived with his father for a year attending the American College of Sofia while his mother went to England to await a visa to emigrate to the United States. At age sixteen, Djerassi and his mother arrived nearly penniless (they had only $20) in the United States in 1939. Djerassi married his first (American) wife in 1943 before beginning graduate study at the University of Wisconsin-Madison where he earned his Ph.D. and became an American citizen in 1945. He worked for Ciba the year before and four years after his graduate studies. In 1949, he was recruited to be the associate director of research at Syntex in Mexico City by then technical director George Rosenkranz, and worked there from 1950-1951 and again from 1957-1960 (while on a leave of absence from Wayne State University before moving to Stanford University).

68.253.191.144 16:03, 19 October 2006 (UTC)

Thank you. I have moved this info to the Carl Djerassi page. You might wish to make further edits and quote sources.--Grahamec 22:58, 19 October 2006 (UTC)

Thank you for moving the info to the Carl Djerassi page. The information was from his two autobiographies (Steroids Made It Possible and The Pill, Pygmy Chimps, and Degas' Horse).69.208.208.210 03:55, 20 October 2006 (UTC)

I also thank you for the info. And for the purposes of the main Oral Contraceptive article, I think leaving out the "young ian chemist" part is a good choice.AdderUser 01:26, 23 October 2006 (UTC)

Needed: How oral contraceptives suppress ovulation

Hi. Ne'er posted anything on the talk pages before, so excuse my possibly incorrect formatting. I find this article to be generally lacking the information one might seek here, but I lack the confidence in my knowledge to add any large sections.

My main criticism is the severe lack of information in the 'Mechanism of Action' section, which merely states 'prevents ovulation'. While this may be sufficient for readers glossing the page over, or teens looking to be informed, it is simply not enough for this article. If one examines pages for any other pharmaceutical in use by a large percentage of the population, the main section is dedicated to what the drug actually does. The section in this article could at least mention the pill's negative feedback effect, the abscense of a LH spike, and the differences between POPs and ones that also contain estrogen. A quick and easy explanation of exactly why placebos are included could also be slotted in. The Menstrual Cycle is a featured article, it could at least use a link in Mechanism of action, and at the top of the page, in addition to the one in the Use section. Any thoughts? 68.147.180.89 08:37, 16 November 2006 (UTC)

Sounds like a good idea, though I don't have the knowledge to contribute. I would encourage you to use references (enclose them in <ref></ref> tags will appear in the Footnotes section near the end of the article). And also realize there is some tension between this page being a top-level article, vs. covering only combined oral contraceptives with Hormonal contraception being the top-level article. This information might be better put in the hormonal contraceptives article. Lyrl _Contribs 00:06, 17 November 2006 (UTC)

Hmm. Checked out this Hormonal Contraceptive article, it didn't carry the information either. I'll try to find a couple decent references to add what I was talking about.68.147.180.89 02:47, 19 November 2006 (UTC)

Postfertilization effects

It also seems to me that the aricle is intentionally deceptive on this point. In all of the medical information websites I found on the web, one of the mechanisms for all forms of the pill was described along the lines of, "The lining of the uterus is also affected in a way that prevents fertilized eggs from implanting into the wall of the uterus," or, "It alters the endometrial lining, inhibiting implantation of a fertilized egg, if ovulation has occurred," or "Both pills also prevent the lining of the uterus from thickening, which means that a fertilized egg is unable to implant itself in the lining and grow". However, this article is presenting information within the mechanisms section as if this particular mechanism is in some serious dispute. Granted, for some forms of the pil the prevailing mehanism was the prevention of ovulation, the alteration of the endometrial lining in those pills still serves the preventative effect of impeding implantation should both ovulation and fertilization have occured. I entered a sentence to clarify this point. Is the endometrial lining mechanism really in serious debate in the medical field? Brad 19:17, 16 December 2006 (UTC)

It was believed a few decades ago that the IUD worked 100% by preventing embryo implantation, that their effect on the endometrium was the only mechanism by which hormonal emergency contraceptives worked, and that all hormonal contraceptives prevented implantation. But studies have now proven that the IUD is highly spermicidal and that this anti-fertilization effect is its primary mechanism of action, that even one dose of hormones as emergency contraception prevents ovulation frequently enough to account for the effectiveness of such regimens, and that the research about any anti-implantation effect of ongoing hormonal contraception is seriously lacking.

All of the evidence for the anti-implantation effect is presented in the controversy section. If another editor has other evidence not presented, or believes the current evidence is presented in a POV way, then please modify. But there is not currently evidence to say for sure that hormonal contraception actually has any effect on implantation rates (or, conversely, that it does not have an effect). Lyrl _Contribs 19:56, 16 December 2006 (UTC)

I noted the following study results after a brief search:

The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. Postfertilization effects would be problematic for some patients, who may desire information about this possibility. This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives.

