CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES

This chapter covers the different related literature and studies, which help the researchers understood the study. It introduces the different ideas, concepts and theories taken from various sources such as: books, journals and magazines.

Local Literature Pills have been the subject of lively debates among the health, religious and socio political sectors of the country. omen are also becoming actively drawn into discussions and

decision!making on fertility care matters which affect their health and lives. "ccording to te#tbook of obstetrics $san Pedro %&&&' as used by (ovely )amacho and act. )ontraceptives pills have enabled women to control their fertility and space in their pregnancy. *pacing birth at least two years apart has improved both the health of mother and children. It prevents the release of an egg during the month cycle. " woman canny gets pregnant if she does not ovulate because there is no egg to be fertilized. In the wide view, family planning is not solely concerned with provisions of accessible, affordable and response means to regulate one+s fertility. It also seeks to empower both women and men to have a better life for themselves, their family and their communities through

responsible parenthood "ccording to te#tbook current social Issue $,apura -../', the Philippines family Planning Program $P0PP' responds to the health needs of both mother and child, it also addresses go the whole family and that of nation. The program focuses mainly an effort to improve and maintain the health of mother and children through life!saving measures such as proper spacing of pregnancies and proper nutrition. The goal of family planning is not entirely to limit the size of the families. It also seeks to prepare couples for responsibilities of having a child. e should

therefore develop the proper attitudes toward se# and cultivate self!discipline. "fter all are affected by the result of rapid population growth. "ccording to 0amily Planning $1e (eon %&&-' tiger are many methods of family planning known to medicine today. They all provide protection against unwanted pregnancy. Pregnancy is avoided if the male sperm does not meet the woman+s mature egg or if the fertilized egg does not become implanted in the lining of the uterus. hen you intentionally do something

to prevent such a union, you are practicing 2birth control2. The most common method of contraception prevents the getting together of the egg and the sperm. )ontraceptive pills prevent the ovaries from realizing eggs and the lining of the uterus from forming. "ccording to 3mergency )ontraceptives $%&&/'. *ince contraceptives are banned by the )atholic )hurch and the government has ceased free distribution of contraceptives in health centers $despite the population boom' most of the public remain clueless in family planning or from at least having kids years apart.

0or most women, the 4orning after Pill is still unheard of. 5ou can consult any gynecologist or family doctor regarding contraception concerns. I highly recommend that for any piney or woman, you have the right to good health care and proper information. " good women+s health care clinic is 0riendly )are )linic located in *haw 6oulevard, 4andaluyong and 6aclaran in Pasay )ity. "n average doctor+s visit will cost you P%%&, very affordable than hospital rates. "ccording to 1iet Pills $%&&/'. in the Philippines, *lenda is not only a diet pill, but also comes with an e#ercise routine. The dancing diva 7alerie )oncepcion promotes *lenda, and is very motivating. *lenda is made up of three capsules to be taken at different times of the day called *upergreens, 0at 6urner and )arbo 6lock. 8esveratrol, the main ingredient in *lenda, helps fat turn into energy, purportedly hastening the loss of weight. 0itrum is one of the top bestselling diet pills. In the Philippines, there is a before and after advertisement that shows a chubby actress who undergoes sensational weight loss and admits that she had been taking 0itrum. 0itrum works, according to many users, because it boosts metabolism and makes you feel the need to be more active9 it also makes you sweat more. :enical is another very popular brand in the Philippines, perhaps because of a 0ilipina actress who used it and was able to keep the weight off. 4ost 0ilipino dishes are ;uite oily. It works directly on your digestive system and blocks enzymes called lipases from breaking down fats. The undigested fats that are not absorbed into the body are eliminated from the body. <nlike some over!the!counter diet pills, :enical is a prescription medication you taken when eating any food that has fat.

Foreign Literature =ral contraceptives available in <* reseacher believe that oral contraceptives may influence cancer risk. )urrently, teo types of =ral )ontraceptives are available in <nited *tates. The most commonly prescribed oral contraceptives contains two man!made versions of natural female hormones $estrogen > progesterone' that are similar to the hormones the ovaries normally produce. This type of pill is often called a 2combiled oral contraceptive2. The second type of oral contraceptive available in the <nited *tates is called the minipill. It contains only a type of progesterone. 6ecause medical reseach suggests that some cancers depend on naturally occuring se# hormoes for their development and growth, scienstists have been investigating a possible link between oral contraceptives use and cancer risk. 8esearchers have focused a great deal of attention on oral contraceptives users over the past ?& years. This has produced a wealth of data on oral contraceptives use and development of certain cancers, although result of these studies have not always been consistent. The risk of endometrial and ovarian cancers is reduced with the use of oral contraceptives. "ttitudes toward oral contraceptive use among women of reproductive age. 1espite the effectiveness of oral contraceptives $=)', their popularity differs across populations. "ttitudes are a significant factor that influence =) use.This report systematically %/ reviews on attitudes toward =) use among women. The matri# method was used to review the literature. "ffective, cognitive and behavioral components of attitudes were analyzed, including satisfaction, safety,

fear@ an#iety, and inconvenience. In general, negative attitudes still prevail across countries. Positive attitudes are more prevalent in 3urope. 3ffective counseling and education are needed for those negatively disposed toward =) use for favorable user compliance strategies for longer continuation with =) regimen must be provided. Population resources and environment $3hrlich %&&&' many birth control practices are as old as recorded history, old testaments contains obvious references to the practice of withdrawal or contains obvious references to the practice of withdrawal of coitus interruptus. The ancient 3gyptian used crude barriers to the cervi# made from leaves cloths and even blocked the cervical canal with cotton fibers. The ancient Areeks practices population control through their social system as well as through contraception, they discourage heterose#ual marriage and encourage homose#ual relationships, especially for men. The action may be distasteful to most of us, but it undoubtedly worked. the penis sheath dates bask at least to the middle ages, when it has made of linen, fish skin+s or sheep intestines. The latter version is still in use today, although it has largely been superseded by the cheaper, more popular, rubber one. 1ouching, the flushing of vagina with water or a solution immediately after intercourse had a similarly long history in 3urope. The modern family planning movement began in the <nited *tates and 3ngland as an outgrow of the women+s right campaign. 0amily Planning in the 1)+s $3hrlich %&&&' at the time of the industrial revolution in 3ngland on early advocate of limiting the size of the families through contraception was labor leader 0ranci+s place. Bis original treatise. Illustrations and proofs of principle of population, was published in -.... It was followed by a series of handbills that urged birth control in the interest

of better economic and physical health, also decided various contraceptive methods.

