If birth control pills are no more dangerous than other over the counter drugs, should they be available over the counter? Apparently the biggest opposition comes from those who don't want teenagers to have easy access to birth control pills. What are your thoughts?

-- Anonymous, July 06, 2000

Answers

I would absolutely love it if birth control pills were available over the counter. Since my insurance doesn't pay for them now, that's not much of a concern, to me.

-- Anonymous, July 06, 2000

I'm sort of conflicted on this one--on the one hand, the BCP themselves are relatively safe, but having them available by prescription only is a major incentive to get women to have regular checkups.

It's already been observed that lesbians have a higher rate of death from breast cancer than straight women, which is thought to be a reflection of the fact that straight women are more likely to see a doctor regularly (because they need to to get birth control). Another concern is cervical cancer, which is caused by a sexually transmitted disease, and can often be successfully treated if detected early with a pap smear.

-- Anonymous, July 06, 2000

There's been a big discussion about this at Hissyfit over the last couple of days ...

I think the health risks associated with birth control pills (particularly blood clots) mean women should have to see their doctor at least twice a year if they're using this form of contraception. I don't think everybody would bother going for a six-monthly check-up if they didn't have to go to get another prescription (I never bother having six-monthly dental appointments). I don't believe birth control pills are no more dangerous than other over the counter drugs.

And from what I understand, most women can get six-monthly supplies of birth control pills prescribed, so it's not like we're currently having to see a doctor once a week to get them. Half an hour every six months is no big deal to me - I'd rather be safe while taking them.

-- Anonymous, July 06, 2000

If anybody's interested in checking out the Hissyfit thread I mentioned, it's here.

-- Anonymous, July 06, 2000

Jackie-

The recommended interval in the U.S. for gynecologist visits is once a year, which is the standard length of a BCP prescription here, so I agree, it's not a huge deal to go to the doctor's to get it, but I fear that many women wouldn't get around to it if they didn't have to. Also, as discussed elsewhere, in the U.S., many women have the additional disincentive of being uninsured.

However, I don't think the blood clot thing is as much of an issue as the cancers I mentioned in my post above. For one thing, they're almost unheard of in young, non-smoking women, and it's not recommended that women who smoke or are over 40 take the pill, anyway, with or without a prescription.

As far as I know, there is no simple test for detecting blood clots before they become problematic (although I may be wrong about this). I think that usually the first sign of a blood clot is a stroke, heart attack, or sharp pain in the extremities, which would probably motivate a woman to see her doctor anyway. In contrast, cervical and breast cancers can be routinely screened with simple, inexpensive tests which can detect disease early, when it is much more treatable.

-- Anonymous, July 06, 2000

Bad idea. *Bad* idea. Bad, bad, bad idea.

After trying with three different types of meds, it was determined a few years back that I simply can't take the Pill. The first round had me bleeding every two weeks; the second had me bleeding every two weeks *and* my moods were all over the place; the third was working like a charm -- until I started getting pains in my arms, legs, and head and it was determined that blood clots were forming. A very scary time, believe me. Planned Parenthood out-and-out told me that they would not prescribe me the Pill in any form, ever again, without medical clearance from a gynecologist, because it just wasn't sitting right with my body.

Remember, these are drugs that *mess with your hormones.* While I'm all for the Pill -- and heartily wish I could take it -- it is still a pretty powerful drug, and I would hate to see someone take it without proper medical supervision.

If a 17-year-old wants the Pill, that's fine by me -- but remember, a 17-year-old might not know enough to stop taking it if she's in pain, or might *ignore* the pain because she prefers that method to any other, or, say, her boyfriend refuses to wear a condom. And if she smokes, there all sorts of other problems that might crop up. The potential consequences make me shudder.

I don't have a problem with teenagers on the Pill, although I hope they take it later rather than sooner -- taken at that age, you're messing with your hormones when your body is still changing! But because of potential medical problems, I think it should stay prescription-only.

