Covering my first medical conference nearly 15 years ago, I feverishly took notes as leading gynecologists explained why older women needed hormones to treat the heart-damaging, bone-robbing disease called menopause. They probably wished they could take back their words after the Women's Health Initiative trial determined in 2002 that hormone replacement therapy causes more disease than it prevents. Now I find myself wondering about the exact risks and benefits of birth control pills, which contain the same hormones. An unsettling new finding suggests that taking the pill for more than a decade increases the likelihood of clogged arteries. I've been on it for seven years and—happily married and satisfied with my three kids—could easily continue for the next 15.
Would 22 years on hormones hurt me? Early observational studies of HRT users found that the women had about half the rate of heart disease of nonusers. Most pill studies have had similarly glowing results: lower rates of ovarian and endometrial cancer, pelvic inflammatory disease, ectopic pregnancy, and anemia. Although pill use increases the risk of cervical cancer and possibly breast cancer, the latest data in the September issue of the British Medical Journal show that women who take it have about a 12 percent lower overall risk of cancer.
A shield? In fact, some experts believe the benefits are so strong that every young woman should take the pill for one year. "If there's any medicine that can actually protect against cancer, it's an oral contraceptive," says researcher David Grimes, a clinical professor of obstetrics and gynecology at the University of North Carolina School of Medicine. "The benefits last for decades even after going off the pill, and that's unique."
But the bulk of the studies has looked at women who take the pill on their own, rather than randomly assigning them to a pill or another form of birth control. With HRT, the discrepancy between the early observational results and those of the rigorous clinical trial has since been partly attributed to socioeconomic differences between users and nonusers: The former tended to be richer, which means better medical care, more nutritious foods, and gym memberships. To me, it seems that women who choose to take the pill similarly could be those able to afford the $25 to $50 monthly pill-pack cost and the annual visit to a gynecologist for a prescription. "That's a good point," allows Philip Hannaford, a professor of primary care at the University of Aberdeen School of Medicine in Scotland, who led the British Medical Journal study. "But I would be skeptical that most of the protective effect of the pill and cancers is really due to another lifestyle factor."
His study did find that benefits against cancer reverse after eight years, mostly because of an increase in cervical cancer rates. So I have to be certain to get regular Pap smears. And women who take the pill have a higher risk of blood clots, especially if they smoke or have hypertension. Plus, research presented at last month's American Heart Association meeting found a 20 to 30 percent increase in artery plaque for each decade of pill use—a finding that, granted, needs to be replicated before it's considered a real worry.
And then there's breast cancer. A UNC study of breast cancer patients ages 20 to 54 found that those who had been on the pill within a year of diagnosis had nearly a 60 percent higher risk of dying from their cancer than those who weren't. Plus, the pill may slightly raise the risk of getting the malignancy, which remains elevated for five to 10 years after women go off it. Given all of these uncertainties, I'm hoping that in a few years, when I hit my 40s, there will be a contraceptive pill for men.