Longtime foes of birth control unravel policy

On the front page of today’s New York Times there is an article entitled, “Longtime Foes of Birth Control Unravel Policy.” The article really follows two distinct pathways. One involves a Mr. Matthew Bowman, a lawyer in the Department of Health and Human Services, who is pursuing the legal aspects of not allowing contraception to all patients as part of the Affordable Care Act. Certain conservative groups have pursued attempts to force businesses not to cover contraception on a religious basis. That is not the aspect that I feel compelled to comment on, although I strongly believe that contraception should be part of universal coverage.

The other portion of the article deals with a Ms. Katy Talento who is a, “White House Domestic Policy Aid.” She has written a number of essays in which she has labeled birth control pills “dangerous carcinogenic chemicals” (cancer causing agents). This is the area I find I must comment on. I have discussed with many of you an interesting article by Malcolm Gladwell (author of Outliers and Tipping Point) that appeared in the New Yorker Magazine more than 15 years ago, entitled, “John Rock’s Error.”

John Rock was one of the inventors of birth control pills and part of Malcolm Gladwell’s thesis was that John Rock erred in bringing birth control pills out as contraceptives. Instead he should have brought them out as cancer reducing agents. There is excellent scientific data that women who take birth control pills have less ovarian cancer, less uterine cancer, and in the doses we are using today, I think that time will clearly show, less breast cancer.

What most doctors and patients do not understand is that birth control pills suppress your body’s own ovarian function and thus they are not on top of what your body makes but rather instead of what your body makes. In the lowest doses, this is actually less circulating hormone than what your body can make. This is well evidenced by adolescents who should be increasing their bone mass until age 30-35 who take too low a dose birth control pill and actually have less bone growth than similarly aged women getting their own cyclic menses. Once again, this is because the birth control pill shuts down normal ovarian function and substitutes the amount of hormone in the pill.

Thus, low dose pills are an excellent choice for perimenopausal women because they will actually lower the amount of circulating hormone bathing their breasts and other tissues.

Furthermore, one of the reasons that gynecologic cancers are on the rise in modern industrialized nations is because women are having too many menstrual cycles. Sometimes patients claim that birth control pills are not “natural.” What did nature expect for us? As higher order primates, nature expected women would have eight children, have to nurse them all for 12 to 15 months (there are no bottles or formula in nature) and along the way probably have three miscarriages. Thus, women could be expected to have no more than 250-300 total menstrual cycles in their lifetime. The typical modern socialized, industrialized woman who has two children and nurses them both for three months will end up with close to 500 menstrual cycles, as most typically have about 40 years of reproductive life. Each year has 13 lunar months. That would be 520 menstrual cycles! This is not “natural.” I am not suggesting that women have eight children and nurse them all for 12 to 15 months but understand that what we have socialized into is not what nature expected.

Thus, there are so many myths and misconceptions about birth control pills and their risks and benefits. I urge you to share this information with any friends, family or coworkers who might find it helpful.

Dr Steven R. Goldstein MD is a Gynecologist in NYC and a perimenopause doctor in NYC.