-- Anonymous, July 06, 2000

Yeah, on the one hand, it would be great for the Pill to be more easily accessible to everyone. On the other hand, it's basically hormone therapy, and I just sort of feel like that sort of thing is best supervised by a doctor. I didn't have any major problems while on it, apart from the mood swings, but I've heard of people who have.

So, um, basically my answer is, I don't know. Yeah.

-- Anonymous, July 06, 2000

No. They're safe for most women, but some shouldn't take them. Mainly because of blood pressure problems, I seem to recall. They also aren't recommended for women over 30 who smoke.

There should be more places like Planned Parenthood where women can get them easily, but they should get an exam, however brief.

-- Anonymous, July 06, 2000

Roe wrote:

Remember, these are drugs that *mess with your hormones.*

Well, actually, they're drugs that ARE hormones. But so are many other over-the-counter drugs, including Melatonin and DHEA. Selling a drug over-the-counter does not imply that it is innocuous--ANY drug is capable of causing dangerous or even fatal side effects if taken by the wrong people, at the wrong dose, or in combination with certain other drugs. Even something as innocuous as grapefruit juice can have dangerous interactions with certain drugs!

I don't think the pill itself is any more unsafe than other non- prescription drugs, but I do think the risks should be made clear in the packaging, just as they are now.

So, Roe, while your reaction to the pill was certainly scary, I don't see how it would have been any different if you'd bought the pill over the counter. Wouldn't you still have seen a doctor after experiencing those side effects?

-- Anonymous, July 06, 2000

I know that for me the biggest reason I make that yearly trek to sit back in the stirrups is so I can get my prescription refilled.

Yes, I know that every woman needs to get the yearly pap smear and the health benefits for such, but it isn't the most enjoyable experience in the world and I'm afraid that if I wasn't ~forced~ to go in order to get another years worth of pills that I just might let it slide.

(And all of the insurance coverages I have had only allowed for one visit/check up with a GYN a year, so that every six month thing doesn't work out too well moneywise).

Out of my circle of friends, I'm the only one on the pill and also the only one who has a regular yearly GYN checkup. Others go only when something is wrong. My mom, for goodness sake, I don't think has seen a GYN since she had me 30 years ago - she hates them so much that even the threat of cancer won't get her into a doctors office.

As much as I'd like birth control to be readily available to all, I think that getting a teenage girl into the habit of going to the Gyn for a yearly exam is a good thing. And if that means keeping the pill by prescription only then so be it. Besides the fact that there are so many side effects of the pill - I personally think its best to be on it when under a doctors care.

- t

-- Anonymous, July 06, 2000

I can see where you all are coming from, but the idea of forcing a (mostly) unrelated test on women in order to give them a relatively safe drug kind of bugs me. Yes, everyone should have a year PAP test and pelvic exam. Guys are also supposed to have a yearly prostate exam, aren't they? Testicular cancer exam? We sort of leave that up to them, though -- and yeah, most young guys don't have the tests even though they should. But why do they need the coddling more than we do?

For those of you who support requiring prescriptions for birth control pills for women because otherwise women wouldn't get their yearly exams -- would you support a similar limitation on any drug for men? Condoms aren't really a good example, but what about Tagamet or Zantac, two antacids that were recently taken off the prescription list? What if you couldn't get those without a prescription, and that prescription was tied in with a prostate exam or a PAP test? (I can't think of a drug that's primarily used by men that's anywhere near as common as the pill, unfortunately. Rogaine, maybe?)

It just strikes me as an odd and awfully paternalistic reason for requiring a prescription. If the concern were really blood clots and other associated risks of the pill itself, I would think the only yearly test you'd need would be a blood test, maybe blood pressure, etc.

My doctor, by the way, wrote me a two year prescription last year. I'm going in tomorrow for my annual exam even though I don't need to do so in order to keep getting my pills.

