Tuesday, September 15, 2009

Book reading

I am re-reading a book called 'The Pill And Other Forms Of Hormonal Contraception' by John Guillebaud, subtitled 'The Facts: All The Information You'll Need - Straight From The Experts.' I have spoken to Dr Guillebaud, he's a nice man, and his intent with this book is to give women 'all the information' as the subtitle says so that they can exercise their own judgement about how they choose to control their fertility.

The facts he presents are mostly to do with the physical side effects of the pill - arguing from a standpoint that you are less likely to die from taking the pill than from smoking, crossing the road, or indeed being pregnant. Some of it is an effort in calming the media flare ups around pill related scares.

I had never before, however, read the foreword by his wife, Gwyneth Guillebaud. In this she asks several questions: Do we still feel the same about the pill now as we did on its release? Does taking the pill mean taking control or being controlled? Did the pill liberate men more than women?

Dr Guillebaud states in his book that he believes suppressing a woman's menstrual cycle is not unnatural, explaining that for centuries women spent much of their lives pregnant and therefore did not have the number of periods women do today. He asserts that the artificial hormones used in the pill are as close to the natural hormones' make-up as possible. He argues that statistics showing the physical problems caused by the pill are skewed - women take the pill for years and as illness is a part of life, that illnesses occur when a woman is on the pill could be merely coincidental, rather than related.

When listing the negative effects of the pill Dr Guillebaud places 'depression' and 'loss of libido' in definite brackets - setting them very much aside from common physical problems such as migraines and urinary tract infections and the more serious increases in the risk of breast or cervical cancer development. Under the assessment of this much used book, such changes are definitely secondary and of less concern. Now, I'm not saying that loss of libido should be considered of the same 'seriousness' as breast cancer, but I do think that the emotional effects of the pill are overlooked. Despite their insiduous, far reaching impact on women's lives they are too often considered negligable, unimportant.

The pill's emotional effects can be debilitating. Some women feel desperate, like life is not worth living. To dismiss these issues as likely unconnected to the pill, as mere coincidences, only goes to prove how difficult it is for women to get their thoughts heard by those in the medical profession. Depression is a complex matter, and of course the pill is not the only known cause, but it can be a factor, and for the sake of the depressed this ought to be made clear.

Even in this otherwise modern, up-to-date book there is reiterated the idea that women get depressed because they are sad that they can not conceive. This statement is frustratingly Victorian in its assumptions.

In the Victorian age it was believed that if women had access to education or worked on the same pursuits as men they ran the risk of becoming infertile. The Victorian doctors felt that if women thought too much, or were over-stimulated they could lose the capacity to menstruate entirely. Some Victorian doctors went so far as to say that allowing women to learn and work would bring an end to the human race. As Lisa Appignanesi states in 'Mad, Bad and Sad: A History Of Women And The Mind Doctors' these attitudes have not disappeared . We now see the same ideas in newspaper headlines that claim working mothers are ruining their children, career women will miss out on having babies or will suffer with their inability to cope with the stress.

Back then, when pregnancy and child birth carried a higher risk of resulting in illness or death, the promotion of ideas connecting menstruation to mental breakdown exaggerated women's fear of their own bodies. They were required to be suspicious of themselves, watch their periods for signs of change and keep themselves physically and emotionally in check at all times - lest they be chucked in an asylum.

It was believed at this time that women were more disposed to mental illness than men. Much psychological understanding was based on the workings of the nervous system and it was thought that women's uterus and ovaries had a particular effect on their nerves. Women were considered frail and prone as such to many disorders. The behaviour of some GPs towards their female patients coupled with the lack of acknowledgement of the pill's emotional effects suggests to me this mindset has lived on to the present day.


http://books.google.com/books?id=BvoKKb_DfwwC&pg=RA11-PA38-IA6&lpg=RA11-PA38-IA6&dq=guillebaud+pill+ladder&source=bl&ots=KnSDbklNJH&sig=amJiSbbxd_tEEdBMHkIeKFOHcp4&hl=en&ei=KYewSpjGCILOsQOExszMCw&sa=X&oi=book_result&ct=result&resnum=10#v=onepage&q=guillebaud%20pill%20ladder&f=false


I've added here a link to a page reproduced from Dr Guillebaud's book which I have previously found useful. It is a ladder graph showing the different brands of pill arranged by the amount of oestrogen and the kind of progestogen they contain. If you do indeed want to stay on the pill, or want to try another brand, this information is good to know.

As a rule, the less oestrogen involved the better, or at least the less bad, the pill is for your body.
The progestogens norethisterone (contained in Norimin, Binovum, Trinovum, Synphase, Brevinor and Ovysmen - which are tri and biphasic pills)and levonorgestrel (contained in the popular Microgynon, Ovranette and Eugynon) are considered the safest, and should be a first choice. The pills seen at the very bottom of the ladders are progestogen-only pills (or POPs), the details of which I will address later.

Referring to this table can help you manouever your way through the pills and work out why certain brands might cause problems. But, remember, each woman's body is different in its natural hormone levels through a month, and its ability to absorb and receive hormones, so this can only provide a rough guide.

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