Based on this,I have re-inserted the cautionary description in the methods section to the affect that this is a recognized secondary mechanism - it is important that people concerned about whether the pill interferes with implantation understand these study results are out there.

Brad 17:26, 23 December 2006 (UTC)

The Larimore and Standford article quoted by Brad seems to be a comprehensive review of current knowledge on the subject. I've rewritten the "controversy" section (retitled "postfertilization effects") to heavily reference it. However, that is only one paper by two people. As far as serious research on the question of postfertilization effects, we seem to have Larimore and Standford in the yes-they-exist camp, and the American Association of Pro-Life Obstetricians and Gynecologists in the still-unproven camp. And no one else doing research, just a bunch of repeating speculation that originated in the 1960s. I don't know that the sources presented so far show a medical consensus for either position, though I would be interested in seeing any such sources others are aware of or find.

My only critisism of Larimore and Standford is their presentation of the intrauterine vs. extrauterine pregnancy ratios. While they document their sources meticulously, and note where the same study is published in more than one place (so they don't count the same study multiple times), the articles they reference distressingly do not support their claims. The WHO study and the meta-analysis they cite actually found no increased risk related to oral contraceptives, even with the pregnant controls. And the study that found the biggest risk increase was confounded by not including women seeking abortions - but that information is completely absent from the Larimore and Standford analysis. Lyrl _Contribs 23:13, 23 December 2006 (UTC)

A good RECENT (September 2006) overview of this controversy can be found here: http://www.asa3.org/ASA/PSCF/2006/PSCF9-06Sullivan.pdf Dennis Sullivan comes from the perspective that there are valid ethical questions, but that the liklihood of a COC-induced abortion is so statistically small as to be almost negligible. I did not have time to post any references to it in the main article, but I think it may be very useful. The weakness of Sullivan is that he is entirely focused on COC's, and although he admits that the abortifacient mechanism in POP's is inherently more plausbile, it is not the intent of his article to examine them, only COC's. Brad 23:55, 23 December 2006 (UTC)

Additionally, I am not sure why the purely philosophical debate about when pregnancy actually begins necessarily needs to be conflated with genuinely medical debate about whether or not oral contraceptives actually inhibit the implantation of a fertilized egg. Does anyone else feel the need to keep these two debates separate in the sections of the main article - both are of value on the subject, but it seems wrong to me to lump them together. Brad 00:02, 24 December 2006 (UTC)

Researcher's political beliefs on abortion seem to influence their opinions on postfertilization effects. Pro-choice researchers have a tendency to deem such effects 'likely' if they seem theoretically plausible, while pro-life researchers have a tendency to demand evidence for effects that are disturbing to them. However, the section is not currently written in a "be aware of biases" way so I see where it could be more distracting than helpful where it is in the article. I'm hesitant to give a four-sentence paragraph with no expansion potential (as it's a summary of another article) its very own section. But I'll go along with the flow if Brad and/or others feel the article would read better with the political stuff sectioned off. Lyrl _Contribs 00:21, 24 December 2006 (UTC)

The current wording I think approaches a good NPOV feel; however, the often opinionated debate surrounding the "when does pregnancy begin" question, with its (necessary) moral and religious overtones, seems to me to somewhat undermine the legitimacy of the scientific question of whether implantation is detrimentally affected, when the two are combined as a single section. Perhaps I am being too subjective. Brad 21:05, 25 December 2006 (UTC)

Proportion of women using oral contraceptives

There is no information included in the article about the proportion of women taking the birth control pill. I would believe that statistics to this effect would be important in understanding the social and cultural aspects of birth control. Nealc9999 05:13, 29 November 2006 (UTC)

The information is limited, but there is some there. From the very first paragraph in the article: usage prevalence varies: one quarter of reproductive age women in the United Kingdom take the pill, but only 1% of women in Japan. If you're interested in the topic, I would encourage you to do the research needed to create a section on "Prevalence" or equivalent. Lyrl _Contribs 23:43, 29 November 2006 (UTC)

Inclusion of Ormeloxifene/Centchroman - an oral contraceptive

The following represents a decently-sized monkey wrench.

Currently, this article describes oral contraceptives as unilaterally hormonal. However, there exists a non-hormonal oral contraceptive called Ormeloxifene, a.k.a. Centchroman. It is not hormonal, it is a selective estrogen receptor modulator, in the same class of medications as tamoxifen. Ormeloxifene has been used in India as birth control for over 15 years. I want to incorporate ormeloxifene appropriately into this article, as it is an oral contraceptive.

Conceivably, one could identify those instances in this article where oral contraceptives are referred to as always hormonal, and to change the phrasing in those instances to refer to them as "hormonal oral contraceptives". Then, a section on ormeloxifene could be added. However, the current article is entirely written in regards to hormonal oral contraceptives; describing their mechanism of action, formulations, effectiveness, side effects, packaging, social and environmental impact, and so forth. Changing all of this to be inclusive in its language of ormeloxifene would be very labor-intensive.

