Birth control pill turns 60 in Brazil amid doubts and myths

Carioca Fernanda* started using the contraceptive pill at age 18 to prevent pregnancy because, at the time, she started a treatment for acne with Isotretinoin, a drug that cannot be used by pregnant women.

“But seven years later, many cases of women with thrombosis related to [pílula] that I used. That’s why I stopped using it,” she says.

This is the story of many women. Although it is the contraceptive method most used by Brazilians, according to a survey carried out in 2021 by the Ipsos Institute, there is an increasing movement of abandonment for fear of side effects. Nor does it seem that, in the very recent past, he was considered a revolutionary.

This Sunday (15), the contraceptive pill completes 60 years of its approval in Brazil. It arrived in the country brought by women who traveled to other countries, since in the United States, for example, it had been approved two years earlier, in 1960.

But the drug could have reached the shelves even earlier, says historian Luiz Antonio Teixeira, a professor at Fiocruz’s Fernandes Figueira Institute (Oswaldo Cruz Foundation).

“The role of hormones in the control of the menstrual cycle and the possibility of using them to prevent conception was already known. The development of contraceptives did not occur previously for cultural reasons”, he says.

The historian says that contraception was seen as immoral and “sinful”, since it was established that the role of women in society was only to procreate. Subsequently, the pill became a birth control tool.

It was from that moment on that women began to decide whether or not to have children, and entered the job market. “By separating sex and procreation, the pill enabled a new way of conceiving and living affective and social relationships. In this way, it gradually transformed the views on sexuality, gender and family”, says Teixeira.

Today, not only it but all other contraceptive methods are part of reproductive planning strategies. But how did a drug that was considered innovative gained such distrust?

Is the birth control pill safe?

Gynecologist Carolina Sales Vieira, professor at FMRP-USP (Faculty of Medicine of Ribeirão Preto, University of São Paulo), explains that there are two types available on the market, both made with synthetic versions of hormones: the one composed of progesterone and estrogen (called combination pill), and another made with progesterone alone. Both are equally effective.

“Progesterone inhibits ovulation and makes the cervical mucus more viscous, which prevents the sperm from ascending to the uterus. Estrogen, on the other hand, works by programming bleeding”, explains Carolina. This means that those who take the progesterone-only version menstruate less often.

Just like any medication, the pill has adverse effects. The main ones caused by the combination are nausea, vomiting, headache and pain and swelling in the breasts. “Most of the time, these are transient symptoms that pass after three months. [de uso]”, says the gynecologist.

There are also more serious, albeit rare, effects such as thrombosis and stroke. A robust review of studies commissioned by the WHO (World Health Organization) and published in the Journal of Obstetrics and Gynecology Research showed that the overall risk of thrombosis among women of reproductive age is 5 cases in 10,000. But when pills are used, it rises to a maximum of 20 out of 10,000.

But even so, the danger is still small. For comparison purposes, during pregnancy, the possibility of venous thromboembolism increases from five to ten times, and can reach 20 times in the puerperium, in relation to non-pregnant women of the same age, according to a protocol produced by Febrasgo (Brazilian Federation of Associations of Gynecology and Obstetrics).

Strokes from the pill are ten times rarer than thrombosis, according to a review of Cochrane research.

It is worth noting that the serious problems are restricted to the combined version. “The effects of the progesterone-only pill are only mild,” says the professional.

According to gynecologist Jaqueline Neves Lubianca, from Febrasgo, specialists need to evaluate each patient to understand whether the combined option is ideal.

“There are risk factors for thrombosis, such as obesity, sedentary lifestyle, smoking, cardiovascular disease and history. We try not to use it in this niche, where the risks are adding up. If we take care, it is safe”, informs Jaqueline.

Pill as a treatment

In addition to being a contraceptive, the pill is part of the therapy of several diseases. This is the case of publicist Bruna Macedo, 28, from São Paulo. She started using it to prevent pregnancy when she got married seven years ago.

“After six months, I found out that I had polycystic ovary syndrome. Sometime later, I started to experience stronger cramps, swelling, prolonged bleeding. So, my doctor changed the medication to a pill indicated for the treatment”, says Bruna.

Even so, the reports of thrombosis left Bruna with a back foot. “We see several things on the Internet about this. I was afraid of suffering some serious effect and I took these doubts to the doctor, who guided me very well”, she says.

Bruna’s treatment with the contraceptive has been satisfactory.

“I have nothing to complain about. In the future, I will stop and continue with other methods, but at the moment she treats my syndrome. When there is any doubt, I always take it to my doctor.”

The remedy is used by those who suffer from the syndrome and endometriosis, as it alleviates the symptoms. “It also helps to treat acne, reduces excess hair, relieves cramps and in the long term protects against endometrial and ovarian cancer”, informs Lubianca, a Febrasgo gynecologist.

Regardless of the reason that leads someone to take it, the important thing is to have information and understand that there are alternatives. “We shouldn’t demonize hormonal contraception because the cumulative effects are good. It’s a matter of risk and benefit, and of making the patient aware of all the methods available to make the choice.”​