Why is the pill demonized today, and how can young women's fears be allayed?

The effective possibility for women to control their births, a true symbol of the feminist conquest, is inseparable from the emancipation of sexuality, and the arrival of the contraceptive pill in the 60s was the jewel in the crown. Once the hobbyhorse of feminists the world over, and more than adopted in France, the pill is now the object of all doubts and irrational fears.

What has happened so that, in just two generations, a growing number of women have inexorably thrown the pill out with the bathwater?
What has happened in 50 years to turn an angel into a demon?
What has happened to make women so misinformed?
A little history to understand it...
In the early 60s, contraceptive hormones arrived in the United States. In France, it was shortly before May 68. After a year of heated debate, the Neuwirth law legalized the pill on December 19, 1967. It wasn't until 1972, when the law was still in force, that women finally got to grips with this precious achievement,

The French law of 1920 imposed severe penalties on those responsible for or complicit in advertising or providing information on contraception and abortion, in other words doctors, pharmacists, emancipated women, proselytizers or not.
All women who were sexually active within or outside marriage had an obsessive fear of pregnancy, and they were right. When you're sexually active, you're theoretically "programmed" to have twelve children over the course of your genital life. Twelve children! That puts things back into perspective. ...
Women fought for this unheard-of freedom, to be able to "make love" without consequences, to dissociate sexuality and reproduction, to control their fertility without risking unwanted pregnancy. In this sense, they were emerging from the age-old fatality of being nothing more than "wombs" devoted to procreation alone. At the time of these first pills, so ardently defended and desired, we were coming out of '68. The zeitgeist was infused with the slogans of "unhindered pleasure".
At the time, the first women to use the pill were taking doses three to four times higher than today's, with even "stronger" estrogens, and despite some very real side effects at the time, "the pill worked better".
Today, with second-, third- and fourth-generation pills (see Four generations of pills box), women benefit from much lower doses, much safer metabolically and just as effective. With the benefit of hindsight, doctors now have a better understanding of the benefits and risks of the different pills, and know which contraception to prescribe for which patient, depending on her medical history, her heredity and her particular profile (weight, risk factors, etc.). The contraindications to the Pill are well known and sought-after, as are the additional therapeutic benefits, which today are unfortunately insufficiently explained. As a result, women are becoming more and more reluctant to use the pill! After thirty years, only one woman in three uses it when she's on contraception, preferring the equally reliable IUD, but also and above all a return to natural methods that are far more uncertain and restrictive, with a 20% failure rate.
From the 2000s onwards, the Health Authorities' precautionary principle and zero risk ("Mad Cows", "Mediator") were born, and a wind of ecology began to blow over the whole of society, making us more concerned about what we ate, breathed and absorbed, demanding natural, organic and HEALTHY products. We were going to put our trust back in Good Mother Nature.
The historic turning point came in 2012, with the death of a young girl from pulmonary embolism as a result of prescribing without her family's knowledge of the thrombophilic risk, and above all, the first complaint by a young woman against a pharmaceutical company after a stroke with after-effects. From then on, the AVEP (Association des Victimes Embolie Pulmonaire - Association of Pulmonary Embolism Victims) was formed, social networks and the media went wild, and all the talk turned to the risks of the pill, while all its benefits were downplayed, a trend largely exacerbated by the political stance taken (delisting of 3rd generation pills, withdrawal of Diane from the French market) and the alarming recommendations of the French health authorities (ANSM).



Since then, the loss of confidence in the pill has only increased, as shown by the latest figures published by the Observatoire de la Santé (2016), and a June 2018 Statita survey of a thousand women reveals that use of the pill is still falling (32% of users among women who have contraception).
What exactly is in a pill?
There are currently two types of "pill":
- Estrogen-progestin pills (Combined Oral Contraceptives: COCs), now all mini-dosed, which combine two synthetic hormones, an estrogen and a progestin, generally taken 21 days out of 28.
- Progestin-only pills (often called micro-progestin-only because they contain only one progestin: POP stands for "Progestatrive Only Pill"). These pills are taken continuously, i.e. without interruption between packs. These pills are usually prescribed to women for whom conventional contraception (COC) is contraindicated.

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First-, second-, third- and "fourth-generation" pills are classified chronologically, according to when they were launched. Up to the third generation, the progestogen is of the norsteroid class, with an ever-increasing anti-gonadotropic effect, enabling the dose of estrogen to be reduced, and a weaker androgenic effect (fewer skin problems (acne, hairiness) or even an anti-androgenic effect (sought-after in acne).
- First-generation pills no longer on the market
- Second-generation pills are currently prescribed at 20 or 30 mg Ethynil Estradiol (EE); there are no longer any 50-mg EE pills on the market, the last of which was Stédiril - Third- and fourth-generation pills contain much lower doses of Ethynil Estradiol, at 20 mg or even 15 mg EE, and combine progestogens from different families with different chemical compositions that are even less androgenic (and therefore have less virilizing effects). There are also pills with natural estradiol (Zoely ,Qlaira) and since 2022 with estetrol (natural estrogen).

