The Pill: Myths and Facts
FAQ: Top Questions about the Pill continued...
Bottom line: If you take oral hormones, have gotten the HPV vaccine, and—once you’re no longer a virgin—always use condoms during sex, cervical cancer is not a significant risk, in my opinion.
Who shouldn’t take the pill? There is one group of people who shouldn’t take oral hormones: those with rare clotting disorders. The pill can increase the risk of blood clots in the leg, the lung, or the brain (a clot in the brain causes a stroke).
For most people these are very small risks. But if you have a close family member who had a blood clot in the leg (called a deep vein thrombosis) or the lung (a pulmonary embolism) or who had a stroke, or if your mother had a lot of miscarriages, you may be at higher risk. Your doctor can perform blood tests to see if you have a clotting disorder that would make the pill a bad idea for you.
People who get certain kinds of migraine headaches may also be at higher risk of stroke. I had one eighteen-year-old patient who came to me for help with period pain. I started her on a low-dose pill. Soon after, she was diagnosed with a rare form of migraine that can create visual problems lasting for days. I consulted with her pediatrician and her headache specialist, and we decided she shouldn’t be on the pill. I prescribed high-dose ibuprofen instead.
Will the pill make me shorter? OK, this isn’t really a frequently asked question, since most of my patients don’t know about the pill’s effects on bones. But it’s pretty interesting, so I slipped it in here. Remember, in the last chapter I mentioned that estrogen plays a role in your growth? It helps you build strong bones. But, ironically, it also helps close the growth plates in your bones during your teens. So if you take oral hormones—which include estrogen—during the first year or two of your period, your growth plates may close earlier than they would otherwise, and you might not reach your full height. So instead of being 5 feet 6 inches, you might top off at 5 feet 5 1/2 inches. To avoid that I usually don’t prescribe oral hormones for girls who’ve only recently started their periods. Still, some situations are so severe that oral hormones do make sense, even for girls who’ve only been menstruating for a year or two—but only for a brief period of time.
Overall, oral hormones are incredibly safe. If you’re generally pretty healthy (aside from your period problems, that is), the risk of dying from taking an oral hormone is lower than that of dying in an automobile accident. You probably get in a car every day because you have a long way to go and the risks are small. Oral hormones are similar. For most girls with severe period problems, the big benefits outweigh the smaller risks.