Local Studies " 8ight to )ontraception in the Philippines The New York Times ran an eye!opening story about a bill in the Philippines that would re;uire governments down to the local level to provide free or low!cost reproductive health services, including condoms and birth control pills. *hould the bill, called the 8eproductive Bealth 6ill, pass, it would effectively nullify the complete ban on birth control in 4anila )ity that the )enter has been fighting since %&&/. The billCs language clearly states that any legislation inconsistent with the federal law will be repealed. In %&&/, a case was filed by %& 4anila citizens claiming that the policy has violated their human rights and should be revoked immediately. The case, Lourdes Osil et al. v. Mayor of Manila, is based directly on an investigation conducted by the )enter in collaboration with local partners (ikhaan and 8eprocen. The case was originally filed in the Philippine )ourt of "ppeals, but was dismissed on ;uestionable technical grounds. hen a re;uest to reconsider was denied, the petitioners filed

an appeal before the *upreme )ourt which also dismissed the case on technical grounds. The petitioners are continuing their battle and have filed the case in the 8egional Trial )ourt where it is currently pending. The 8eproductive Bealth 6ill is a critical opportunity for 0ilipino legislators to bring the

Philippines back into compliance with its binding human rights obligations D and finally cease the horrific war on women in 4anila )ity. The )enter continues to press the Philippines at the <E and on the national level to pass the 8B 6ill. 6y : Philippine time 4ore about 4anilaCs )ontraception 6an "bortion is illegal in the Philippines, and 4anila )ity sought to make the situation worse when former 4ayor ,ose F(itoG "tienza passed a blanket ban on contraception in %&&&. This ban effectively prohibits 4anila )ity women D especially poor women D from accessing all forms of modern contraceptives, condoms, and information necessary to protect their reproductive health. "s a result, women are unable to prevent pregnancy, even when it would jeopardize their lives, health, or ability to feed their families.

0or a woman who cannot afford contraceptives and is forced to have more children that she wants or can afford, the harsh effect of the ban is felt every day D when she is forced to limit the amount of rice she can provide for her children, when she is abused by her husband for declining se# to avoid pregnancy, or when she is forced to endanger her health with high!risk pregnancies that she could not prevent. International legal bodies have repeatedly condemned the grave and systematic impact of the 4anila )ity ban. 5et the national government has done nothing thus far to mitigate this impact or strike down the ban.

6y : Philippine time It+s lunchtime in 7itas, the sprawling slum built on the )ity of 4anila+s garbage dump. 0lies swarm as 6ing, a H?!year!old mother of five, prepares a meal of salted rice for her children. hile she feeds them, her husband sifts through the mounds of grease!stained cardboard bo#es, plastic bags, and broken glass that crowd their home. Be+ll sell his rotten harvest for about IH.J&. 0or their family of seven, thatCs J& cents per person, per day. The arithmetic is simple, 6ing says. 2 ith every child I have, there is less rice each. I canCt give them all a good life.2 6ing planned on having one child, but birth control was never an option. 0or much of the last decade, the )ity of 4anila, one of 4etro 4anila+s semi!autonomous municipalities, has engaged in a campaign against modern contraception. In %&&&, 4ayor (ito "tienza issued an order effectively banning birth control from city!funded clinics. 3ight years and a new mayor later, the ban persists. The city+s affluent minority buys birth control from private clinics or procures condoms on the sly, but poor women, like 6ing, go without. *he+s hoping that will change. 6acked by local women+s groups and the )enter for 8eproductive 8ights, 6ing and a group of -. of 4anilaCs poorest residents have taken the city to court. Their potentially precedent!setting lawsuit contends that the ban damages womenCs health and violates their rights. They+ve marshaled compelling evidence: a relative increase in maternal deaths, reports of botched back!alley abortions, and children born into families that can+t afford to raise them. 2The conse;uences are far!reaching,2 says "ya 0ujimura!0anselow, a legal adviser to the )enter for 8eproductive 8ights. 2In the -J years we+ve been involved in legal reform for reproductive rights, this is one of the most devastating bans weCve ever seen.2

<nlike most countries in "siaDand most countries around the worldDthis majority )atholic nation of some .& million has moved away from birth control. Eational funds aren+t used to buy condoms or pills, and, though local governments are technically free to buy them, many like the )ity of 4anila won+t. 0or years, international organizations filled the void. 6ut that+s changing. <*"I1, once a leading supplier of condoms in the Philippines is phasing out their contraception program, and some worry other groups will follow. 2They are saying that contraceptives should be sold, not distributed for free,2 says *unset 4ukherjee, a representative for the the <nited Eations Population 0und. FThis is fine, but there is no safety net for the poor.2 In lieu of condoms or pills, government and church authorities promote what they call 2natural2 family planning. omen are advised to purchase a thermometer, monitor their cycle,

and abstain from se# on all but their least!fertile days. 6ut abstinence is a tough sell and people, it seems, arenCt buying it. The country+s population is growing at a rate of about %.HK per year, outpacing increases in agricultural production and economics gains. Poor families, like 6ing+s, are growing fastest. The country+s poorest residents have an average of si# children. The richest, meanwhile, have two. "nd it+s not simply a matter of choice. "sked how many children they+d like to have, Philippine women, rich and poor, say they+d like two. 6ing+s neighbor *heryl, was one of those women, but, at %J, she+s already had five. Three survived infancy. 2 hat we earn here is not enough for children,2 she says. The architects of the ban deny a link between population and poverty. 2I reject the notion that we are poor because we are plenty,2 says former mayor "tienza. 2Poverty is caused by mismanagement, not by the number of people.2 BeCs partly right, of course. 3ndemic corruption and sluggish agricultural production helps keep the Philippines poor. 6ut government statistics

and a host of studies show that population is part of the problem. "ccess to nutrition, education and employment decreases dramatically when a family outgrows its means. 6ut the Philippines+ birth control debate doesnCt turn on economics, which often makes it difficult for human rights activists and policymakers to find common ground. Aovernment and church leaders frame the discussion in 4anichean religious terms, as a battle either for or against human life. "rchbishop Paciano "niceto, who chairs the influential )ommission on 0amily and (ife for the )atholic 6ishop+s )onference in the Philippines, calls birth control advocates 2propagandists of a culture of death.2 *e#, he says, is a privilege and should always be open to the transmission of life. 0ormer mayor "tienza agrees. 0amily planning advocates have been 2brainwashed2 by the est, he says. Bis ban succeeded, he adds, by teaching 4anila+s 2innocent

and ignorant2 women 2true2 0ilipino values. This attitude riles advocates for modern contraception, who maintain there is nothing anti!0ilipino about birth control. Indeed, a survey commissioned by the Philippine (egislators+ )ommittee for Population and 1evelopment found the majority of 0ilipinos are actually in favor of it. In their %&&L study, .&K of respondents said they+d vote for a political candidate who supported the use of modern contraception. "nd many women donCt see birth control as anti!)atholic, either. (ourdes =sil, a mother of seven who joined the lawsuit, says family planning does not violate her )atholic beliefs. 2I donCt think it+s a sin,2 she says. 2It+s different than abortion.2 0or her, this is a matter of rights, not religion. *ince they filed suit in ,anuary, the petitioners say they+ve seen small signs of change. =utreach workers say it+s getting easier for them to provide family planning services independently. "nd, though he+s yet to speak out against the ban, 4anila+s new mayor, "lfredo

