- The Washington Times - Tuesday, October 2, 2001

Carl Djerassi's creation, the birth-control pill, become commonplace in women's medicine cabinets, purses and nightstands worldwide.
The birth-control pills are 28 pills packaged together and containing various amounts of synthetic hormones akin to the body's estrogen and progesterone, depending upon which pill is being taken. The medication prevents pregnancy by stopping a woman's ovaries from ovulating, or releasing an egg.
Many doctors agree that today's pill, beyond its sociological ramifications, is safer than its predecessors and helps stave off ovarian cancers,regulate menstrual cycles and prevent pregnancies.
Positive side effects include reducing the risk of ovarian cysts, ectopic pregnancies and fibrocystic breast disease. Pill usage also can cause weight gain and slightly higher chances of blood clots.
As with any medication, other negative side effects do occur.
"Lisa," which is a pseudonym provided at her request to protect her privacy, is a 31-year-old Internet marketer from outside Roanoke. She began taking birth-control pills 10 years ago as a contraceptive and to prevent a recurrence of ovarian cysts.
"I wondered if it was healthy to be on it so long," she says. Her doctors assured her the pill's benefits outweighed potential complications.
Her doctors first noticed something was wrong about a year ago while she was undergoing blood tests for an unrelated acid reflux condition. One of her liver enzymes was elevated, which prompted further tests.
Eventually, she learned she had a tumor, which now measures 2.8 inches long, growing on her liver.
"Because it is so rare, the immediate thought was that it was liver cancer," says Lisa, who spent a weekend mulling over that devastating possibility until her doctor learned of her long-term pill usage.
After subsequent testing, the tumor appears to be benign.
"It wouldn't have been caught if it weren't for the blood tests," Lisa says. "I don't know how long I've had it."
Dr. Tony Ringold, Lisa's gastroenterologist, says he sees about three or four similar cases a year.
"It's unpredictable, but clearly related to the birth control pill," Dr. Ringold says. "Before 1960, this was unheard of."
Lisa will have the tumor removed in a few months.
"This is a pretty major operation on the horizon," she says, more than a bit concerned about its consequences, including a large scar across her midsection.
Merck & Co., a pharmaceutical products and services company based in Upper Gwynedd, Pa., says on its Web site that benign tumors similar to Lisa's have "increased in prevalence because of widespread use of oral contraceptives."
The tumors, the site says, often shrink if the medication is stopped.
Most doctors agree that such situations are rare with pill usage, which began about 40 years ago, when the medication first earned the Food and Drug Administration's approval.
A recent report in the Journal of the American Medical Association says women taking the pill are nearly twice as likely to suffer strokes.
However, women during their reproductive years rarely suffer strokes, so the report concludes that doubling those tiny figures represents but a fraction of a risk to the pill-taking population. It translates to one additional stroke yearly per 24,000 women for low-dose pill users and one per 12,000 women for higher dosages.
Dr. John Larsen, professor of obstetrics and gynecology at the George Washington University Medical Center, says the pill puts the ovaries at rest, which causes a "big drop" in the chances for ovarian cancer.
Women on birth-control pills should "flat out stop smoking" and take the pill at the same time each day for maximum effectiveness, he adds.
Dr. Larsen says he has met women on the pill who developed liver tumors, but he knows of no way to prevent that from happening in such rare cases. Modern imaging technology might be able to spot the tumors early, but he says they would be too expensive for widespread use and too rarely effective to be part of a regular medical program.
Dr. Larsen says the key concern his patients have regarding the birth-control pill is its propensity to cause weight gain.
Dr. Karen Perkins with Mercy Medical Center in Baltimore says the amount of time a woman is on birth-control pills has no bearing on any potential side effects.
Negative consequences, such as blood clotting, a risk that increases if users smoke, typically happen within the first year of use, Dr. Perkins says, and most often involve women older than 40.
She suggests that women taking birth-control pills for the first time report any symptom, from cramping to shortness of breath, to their physicians to be safe.
"It's one of the safest birth-control methods we have, in terms of long-term side effects," she says.
Women experiencing side effects on the Depo-Provera shot, an injectable birth-control medication, must wait three to six months for the medication to leave their bodies. Women who take birth-control pills can stop taking the hormones, and the effects will lessen in a few days.
Dr. Dwight Im, associate director of Mercy's Gynecologic Oncology Center, says the only reluctance he might have is prescribing birth-control pills to a patient if she were older than 35.
Age was a key factor in a report released last month from Dutch researchers at the University of Groningen linking long-term use of birth-control pills at menopause to increased risk of cardiovascular and kidney disease.
Obese patients already are at risk for high blood pressure, so their pill usage can be cause for greater pressure scrutiny.
Over the years, the pill's makeup and range of side effects have changed "dramatically," Dr. Im says. The modern birth-control pill, on average, contains about 20 micrograms of estrogen, down from about 50 micrograms in its earliest incarnation. That means fewer hormones, fewer side effects.
As for Lisa's tumor, Dr. Im disagrees with her doctor's diagnosis.
"I would be surprised if estrogen was the direct agent of the tumor," he says, referring to the ingredient in birth-control pills associated with possible tumor growth.
None of these arguments would be possible if not for Mr. Djerassi's handiwork.
Mr. Djerassi, now a chemistry professor at Stanford University in California, says he doesn't see much debate over his creation these days, particularly compared to the late 1950s, before it received FDA approval. Mr. Djerassi was traveling through Germany when contacted and could only respond via e-mail.
"But for every epidemiological study saying one thing, there is another saying almost the opposite," writes Mr. Djerassi, whose new book, "This Man's Pill: Reflections on the 50th Birthday of the Pill," walks readers through the years since its creation.
"Suppose, for instance, that you accept 'a higher incidence of strokes.' What is this 'higher' incidence by comparison to say, the well-documented reduction in ovarian cancers in Pill users, which saves thousands of lives per annum?" he asks.
Mr. Djerassi suggests that women contact the Centers for Disease Control and Prevention (www.cdc.gov) for the most reliable information on contraception.
Lisa understands how rare her case may be, but that didn't stave off the emotions wrought by her diagnosis.
"I stopped immediately and threw the rest away," she says of the birth-control pills that had been a part of her life for the past decade.
She suggests women "be aware of the side effects and the possibility of complications" inherent with birth-control pills, or any medication, for that matter.
"You see the fine print that's not going to happen to me," she says. "It does happen to somebody."

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