Which women should absolutely not receive estrogen-progestin contraception?  know and absolutely seek out contraindications
Women whose close relative (father, mother, brother, sister) or themselves have suffered from venous thrombosis, i.e. phlebitis, possibly pulmonary embolism, before the age of fifty. Of course, when a thrombophilia has been diagnosed, but even without a labelled thrombophilia (50% of thrombophilias are currently undetectable). While the risk of death from phlebitis is modest but not negligible (2%), it becomes much more worrying with pulmonary embolism (10%).
Women whose close relatives or themselves have suffered arterial thrombosis leading to stroke or infarction before the age of 50.
Especially all women at cardiovascular risk: hypertensive, obese, diabetic, with fat disorders (triglycerides, excess cholesterol). Arterial accidents are much rarer, but far more serious, with mortality rates as high as 50%!
So, after a thorough police investigation and clinical examination, the healthcare professional knows which women he can or cannot dispense with the conventional pill (COC) or a skin patch or vaginal ring (CHC = Combined Hormonal Contraception = pill + patch + ring), in search of additional benefits, or consider progestin-only contraception (POP: Progestatrive Only Pill) or even a non-hormonal contraceptive method.

Benefits women are "depriving themselves" of by refusing the pill.
The pill isn't just a contraceptive method, it's a "medicine" in its own right. And for some women, or in certain medical conditions, it's the only effective medication.
The pill makes it possible to manage your menstrual schedule (or even eliminate them without risk). It reduces the abundance of menstrual periods by transforming them into "withdrawal haemorrhage". Indeed, 30% of women suffer from heavy periods (menorrhagia), which worsen with age, and can be followed by anaemia due to induced iron loss. However, the pill (but also vaginal rings, skin patches and, of course, any hormonal approach) reduces menstrual flow by almost half, making daily life much easier and limiting discomfort, not to mention the fatigue caused by anaemia. The pill also acts on menstrual pain (dysmenorrhea) by reducing the synthesis of prostaglandins, and is the first-line treatment for endometriosis (10% of women).
In women who suffer from migraines with each menstrual period (known as catamenial migraines), COC and POP pills dramatically reduce the frequency of attacks, especially if used continuously to suppress menstruation. Remember that COCs (with estrogen) are contraindicated in migraine with aura.
COCs are also highly effective for many women suffering from premenstrual syndrome and cystic fibrosis of the breast.
The risk of rheumatoid arthritis is also reduced, and the longer you use the pill, the greater the effect. The effect is modest but significant: 20% less risk after seven years.

As for the risk of cancer? fears often unfounded

Testimonials are circulating on social networks, and like "there's no smoke without fire...". In response to these rumors and other #jarretelapilule hashtags, widely relayed by the media, the Collège National des Gynécologues Obstétriciens Français (CNGOF) reacted in 2017 with a methodical press release that takes up each allegation point by point, the full text of which can be found at www.cngof.fr .
In the case of breast cancer, the doctors' conclusion is unequivocal: no, it's not true that the pill increases risk. "The majority of studies show no significant overall increase in the risk of breast cancer in women who have used estrogen-progestin contraception". Various studies show that, if there is a stimulating effect, it develops on an already existing cancer, but it is not the pill that transforms normal cells into cancerous cells!
For uterine cancer, the results are unanimous: not only does the Pill not increase the risk of uterine cancer, it reduces it by 30% to 50%.
For cervical cancer, the data are less clear-cut and inconclusive, with other factors, such as the presence of papillomavirus, interfering with this cancer.
In the case of ovarian cancer, which is generally discovered very late in women's lives, the pill reduces the risk by 30-50%, depending on the length of time it is taken. The longer the pill is taken, the lower the risk of ovarian cancer, with a benefit up to thirty years after stopping contraception.
For colorectal cancer, the risk of tumors is reduced by 20%, and the protective effect of the pill fades ten years after discontinuation.
In the final analysis, the CNGOF's conclusion is unequivocal: the benefit-risk ratio of the pill in relation to cancer is highly favorable. "Users even show a significant reduction of around 10% in the overall risk of cancer".

What about emergency contraception? widely used since the abandonment of hormonal contraception for natural methods?

Emergency contraception (EC),or "morning-after pill", refers to contraceptive methods that a woman can use to prevent pregnancy after unprotected intercourse (IUD to be inserted within 5 days, which has the advantage of providing long-term contraception). ) or, more often, a Levonorgestrel (progestin) tablet (Norlevo® or Vikelia®) within 72 hours or ulipristal acetate (Ellaone®) within 5 days (these IUDs can be obtained without prescription and are free of charge for minors), their repetition is not dangerous, but they can lead to cycle irregularities and, of course, lack of efficacy, unlike long-term hormonal contraception.

Conclusion

Unquestionably, the "pill" does not deserve the counter-publicity it receives in the 21st century, all the more so as now, no doubt thanks to the 2012-2013 crisis, it is prescribed in a completely precautionary and appropriate manner.
Women's quality of life is greatly improved, not forgetting that for many of them, hormonal contraception is also therapeutic.

For further information.
- Consult the 2018 French recommendations on contraception at www.cngof.fr
- Book "Women, wake up". Dr Brigitte Letombe. Editions First