(im, has met with pro!family planning groups and e#pressed some willingness to collaborate with EA=s. 8oberto "dor, e#ecutive director of the 0amily Planning =rganization of the Philippines, says the suit comes at an opportune time. Be sees it as part of a nascent nationwide push for reproductive rights. 2 e+re hoping this will create a bandwagon effect,2 he says, 2 e think this could be noticed by e#ecutives at the highest levels of government and church.2 0or 4anila+s poorest families, that change can+t come soon enough. 8ead more: http:@@www.time.com@time@world@article@&,/J..,-/-%%J&,&&.htmlMi#zz-A(bN%mu< 6y:3mily rauhala@manila

"dvocating for 8eproductive Bealth in the Philippines, 2009 Beidi Tuason, 4PB )andidate (ikhaan )enter for omenCs Bealth

Beidi worked with a womenCs reproductive health EA= in the Philippines called (ikhaan enter for omenCs Bealth. (ikhaan focuses on the provision of reproductive health direct

services, as well as advocacy, policy, research, and community organizing with poor and marginalized women in the Philippines, a country in which contraception is not widely available and abortion is illegal, and more than half a million $usually unsafe' abortions occur. "s the 8eproductive Bealth 8esearch, Policy, > "dvocacy intern, she worked on various projects including: assisting in the collection and analysis of womenCs stories of illegal and unsafe abortion for use in a (ikhaan report and documentary about abortion in the Philippines9 the production of technical assistance and policy educational sheets for use in the advocacy for the passage of the 8eproductive Bealth 6ill in Philippine )ongress9 conducting interviews with

community health workers, community leaders and (ikhaan staff about 8B issues during regular site visits to communities9 and assisting with written and visual documentation of (ikhaan events, trainings, and conferences. " young girl, 6ata, holds a sign advertising the free reproductive health services offered by (ikhaan )enter at the orld Pop 1ay 8eproductive Bealth 0air, Philippines . 6i#by Intern

Beidi Tuason spent her summer with (ikhaan as the 8eproductive Bealth 8esearch, Policy, > "dvocacy intern, where she worked on various projects including: assisting in the collection and analysis of womenCs stories of illegal and unsafe abortion and conducting interviews with community health workers, community leaders and (ikhaan staff about reproductive health issues during regular site visits to communities. Aovernment and contraception 6y 8ina ,imenez!1avid Philippine 1aily In;uirer 0irst 0iled <nder: Posted omen, Population, Aovernment %%:HO:&& &O@&J@%&-&

4"EI(", PhilippinesDIf you listen to officials of the waning "rroyo administration, outgoing President Aloria 4acapagal!"rroyo included, youCd get the impression that 0ilipino women have no problem planning their families or getting their hands on the contraceptives they need. To sum up their arguments, they say that contraceptives are legal in the Philippines, in fact, women and couples need only visit their local health )enters where they can get them either for free or at subsidized prices. True, ever since President "rroyo took office, no national funds have

been earmarked for the purchase of family planning supplies. 6ut this is only because health services have been devolved to local government units, who have been given the responsibility to buy contraceptives and make these available to the public. 6ut these arguments mask several uncomfortable Ftruths.G " study titled F0acts on 6arriers to )ontraceptive <se in the Philippines,G conducted by the Auttmacher Institute and local health advocacy group (ikhaan, points out that over the past decade, contraceptive use has hardly increased among 0ilipino women. "nd yet, the study goes on, Fwomen are having, on average, about one more child than they would like.G Eational surveys show that women aged -J!?. want to have %.? children but end up having, on average, H.H. The situation appears even direr if we break down the statistics according to income level. The poorest women have about two more children than they want, while those in the highest income level have the number of children they want $generally one or two'. =nly ?percent of the poorest women use or can afford contraceptives, compared with J& percent of the wealthiest. "nd while in theory the local governments are supposed to have taken on the burden of meeting the Fcontraceptive demandG of their constituents, the reality is that Flocal governments do not receive sufficient funds under the revenue sharing scheme to fully meet this responsibility.G

The irony is that the 1epartment of Bealth has taken on the burden of procuring drugs and supplies for tuberculosis control, immunization and malaria which it distributes to the (A<s. It could very well purchase contraceptive supplies, but only if Fit gave priority to family planning services.G

Philippines: )ontraceptives as (ife!savers 6y: Perla "ragon!)houdhury, omens 0eature *ervice

4ina was too poor to buy pills and too powerless to say no to her husband whenever he came home drunk. 2I would always give in,2 she said. 2=therwise, he might have created a scene and disturbed my employer, "te )ris, who took us all in, including my son, when I applied as her helper.2 4ina eventually became pregnant but prioritised the schooling of her son over prenatal care. *he got access to health care only in her seventh month and only when a neighbour referred her to the nearby )ommunity Bealth )are )linic of the 0amily Planning =rganization of the Philippines. 2The medical personnel there were really alarmed when they saw me,2 recalled 4ina. hen her time came, 4ina was rushed to a nearby birthing clinic and she remembered

that her employer had to pay for everything. 6ut even before 4ina could celebrate her daughter+s second birthday, she became pregnant again. The pregnancy forced her to ;uit her job and return to her hometown. *he gave birth to her third child in the public ward of the district hospital. 4ina is just one of the poorest HJ per cent of 0ilipinas who make up JH per cent of the unmet

need for contraception, says ,osefina )abigon, Ph.1. of the <niversity of the Philippines Population Institute $<PPI'. " demographer, )abigon collaborated in a research study with the Auttmacher Institute, a <*!based organisation advancing se#ual and reproductive health worldwide through research, policy analysis and public education. 0or their research, the team used the Philippine %&&& census data9 referred to the %&&H Eational 1emographic and Bealth *urvey $E1B*' as well as the costings from the Philippines Bealth Insurance )orporation for various years but mainly for %&&/. 1ata from the 1epartment of Bealth in the form of hospital reports on discharges for -..L!%&&% was consulted to establish trends. " survey of health professionals, including those from non!government organisations was also undertaken. 1etails of the study, entitled +4eeting omen+s )ontraceptive Eeeds in the Philippines+,

were presented earlier this year. "ccording to )abigon it revealed that in %&&/ there were H.? million pregnancies in the Philippines, of which -./ million, or J? per cent, were unintended. =f such unintended births, -.% million were mistimed or unwanted, and JO&,&&& were induced abortions. *he also noted that in most regions, unmet need is concentrated among poor women and that it is highest $/L per cent' in the "utonomous 8egion of 4uslim 4indanao $"844', which includes 6asilan. In 3astern 7isayas, which includes 3astern *amar, it is L/ per cent and in the Eational )apital 8egion, which includes 4anila, it is -/ per cent. "t the 0orum, 1r ,unice 4elgar, e#ecutive director of the women and health group (ikhaan ! one of the partner organisations of Auttmacher Institute in the study ! spoke about the e#periences of poor women from these places. Eot very far from 4ina+s former place of employment ! Nuezon )ity ! is 4anila, where

