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The Pill: Myths and Facts

FAQ: Top Questions about the Pill continued...

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.

Not a License for Sex

Lori’s mom told me privately that she was afraid that putting Lori on oral hormones would give her the green light for sex. I reassured her that’s not the case.

“You know, fear of pregnancy actually isn’t the major reason girls decide not to have sex. They wait or don’t wait because of peer pressure, the values of their friends and family, concern about their reputation, or just plain good judgment. Being on the pill probably won’t affect her decision one way or the other.”

I also remind parents that this is a great time to revisit the “what you didn’t learn in sex ed” discussion. Whenever I prescribe oral hormones for girls who are virgins, I tell them it’s incredibly important to their future health to wait until at least eighteen to have sex—and even longer is better. I also remind them that the pill doesn’t prevent sexually transmitted diseases. (You should see their faces when I open my huge medical textbooks and show them actual photos of women with herpes, genital warts, syphilis, and pus-filled blisters. It makes quite an impression.)

And, of course, I remind them that even if they never, ever miss a single pill, one in one thousand women who take the pill will still get pregnant. Of course, most women and teens do miss a pill now and then: In that case, 8 percent of women will get pregnant on the pill. You heard me. That’s eight out of one hundred. I’ve delivered several babies who were “pill accidents.” I even know several women doctors who got pregnant this way. If it can happen to doctors, it can definitely happen to you.

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