Perils of the Pill

Although the Pill is the most effective method of contraception yet devised, it has not proved an unmixed blessing to all of the 8,000,000 American women who use it. Many women on the Pill experience minor problems such as nausea, headaches and breast tenderness; others have menstrual irregularity and are temporarily infertile after they give it up.

For a relatively small number of users, however, there are more serious side effects. Studies carried out in the U.S. and Great Britain have shown that women who use the Pill are more prone to circulatory problems like clotting than those who do not. Now it appears that these women are more susceptible to strokes as well. According to a report published in the New England Journal of Medicine, women who use the Pill are nine times as likely to suffer strokes as those who rely on other means of contraception.

Doctors have suspected for some time that the Pill might cause clotting in arteries feeding the brain, but have never found positive proof. The new study--carried out by neurologists from a dozen major university hospitals during a two-year period between 1969 and 1971--goes a long way toward providing it. After locating 598 nonpregnant women between the ages of 15 and 44 who had been hospitalized with strokes, the researchers matched them against two carefully chosen control groups. One consisted of women of the same ages and races hospitalized for other causes, the other of healthy women living in the same neighborhood.

Comparing the contraceptive practices and health records of the groups, the researchers found that use of the Pill was twice as common among the stroke victims as it was among controls. The study also established a strong connection between the Pill and thrombotic strokes, which are caused by blood clots in the brain; use of the Pill was three times more frequent among victims of this type of stroke than among controls. A similar but somewhat weaker link was found between the Pill and hemorrhagic strokes, caused by the rupture of a blood vessel in the brain. Nearly twice as many victims of such strokes used oral contraceptives as did the controls.

Doctors believe that the Pill's effect on clotting accounts for the increased incidence of thrombotic strokes. Why the Pill causes hemorrhagic strokes is less certain, but some doctors suspect that estrogen, a female hormone that is a prime ingredient of oral contraceptives, may aggravate hypertension.

Still, most doctors refuse to condemn the Pill. They feel that the risk of stroke even among women who use oral contraceptives is extremely small. Britain's Dr. Martin Vessey, a leading student of Pill problems, reports that out of every million women using the Pill, only 100--one in 10,000--will suffer strokes attributable to it each year. Of these, only five will die.

Even these deaths can be prevented if doctors exercise more care in prescribing the Pill. Some women who ask their doctors for the Pill are now handed prescriptions after only cursory examination. Clinic patients may be asked few, if any, questions about their medical histories before they are given supplies of oral contraceptives.

Dr. Stanley Birnbaum, acting chief of obstetrics and gynecology at New York Hospital, believes that such laxity is more perilous than the Pill itself. Doctors should examine each patient and question her carefully before prescribing the Pill, he says. They should exercise extreme caution in giving it to anyone with a personal or family history of circulatory problems. Other doctors require Pill users to report regularly for examination to check for high blood pressure. Some even go so far as to insist that women on the Pill stop smoking. Among the stroke victims studied, 73.8% were smokers.

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