4ayor "lfredo (im has not revoked an e#ecutive order of his predecessor that favoured natural family planning over artificial methods. 4elgar cited a case from a study by (ikhaan on the social impact of former 4ayor ,ose "tienza+s e#ecutive order: T.8., H., has never used contraceptives and got pregnant. *he and her baby almost died because of obstetric complications. *he faced barriers to family planning in terms of poverty and the twin lack of a government programme and of funding for family planning. "nother resident interviewed by (ikhaan for the study e#plained, 2I want to use family planning to limit the number of my children. " mother is the one who has to search for food, school allowance and everything else, on top of doing the household chores. I feel sorry for my kids, I+m full of pity and can+t help crying when one of my children is sick and I can+t buy medicines.2 " third interviewee talked about domestic violence. 24y husband and I would ;uarrel when I refused to have se# for fear of getting pregnant. Be suspected me of having an affair and would hit me on the thighs. Then he left and didn+t communicate for a year. I went to my sister+s with my si# children and supported them and myself by working as a laundrywoman,2 narrated the young mother. In 3astern *amar, (ikhaan had a study on maternal health, which documented how 6.(., H/, died of bleeding when she gave birth to her ninth living child, who had to be adopted by a neighbour when her husband could not take care of child. 26.( was too poor to buy pills after getting an initial pack,2 recalled 4elgar. 2Ber family survives on slash!and!burn farming and lives an hour away from the barrio $village'. The outreach of health services is poor where she lives.2 In a similar study in 4indanao, (ikhaan saw obstetric complications in four women from 6asilan, on an island H& minutes away by boat from

the nearest health centre. 2Three are on!off users of contraceptives and one is a non!user,2 said 4elgar. 2They have one to -% children, what with inade;uate supply of contraceptives. They have had +near!misses+ while giving birth. =ne had an inverted uterus, another had eclampsia and profuse bleeding, and the third had prolonged labour,2 she revealed. *tudy authors ,ac;ueline 1arroch, *usheela *ingh and Baley 6all ! all of them attached to Auttmacher Institute ! and )abigon have calculated the funding re;uired to provide modern contraception to all women who are at risk from unintended pregnancies in the country. They argue that the annual budget for family planning needs to increase from PhP -.. billion $<*I-P PhP ?/.-H' to PhP ? billion. "ccording to )abigon, the amount is not prohibitive. *he e#plained, 2The medical costs linked with unintended pregnancy would fall from PhP H.J billion to PhP O&& million. Increasing investments in contraceptive supplies and services is especially critical to improving the health of poor women, who face the greatest barriers in achieving the family size they desire. 3nsuring contraceptive access is not only wise fiscal policy but also has a profound effect in improving public health.2 Poor women will gain if donors and the Philippines government fund contraception concluded, the study argues. *haron )amp, Ph.1., president and )3= of Auttmacher Institute, said, 2The initial investment in contraceptive services of PhP ? billion may seem great but there is a much higher cost associated with unintended pregnancies, including treating the conse;uences of unsafe abortion.2 People in the Philippines no longer get free or affordable contraceptives. It is to change this situation that councillors like ,oseph ,uico of Nuezon )ity, who has braved threats of

e#communication from the church, have pushed for the full range of contraception. (awmakers like 3dcel (agman of "lbay are also fighting for a national policy on reproductive health. )oncluded 4elgar, 2 hy should government spend PhP? billion for contraceptionQ 6ecause contraceptives prevent %&!HJ per cent of maternal deaths $<E0P"'. 6ecause of social!economic benefits. 6ecause it will take only &.%/ per cent of the PhP -.? trillion budget for %&&.. 6ecause it is the moral and ethical thing to do.2 omens 0eature *ervice covers developmental, political, social and economic issues in India and around the globe. To get these articles for your publication, contact www.wfsnews.org website. 0* at the

Foreign Studies Internal ,ournal of Aynecology and obstetrics $*chenker %&&&' as used by (ovely )amacho and etc. The dominant attitudes of the major religious communities discourage progress in understanding of reproduction and attempts of its control. In ,udaism, se#ual relations are a good thing with marriage. In fact there prescribed two separate commandment of Aod. =ne is to be fruitful and multiply, the other is that a man must not hold from his wife her food, her clothing, or her conjugal rights. )ontraception was permitted under certain circumstances. In 8oman )atholic, the primary purpose of marriage is procreation, contraception is a sin multiply and populate the earth.

International ,ournal of Aynecology and =bstetrics $6ernstein %&&&'. "n important theme of the current population consensus is the empowerment of individuals for free and informed decision making, health, pertaining to the reproductive system, reproductive health emphasizes primary health care and recognizes the implications for individual rights to ensure a satisfying and safe se# life. 8eproductive health is not merely new terminology to project a different image of family planning9 it is a different and broader needs based approach with family planning has been well established on the international population conferences need in 6ucharest in -.L?, and 4e#ico in -./?. The concert of reproductive health was developed through e#perience with family planning as a part of maternal and child health. International ,ournal of Aynecology and =bstetrics $*heth %&&&'. There is no ;uestion that contraception is the cornerstone of the fight to reduce abortion. "lthough the relationship between contraception and abortion is fairly comple#. 1ata from several industrialized countries tell us that, where contraception is well established and utilized by the vast majority of people, where it is associated with a proper se# education, the need to resort to an abortion

Relations i! o" Present and Past Studies o" #irt Control Pills

6irth control pills do not cause weight gain in womenDstudy$by 5ashika kapoor R ,anuary %-, %&--' omen who think that taking birth control pills or the oral contraceptives may make them put on weight need to rethink. " novel <.*. study negates the popular belief and claims that birth control pills are not associated with weight gain, so women need not worry. The present study was initiated by a group of researchers headed by 1r. "lison 3delman, a physician in F6irth control pills are the most common method of contraception used by "mericans, in addition to being used by more than -&& million women worldwide. The pills are greater than .. percent effective in preventing pregnancy if taken correctly and consistently,G said the lead researcher. F)oncern about weight gain is one of the main reasons why women may avoid or discontinue birth control, which in turn places them at greater risk for an unplanned pregnancy,G he added. 0or the study, the researchers e#amined the rhesus maca;ue monkeys at the =regon Eational Primate 8esearch )enter for a period of eight months, during which they were given the contraceptives, similar to those taken by humans. The primates were divided into two groups. hile the former consisted of monkeys who

were obese, the latter had ones with normal weight. This breed of the monkeys was chosen, as their reproductive system is similar to that of human beings.

"fter monitoring the weight, food consumption, activity, lean muscle mass, and the body fat of the study subjects, the researchers observed that the obese group lost /.J percent of their weight, as well as -% percent of their body fat, while the normal weighing group members reported putting on some weight. 6enefits of birth control pills as of the recommendations of the <.*. )enters for 1isease )ontrol and Prevention, birth control pills were associated with many health benefits. FTaking oral contraceptives makes women about J& percent less likely to develop ovarian and endometrial cancer than those who have never used them. In addition, contraceptive use does not appear to increase a woman+s risk of breast cancer,G a )1) report said. The study researchers noted that if women were gaining weight with intake of the oral contraceptives, it could be something else that was contributing to the e#tra calories. This study would be published in the 0ebruary issue of the journal Buman 8eproduction. the 1epartment of =bstetrics and Aynecology at =regon Bealth > *cience <niversity. 6reast cancer has never been conclusively proven or disproven as a cancer caused by birth control pills. There have been a multitude of studies that contrast. " study conducted by the )ollaborative Aroup on Bormonal 0actors in 6reast )ancer showed that women are at a slightly elevated risk for breast cancer if they meet certain criteria, such as beginning to use the pill as a teen. 0urther research by this group shows that once a woman stops taking the pill, her risk for developing breast cancer falls back to normal $such as if they had never taken the pill' within -& years.