Another option would be to split the content within the article, with a top-level header for "hormonal oral contraceptives" and another header at the same level for "ormeloxifene". However, this presents the same problem of combing through the existing content to find and change references to oral contraceptives as necessarily hormonal.

My thought is that it might be simplest to move the bulk of this article to the location of hormonal oral contraceptive, and to make oral contraceptive a disambiguation page between hormonal oral contraceptive and ormeloxifene, as they are both oral contraceptives. I realize that people may feel hesitant to do this, but the advantage of doing it this way this would be that it would be much less labor-intensive in terms of properly editing the oral contraceptive article to be inclusive of all forms of oral contraceptives. What do you think? Joie de Vivre 21:23, 16 December 2006 (UTC)

I would tend to be even more specific, the current article is almost exclusively about Combined Oral Contraceptive Pill (COCP) and should be largely moved there. This Oral contraceptive page then perhaps just sets out the history of the COCP, Progesterone Only Pill (POP - should be renamed as Progestagen Only Pill, rather than US-centric Progestin Only Pill) and, not unreasonably, a small mention also of ormeloxifene (small only in as much that only used in a single country). Combined Oral Contraceptive Pill would have details on the specific details, formulations and side-effect of the class of drugs.

This would give the following Heirachy of articles:

                     Birth control                  
                           |
    +----------------------+-----------------+----...others
    |                      |                 |
Oral contraceptive   Hormonal contraceptive  |
    |                      |                 |
    +----------+----+      |                 |
    |          |    |      |                 |
    |          +----+----+-+--+-------+      |
    |          |    |    |    |       |      |
ormeloxifene COCP  POP Depo Implanon IUS    IUD     etc David Ruben  00:58, 17 December 2006 (UTC)

Thank you for your support. I agree that the content of this article does not belong under hormonal oral contraceptive, as I had originally proposed, but that it would better fit under Combined Oral Contraceptive Pill. -- Joie de Vivre 23:21, 17 December 2006 (UTC)

The following discussion is an archived debate of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the debate was move —Mets501 (talk) 02:17, 27 December 2006 (UTC)

Requested move

Oral contraceptive → Combined oral contraceptive pill — There are three main types of oral contraceptive; the Combined oral contraceptive pill (COCP), the progestogen only pill (POP), and ormeloxifene. The current content of Oral contraceptive focuses exclusively on one type, the COCP, with a prominent infobox and extensive information about the COCP. There are only a few words on the POP, and no mention of ormeloxifene. The POP has its own well-written article, as does ormeloxifene. Moving the content about the COCP to the page with that title will allow for disambiguation of all oral contraceptives at Oral contraceptive, with links to each type's own page. Joie de Vivre 14:03, 21 December 2006 (UTC)

NOTE: Apparently, Lyrl went ahead and moved the content after this notice had been up for about a day and a half. I was not anticipating this, nor was I aware that this had been done until I discovered it. Since it is the holidays and many people may not have had a chance to speak their piece, this notice will remain up until well after the New Year. Support, opposition, or comments remain welcome. Joie de Vivre 18:55, 24 December 2006 (UTC)

Survey

Add  # '''Support'''  or  # '''Oppose'''  on a new line in the appropriate section followed by a brief explanation, then sign your opinion using ~~~~.

Survey - Support votes

Support - I proposed something similar several months ago (here). Lyrl _Contribs 02:41, 22 December 2006 (UTC)

This makes a lot of sense, and gives the subject much more clarity. Brad 20:54, 25 December 2006 (UTC)

Survey - Oppose votes

Discussion

What about male oral contraceptives? Would those be linked to also? Lyrl _Contribs 02:41, 22 December 2006 (UTC)

I don't see any reason why not. Joie de Vivre 13:15, 22 December 2006 (UTC)

The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Move of Oral Contraceptive contents to "Combined oral contraceptive pill"

This is intended to be a space where people can discuss this change, if necessary. Although of course I support my own suggestion, I wasn't aware that others would take such quick action to make the move: I suggested this move on the 21st. Lyrl surprised me by making the move on the 23rd, and then Mets501 closed the debate on the 27th. It is possible that some people might have been on vacation or busy with their families during Christmas. If anyone feels they were not given enough time to voice their opinion, please feel free to do so, here. 18:20, 27 December 2006 (UTC)

"Pregnancy rate" rather than "failure rate"

Note discussion at Talk:Birth control#"pregnancy rate" rather than "failure rate" re replacing occurrences of "failure rate" with "pregnancy rate". I would also like to see the same change on this page. Please make any comments there. --Coppertwig 04:04, 8 January 2007 (UTC)

Mayo Clinic Proceedings

69.208.173.236's edits are confusing. He changed the statistics, deleted a whole paragraph, and added several adjectives which together sound anything but encyclopaedic. I think it should be reverted, but every time I revert I get reverted so I'll post it here. Chooserr 01:46, 10 January 2007 (UTC)