In contrast, was research conducted by the

omen+s )ontraceptive and 8eproductive

3#periences $ omen+s )"83'. This study was smaller than the study above, but still significant in numbers. This research showed that both current and former use of the pill did not increase the risks for developing breast cancer. hen the E)I did their own study, the results showed that women were at risk for breast cancer if they used the pill. omen in this study were asked when they last took the pill. The

results showed that women who had used the pill within the last five years were at an increased risk for breast cancer. eb41, a site that gathers current health research and offers it in consumer friendly doses, is sketchy on the pill and breast cancer. "ll they+ll say is maybe you should take it, and maybe not. 24aybe2 is not very scientific, but when it comes to breast cancer and birth control pills, at the moment, that+s all we+ve got. *hould you take birth control pills is a personal ;uestion. (ike any medical drug, you need to weigh the risks of taking the pill against the pros of taking the pill. Eot to mention you also should consider other birth control pill side effects and learn about the various birth control pill brands before making a decision. 5our health care provider can discuss all the pros and cons of the pill further with you and help you decide if your lifestyle choices make the pill a smart or not so smart choice for you personally.

3ven when you have all the facts about birth control pills and cancer, it can still be confusing. Taking the pill should never cause you ongoing and unneeded stress due to worries of what problems the pill may cause. If you have constant worry about the pill, you may want to look into other birth control methods. Initial "uthor:$ ,ennifer )hait ' 2I have been taking birth control pills for about si# months now. I am thrilled at the idea of not becoming pregnant, however, my problem is tremendous weight gain as a result of water retention. I have e#perienced no increased appetite, however my breasts are a full cup size larger and I feel that I have an added layer onto my body that makes me very uncomfortable. Is there anything that can be done about this problemQ2 "nonymous. 6efore we know if there is any way we can treat weight gain associated with oral contraceptives, we need to know if birth control pills cause fluid retention and by what mechanism, do they cause increased appetite and how, and do they cause temporary or long term weight gain by those or any other mechanismsQ ith studies of recent low dose oral contraceptives, the whole premise as to whether there is any change in weight at all with beginning oral contraceptives is in ;uestion $-'. This and other studies indicate that, on the average, women do not gain weight because of the pills. 8emember this means that if J!-&K of women report weight gain when starting oral contraceptives, there is an identical J!-&K of women who gain weight even though they did not get active birth control pills. In other words the weight gain with pills was coincidental but not a

cause and effect. e know from older birth control pills studies, however, that weight gain was a problem both from fluid retention and from more fat deposition so we need to look at what was learned from those studies because those factors may be active in some women who are sensitive to them even at today+s low pill hormone doses. 1o most women gain weight when starting on oral contraceptives and if so how muchQ 0or the most part, older studies using higher dose pills tend to show an average of about J lb weight gain using pills. =ne study looked at adolescents who were using 1eproProveraS $14P"' for contraception and compared them to other teens using birth control pills $-'. They found that after one year of contraception, the average weight gain was O.O lbs $H.& kg' in the adolescents using shots $14P"' and J.H lbs $%.? kg' when using oral contraceptives. 4ore importantly, only LK of pill users gained more than -&K of their body weight while %JK of the 1epoProveraS users gained more than -&K. If you just look at the average weight gain of O.O lbs vs J.H lbs, you would conclude that 14P" had only a slightly higher weight gain than pills. The fact that these averages include -/K more woman who gained greater than -&K of body weight can be hidden by average weight changes. Thus 1epoProveraS has a greater side effect of weight gain than oral contraceptives. In another study with a fairly high dose pill $J& mcgm' from %& years ago, investigators found an --.?K weight increase of over ?.? lbs $%.& kg' but also a -?.HK incidence of over a ?.? lbs weight loss on the same pill $-'. In other words there was just as much weight loss as weight gain. This finding could be interpreted as the pills cause no overall weight change in woman on

the average, but an alternative e#planation is that some women get nauseated from pills and have a net weight loss while the others who did not get nauseated gained a substantial amount of weight. 1o oral contraceptives cause water retention and how muchQ 3strogen in high doses is known to cause weight gain especially that due to fluid retention $-'. The more estrogen there is in a pill, the more tendency to gain weight such that a J& mcgm pill will result in more weight gain than a HJ mcgm pill $-'. The mechanism of action is probably direct stimulation by the estrogen in pills of kidney substances called renin!angiotensin that cause water retention. The water retention then causes sodium $salt' retention. " lower estrogen level pill, e.g., %& mcgm, will help reduce weight gain due to fluid retention.This was confirmed in a more recent study with H& mcgm pills in which there was essentially no difference in weight gain or weight loss between the placebo group and the oral contraceptive group $-'. "gain, however, H&K of these women had a weight gain of more than - lb but the net result was the same in the control group. Those who did have weight gain had increased fat but no difference in fluid retention amounts indicating that fluid weight gain may be less of a problem with the newer, lower estrogen pills. 1o birth control pills stimulate your appetiteQ There have been reports through the years, especially with the older, higher dose pills, of adverse effects on insulin resistance $-'. 3ven recent studies seem to indicate that current pills can raise insulin levels $-, -'. Insulin resistance is a condition in which insulin levels rise in response to carbohydrates and

drive all energy into the fat cells and essentially prevent weight loss even with dieting $-'. Eot all women are susceptible to insulin resistance and thus not all women gain weight using oral contraceptives. Those that have a tendency to abnormal glucose metabolism, however may be the ones who gain weight. If a woman gains weight upon starting oral contraceptives and there are not other e#planations, she should be checked out for possible insulin resistance. "re there other mechanisms by which pills cause weight gainQ In one study of pills, a formulation containing desogestrel as the progestin and slightly less estrogen had significantly less weight gain when compared to a pill containing norethindrone $=rtho Eovum L@L@LS' $-'. This may imply that the specific progestin has a role in weight gain, possibly through a lesser degree of insulin resistance. =r it could be the combination of lower estrogen and the specific progestin but in any case, there was less weight gain. )urrently marketed pills with desogestrel as the progestin are 1esogenS and =rtho!)eptS. hat can you do if you have weight gain on the pillsQ <sing the lowest possible estrogen containing birth control pill should minimize weight gain and swelling from water retention. )urrent %& mcgm pills which are the lowest estrogen doses available are: "lesseS (evliteS (oestrin!0eS 4ircetteS If you are not taking one of the lowest dose pills, ask your physician or health care provider to switch you to one of the lowest dose pills, especially if you are having any weight gain or fluid retention symptoms. "ny weight gain after starting pills of more than JK of body weight may be a signal of a

woman+s tendency toward insulin resistance or abnormal glucose metabolism. ith this amount of weight gain associated with an oral contraceptive, I would suggest the woman be evaluated for possible insulin resistance. If this condition is present, she will have to adopt a low carbohydrate diet. *imple sugars in any amount and high carbohydrate only snacks or meals will negate all other dieting efforts on a daily basis and frustrate any long term ability at weight control. $0rederick 8. ,elovsek 41, 4*'! http:@@www.wd#cyber.com@ncontr--.htm 6irth control risks for women with heart defects 6y $"my Eorton' E3 *ep %H, %&-& -%:&%pm 31T $8euters Bealth' ! omen with congenital heart disease need to be cautious about pregnancy and 5=8T U Thu

birth control choices because some options can increase heart risks, but many are unaware of the concerns, a new study suggests. The research involving JHO Aerman women born with heart defects found that nearly half had not been counseled about their risks related to contraception and pregnancy. hat+s more, of

the women with contraindications to using birth control pills, %& percent were currently taking them. The findings point to a need for greater awareness among both women and their doctors of the risks certain contraceptives present for women whose hearts are already compromise, researchers report in the "merican ,ournal of )ardiology. 4any women with heart conditions can safely become pregnant or use contraceptives to prevent pregnancy. 6ut certain severe congenital heart conditions raise the risks both of pregnancy complications and adverse effects from various birth control options.

In the Aerman study group, roughly one third of the women had contraindications to using birth control pills containing estrogen and progesterone, which can cause blood clots and raise blood pressure in some users. That included women with conditions considered 2absolute2 contraindications to using the Pill, such as severe heart failure9 cyanotic heart defects, which limit the circulation of o#ygen throughout the body9 a history of blood clots9 and a rare heart defect called 3isenmenger+s syndrome that is marked by high blood pressure in the lungs $known as pulmonary hypertension'. The group also included women with 2relative2 contraindications to oral contraceptive use, including smoking and arterial high blood pressure. =f these at!risk women, H? !! or nearly %& percent !! were nonetheless currently using the Pill. In addition, ?H percent of the women overall said they had never been counseled about birth control. "n even larger proportion of the group was unaware that pregnancy would also present special risks for them ! ?/ percent said their doctors had never talked with them about pregnancy or any pregnancy!related risks associated with their condition. 1uring pregnancy, a woman+s blood volume and heart rate increase, putting an increased strain on the organ. omen with certain heart conditions !! including severe heart failure,

cyanotic heart defects and 3isenmenger+s !! are considered to be at high risk of complications.

*i#ty women in the current study fell into this high!risk group, H. of whom were of reproductive age and se#ually active. =f these, %/ percent were not using any birth control at all. It is not surprising that so many women in the study lacked any counseling on pregnancy and contraception, according to senior researcher 1r. Barald Taemmerer, of the Aerman Beart )enter 4unich. The area of 2adult congenital heart disease2 !! that is, caring for adults who have survived inborn heart defects !! is new even within the field of cardiology, he told 8euters Bealth in an e!mail. 4any doctors, including gynecologists, may not be aware of the specific pregnancy!related issues related to the various types of congenital heart defects, Taemmerer e#plained. 6esides birth control pills, certain other contraceptives may carry risks for some women. It is not clear, for e#ample, whether intrauterine devices $I<1s' might pose a risk of endocarditis !! an infection of the lining of the heart !! in vulnerable women, such as those who have had a heart transplant. http:@@www.reuters.com@article@%&-&@&.@%H@us!birth!control!id<*T83O/4HB6%&-&&.%HQ pageEumberPomen+s 6rains on *teroids 6irth control pills appear to remodel brain structure 6y )raig B. Tinsley and 3lizabeth ". 4eyer U *eptember %/, %&-&

It seems that weekly we hear about some professional athlete who sullies himself and his sport through abuse of steroids. The melodrama unfolds, careers and statistics are brought low and asterisked, and everyone bemoans another fallen competitor. 5et there are millions of cases of steroid use that occur daily with barely a second thought: 4illions of women take birth control pills, blithely unaware that their effects may be subtly seeping into and modulating brain structure and activity. It is a huge e#periment whose resolution will not be known for a while, but a new study in the journal 6rain 8esearch demonstrates that the effects are likely to be dramatic. It found that birth control pills have structural effects on regions of the brain that govern higher!order cognitive activities, suggesting that a woman on birth control pills may literally not be herself R or is herself, on steroids. The human brain is a remarkable structure, not least because of its seemingly infinite capacity for change, adapting millisecond by millisecond. Indeed, a structure with tens of billions of neurons, each of which has the ability to elaborate and branch and become more comple#, while changing its activity in the process, is the very definition of change. This so!called neuroplasticity is a hallmark of the nervous system. It can, however, be augmented, boosted, by artificial means, and if we are not careful, the brain may go all catawampus. *teroid hormones, which are e#creted by endocrine organs such as testes and ovaries, flow in abundance throughout the bloodstream, reach target organs and structures, and e#ert powerful effects on them. To wit, the cockCs comb, the buckCs antlers, the lionCs mane, the

blood!engorged uterus. hat of the mammalCs nervous systemQ It turns out that the brain is a veritable sponge for steroid hormones. In the male, the androgen testosterone $or a metabolite' binds to brain receptors and sculpts that structure into the aggression!promoting, se#!craving, risk!taking regulator with which we are all familiar. 6y the same token, the comparative lack of androgen hormones in the female produces the kinder, gentler, softer neural substrate that distinguishes itself from the male by dint of its vastly different behavioral repertoire. hereas the subtle structural effects of naturally!occurring steroid hormones and se# differences in the brain have been e#tensively studied, few studies have e#amined the role of synthetic hormones on changes in the human brain. hat happens, then, when the female brain

gets a significant and artificial dose of steroid hormone, either progesterone, estrogen or bothQ e know what happens below the waist, the pregnancies prevented. neck, as this steroidal tsunami washes over the neural coastlineQ It appears that the brain, that sensitive organ replete with steroid receptors, reacts to its hormonal milieu with startling structural modifications. 8esearcher 6elinda Pletzer, of Paris!(odron!<niversity *alzburg, and her colleagues used 48I and vo#el!based morphology to e#amine the brains of men9 women on the pill9 and Fnaturally cyclingG women not on the pill. The researchers found that males have considerably larger areas of gray matter in brain regions associated with learning and memory, known as the parahippocampal gyrus and hippocampus, as well as an area associated with emotional regulation, the amygdala. These data are consistent with many studies that provide evidence for gender differences in brain and hat happens above the

behavior. 0urther, naturally cycling women showed an increase in gray matter volume in the right fusiform@ parahippocampal gyrus when circulating levels of estrogen and progesterone were low versus the phase when levels of these hormones were both high. 1oes that increased gray matter translate into enhanced performanceQ It is not clear. 8esearch into the hormonal regulation of cognition is e#tremely complicated. "s Pletzer mentions, human f48I studies have revealed that these areas are associated with spatial navigation abilities. =ther work suggests that hippocampalRdependent spatial memory is enhanced by higher levels of estrogen. <nder some conditions, however, estrogens have no effect or can even impair performance in rats. "dditionally, in PletzerCs study, women using hormonal contraceptives showed larger gray matter volumes in the prefrontal corte#, pre! and postcentral gyri, the parahippocampal and fusiform gyri and temporal regions, when compared to naturally cycling women. The brain works like a neural beehive9 the proper coordinated functioning of groups of tasked neurons are important to successfully accomplish a variety of mental tasks !! even the sensory processing and motor coordination needed for something as simple as picking up a hot cup of coffee without scalding oneself. "gain, we do not know whether this increased gray matter translates into better or worse performance, but there likely is little good about treating a woman+s brain like a spongy accordion. 0urther, although the Pletzer data are suggestive, there are other methodological and interpretational issues worth considering. 0or e#ample, the authors did not e#amine levels of

circulating hormones in the male and female subjects $e.g., testosterone or estrogen, respectively'. *uch data would have been helpful in determining the timing of the neural structural effects. 0urthermore, the types of hormonal contraceptive were not e#amined, lumping them all into a vague Fhormonal contraceptivesG group. There is a high level of variability and differential ratios in levels of estrogen and progesterones in birth control pills. PletzerCs team, despite showing significant neuroanatomical alterations, did not perform behavioral or cognitive tests of their subjects that could have helped e#plain the meaning or functional conse;uences of the changes. )omparing other published work with the Pletzer study allows us to make inferences, but they are, at best, speculative given the uni;ue details of the current research. There are pretty large differences in the structure of the brain that are attributable to cyclic fluctuations in natural hormones, and that appear to be due to unnatural concentrations of synthetic hormones. 6ut since the authors did no cognitive testing of their subjects, we can only speculate about the behavioral effects. (ast, birth control pills also keep hormones low. *o, there are two simultaneous events tugging at the data, a confound: the hormonal effects of the pills themselves, and the lowering of the normal hormones, both of which could bring about the structural effects. *o even the actual hormonal basis underlying the reported structural differences remains unclear. *till, overall, the Pletzer data do reveal some startling effects of oral contraceptive hormones. There are natural hormonal fluctuations that are a conse;uence of menstrual cycle oscillations, and which have organic effects of their own, but these have been a part of female

mammalsC lives since time immemorial. Eow, we are superimposing onto this sensitive substrate a steroid hormone cocktail with the potential of marking the brain in dramatic fashion. The possibility that an accepted form of chemical contraception has the ability to alter the gross structure of the human brain is a cause for concern, even if the changes seem benign !! for the moment. In any event, women need to have all of the medical and now, neurobiological, information they can use in informing their personal contraceptive decisions. (ike the rest of life, and like the steroid choices made by those ballplayers, there are costs and benefits. The benefits are well established9 the costs, however, are still coming to light. http:@@www.scientificamerican.com@article.cfmQidPwomens!brains!on!steroids 6irth )ontrol Pill )ould )ause (ong!Term Problems Indicates ,an &?,%&&O In the ,anuary issue of The ,ournal of *e#ual 4edicine, researchers have published a new investigation measuring se# hormone binding globulin $*B6A' before and after discontinuation of the oral contraceptive pill. The research concluded that women who used the oral contraceptive pill may be e#posed to long!term problems from low values of 2unbound2 testosterone potentially leading to continuing se#ual, metabolic, and mental health conse;uences. *e# hormone binding globulin $*B6A' is the protein that binds testosterone, rendering it unavailable for a woman+s physiologic needs. The study showed that in women with se#ual dysfunction, elevated *B6A in 2=ral )ontraceptive 1iscontinued!<sers2 did not decrease to values consistent with those of 2Eever!<sers of =ral )ontraceptive2. Thus, as a conse;uence of the chronic elevation in se# hormone binding globulin levels, pill users may be at risk for ith Testosterone, Eew 8esearch

long!standing health problems, including se#ual dysfunction. =ral contraceptives have been the preferred method of birth control because of their ease of use and high rate of effectiveness. Bowever, in some women oral contraceptives have ironically been associated with women+s se#ual health problems and testosterone hormonal problems. Eow there are data that oral contraceptive pills may have lasting adverse effects on the hormone testosterone. The research, in an article entitled: 2Impact of =ral )ontraceptives on *e# Bormone 6inding Alobulin and "ndrogen (evels: " 8etrospective *tudy in omen with *e#ual

1ysfunction2 published in The ,ournal of *e#ual 4edicine, involved -%? premenopausal women with se#ual health complaints for more than O months. Three groups of women were defined: i' O% 2=ral )ontraceptive )ontinued!<sers2 had been on oral contraceptives for more than O months and continued taking them, ii' H. 2=ral )ontraceptive 1iscontinued!<sers2 had been on oral contraceptives for more than O months and discontinued them, and iii' %H 2Eever!<sers of =ral )ontraceptives2 had never taken oral contraceptives. *B6A values were compared at baseline $groups i, ii and iii', while on the oral contraceptive $groups i and ii', and well beyond the L day half!life of se# hormone binding globulin at ?.!-%& $mean /&' days and more than -%& $mean -.O' days after discontinuation of oral contraceptives $group ii'. The researchers concluded that *B6A values in the 2=ral )ontraceptive )ontinued!<sers2 were ? times higher than those in the 2Eever!<sers of =ral )ontraceptives2. 1espite a decrease in *B6A values after discontinuation of oral contraceptive pill use, *B6A levels in 2=ral )ontraceptive 1iscontinued!<sers2 remained elevated when compared to

2Eever!<sers of =ral )ontraceptives2. This led to the ;uestion of whether prolonged e#posure to the synthetic estrogens of oral contraceptives induces gene imprinting and increased gene e#pression of *B6A in the liver in some women who have used the oral contraceptives. 1r. )laudia Panzer, an endocrinologist in 1enver, )= and lead author of the study, noted that 2it is important for physicians prescribing oral contraceptives to point out to their patientCs potential se#ual side effects, such as decreased desire, arousal, decreased lubrication and increased se#ual pain. "lso if women present with these complaints, it is crucial to recognize the link between se#ual dysfunction and the oral contraceptive and not to attribute these complaints solely to psychological causes.2 2"n interesting observation was that the use of oral contraceptives led to changes in the synthesis of *B6A which were not completely reversible in our time frame of observation. This can lead to lower levels of +unbound+ testosterone, which is thought to play a major role in female se#ual health. It would be important to conduct long!term studies to see if these increased *B6A changes are permanent,2 added 1r. Panzer. 1r. "ndre Auay, study co!author and 1irector of the )enter for *e#ual 0unction@ 3ndocrinology in Peabody, 4" affirmed that this study is a revelation and that the results have been remarkable. 20or years we have known that a subset of women using oral contraceptive agents suffer from decreased se# drive,2 states 1r. Auay. 2 e know that the birth control pill suppresses both ovulation and also the male hormones that the ovaries make in larger amounts during the middle third of the menstrual cycle. *B6A binds the testosterone, therefore, these pills decrease a woman+s male hormone availability by two separate mechanisms. Eo wonder so

many women have had symptoms. 2This work is the culmination of L years of observational research in which we noted in our practice many women with se#ual dysfunction who had used the oral contraceptive but whose se#ual and hormonal problems persisted despite stopping the birth control pill,2 said 1r. Irwin Aoldstein, a urologist and senior author of the research. 2There are appro#imately -&& million women worldwide who currently use oral contraceptives, so it is obvious that more e#tensive research investigations are needed. The oral contraceptive has been around for over ?& years, but no one had previously looked at the long!term effects of *B6A in these women. The larger problem is that there have been limited research efforts in women+s se#ual health problems in contrast to investigatory efforts in other areas of women+s health or even in male se#ual dysfunction.2 To better appreciate the scope of the problem, oral contraceptives were introduced in the <*" in -.O& and are currently used for reversible pharmacologic birth control by over -& million women in the <*, including /&K of all "merican women born since -.?J and, more specifically, %LK of women ages -J!?? and JHK of women age %&!%? years. 6y providing a potent synthetic estrogen $ethinyl estradiol' and a potent synthetic progesterone $for e#ample R norethindrone', highly effective contraception is achieved by diminishing the levels of 0*B and (B, thereby reducing metabolic activity of the ovary including the suppression of ovulation. *everal studies over the last H& years reported negative effects of oral contraceptives on se#ual function, including diminished se#ual interest and arousal, suppression of female initiated se#ual activity, decreased fre;uency of se#ual intercourse and se#ual enjoyment. "ndrogens

such as testosterone are important modulators of se#ual function. =ral contraceptives decrease circulating levels of androgens by direct inhibition of androgen production in the ovaries and by a marked increase in the hepatic synthesis of se#!hormone binding globulin, the major binding protein for gonadal steroids in the circulation. The combination of these two mechanisms leads to low circulating levels of 2unbound2 or 2free2 testosterone. This article is published in $The ,ournal of *e#ual 4edicine.' http:@@www.medicalnewstoday.com@articles@HJOOH.php *cientists have taken a new look at whether birth control pills are tied to heart attacks. 3arlier, based on reported health problems in women, it was believed that this was in fact true. 6ut this is not so in the case of progestin!only contraceptives, also dubbed the mini!pill. This new information is taken from the results of a half dozen studies conducted and is published in the ,ournal of )linical 3ndocrinology and 4etabolism. 3ach study concentrated on heart attack risks in individuals taking the progestin!only birth control. 4ore than -,/&& women, ages -O to ??, were evaluated and measured against women who did not take hormones at all. "s reported by 8euters, doctors who participated in these studies such as )hrisandra *hufelt, of the omenCs Beart )enter at )edars!*inai 4edical )enter, felt that this outcome is

Freassuring.G This would especially be true for the millions of women who are currently taking the progestin!only contraceptives. 6ut this good news does not include birth control that contains progestin and estrogen. The e#act safety level of this type of pill $combination' is still ;uestioned at this time. In fact, previous studies done found that when compared to women not on the Pill at all, women who take the combination pill had appro#imately twice the risk of heart attacks than

that of their counterparts. 1octors still advise that women, who have heart problems, smoke heavily and suffer from high blood pressure stick with the progestin!only birth control pill. "dditionally, the caveat to the recent development is that it is the very first review to focus solely on mini!pills and the numbers of women involved in the studies were small. "lso, even though the concentration was on the mini!pill, it did not take into consideration the doses or the type of progestin taken. 8esources:$8euters,)edars!*inai.edu' http:@@www.empowher.com@reproductive!system@content@do!birth!control!pills!cause!heart! attacks Past <se of 6irth )ontrol Pills 4ay Poses "dditional 6reast )ancer 8isk for 68)"- Aene 4utations $dateline 4arch -J, %&&H' omen with

Though the link between oral contraceptives and breast cancer risk has been debated over the years, recent studies have shown that women who take the pill today are typically not at a higher risk of breast cancer, compared to those who do not take the pill. Bowever, a newly published study found that women who have a certain genetic mutation called 68)"- might, in fact, be more likely to develop breast cancer, if they used oral contraceptives before -.LJ, when greater amounts of hormones were used in the pills. The findings do not apply to women who have taken the pill after -.LJ, since modern birth control pills contain fewer hormones, though women with 68)"- gene mutations should e#ercise caution when considering oral contraception.

68)"- $breast cancer gene -' and 68)"% $breast cancer gene %' are two genes that, when functioning normally, help repair damage to 1E"Da process that also prevents tumor development. In -..?, researchers discovered that women who carry mutations of 68)"- or 68)"% are at higher risk of developing both breast and ovarian cancer than women who do not have these genetic mutations. 4utations of these genes are uncommon. mutations account for appro#imately JK of all breast cancer cases. To study the association between oral contraceptives and breast cancer risk, *teven ". Earod, 41 of the )entre for 8esearch on omenCs Bealth in Toronto, )anada, and colleagues omen with 68)"-

studied %,O&& women from J% health centers in -- countries. "ppro#imately half of the women had taken birth control pills in the past, while the other half had not. The results showed that women with 68)"- gene mutations who used birth control pills had an even higher risk of developing breast cancer compared to women with 68)"- gene mutations who did not use birth control pills. *pecifically, women with 68)"- gene mutations who used oral contraceptives before -.LJ, used them for longer than five years, or used them before age H& were more likely to face an increased risk of early!onset breast cancer due to the pills. =ral contraceptives did not affect breast cancer risk in women with 68)"% gene mutations. The findings suggest that women with 68)"- gene mutations who used birth control pills prior to -.LJ should be aware of a possible increased risk for breast cancer, over and above the risk that the 68)" gene mutation poses. 6irth control pills made after -.LJ did not pose a

risk. Bowever, the "merican )ancer *ociety suggests that women with 68)"- gene mutations approach the use of oral contraceptives with caution and discuss the issue with their physicians. 6ecause birth control pills have been shown to decrease the risk of ovarian cancer, which also occurs more fre;uently in women with 68)" gene mutations, the true benefits and risks of the pill for 68)"-!affected women is unclear and needs further research. 8ecent studies have shown that modern birth control pills do not typically increase breast cancer risk. 0or e#ample, a study of over .,&&& women, published in the ,une %L, %&&% issue of the Eew 3ngland ,ournal of 4edicine, found that oral contraception does not increase breast cancer risk in women who have taken birth control pills in the past. The study involved analyzing the health of ?,JLJ women between the ages of HJ and O? who had breast cancer and comparing them with ?,O/% women of the same age without breast cancer. "ppro#imately four out of five women in both groups had used oral contraceptives at some point in their lives. The belief that oral contraceptives cause breast cancer stems from the fact that birth control pills contains hormones, including estrogen and@or progesterone $estrogen has been linked with a higher risk of breast cancer in women who take hormone replacement therapy for five years or more'. 6irth control pills manufactured prior to -.LJ contained significantly higher amount of these hormones, but todayCs versions of the pills have very low levels of hormones. =ver ?J million women have used oral contraceptives at some point in their lives, and an estimated -& million women between the ages of -J and ?? take them today.