-- Anonymous, July 06, 2000

In response to Beth's post:

In a sense, cervical cancer is an associated risk of the pill, because it is caused by an STD, and women on the pill have been shown to have a higher incidence of the virus which causes it than women not on the pill.

As for the equivalents in men, young men essentially never get prostate cancer, so only older men are screened for this (those lovely exams young men get are to check for hernias). Testicular cancer is screened for in young men with a manual exam, but the risk is extremely low compared to the sex-linked cancers women can get, and the fatality rate is even lower. In other words, there is scientific evidence that young women really are more at risk, and do have a stronger need to visit a doctor regularly than young men.

But even so, if there were a testicle-related drug widely used by men now that caused them to visit their doctor's office regularly, I'd also be against making that drug available over the counter. It would probably help us cut way down on the prevalence of sexually transmitted diseases!

I don't think it's paternalistic to encourage women to visit their doctors in this way--it's just sticking with something which has been established to save lives.

-- Anonymous, July 06, 2000

Well, I don't go to a doctor yearly because I have a) no health insurance and b) no desire to go on the Pill, but I still think it would be a bad idea to make it over-the-counter.

The Pill is a course of hormone treatments, and should only be taken with a doctor's supervision, for the safety of the patient. I've heard of various bad reactions, including the aforementioned continual bleeding. Having a doctor who can reasure you that a reaction is or is not normal would be a heck of a lot safer than having to guess on your own.

That whole thing about limiting the Pill subscription to one year so that women will have a yearly Pap smear doesn't sit well with me at all. It smacks of telling women what's good for them because they're too irresponsible to act on their own.

-- Anonymous, July 06, 2000

A prostate exam tied in with an antacid? Now there's an injustice!

(just thinking now of all the ways we could provide preventive health care incentives -- "Sir, we'll have your driver's license ready, after you have the eye test -- and than please go in there and drop your pants.")

-- Anonymous, July 06, 2000

Actually, now that I've thought about it for a moment, the idea of tying health care preventive treatments/exams into other social/government required things is an idea I'm all for.

For example: car registration/have BP screening available. (or whatever)

I don't know if making it mandatory would ever be agreed to, but offering incentives and having it as an option would be nice.

Can't really think of a downside.

-- Anonymous, July 06, 2000

After traveling an hour and a half to get to the nearest Planned Parenthood, getting a parking ticket, having to run a tollbooth because I had no change, and having to miss half a day of work just because I needed to get a prescription in order to get the Pill, I am all for over-the-counter Pills.

-- Anonymous, July 07, 2000

I am definitely coming at this from a different angle than people who have hassles and expense associated with getting their prescriptions fulfilled, because in the UK it's free, and there are a lot of Family Planning clinics around which prevent having to go to a doctor. Most of these seem to be centrally located rather than in the suburbs, so people can make appointments for before/after work, or at lunch time.

I know I've been pissed off with having to make an appointment and kill time in a waiting room, but I think it's a small price to pay - this is something which could do me harm and affect me badly, so I'd rather be assured I was not at risk while taking it.

-- Anonymous, July 07, 2000

In the last few years in NZ I've heard about a few women dying from blod clots and I know several who have had adverse reactions to one pill or another...so, maybe medical advice should be sought... but I'm with Beth in that I hate the whole idea of forcing one thing on people just to get another... grr, hate it..

I don't know about the US but in NZ huge sums have been spent on trying to make women aware of the need to get check-ups, so hopefully this info will have sunk in...as for men tho' I've only seen one small campaign which mentioned prostrate or testicular cancer... I'm lucky, I know where to look for information but others?

neway...I guess that I'm saying prescription annoying but perhaps safer...but imho choice is more important!

-- Anonymous, July 07, 2000

I just had a few more thoughts to add:

1) I've sort of already made this point, but I really don't see how the dangers of taking the pill itself would be reduced by having it available by prescription only. Unless you have a pre-existing condition, there is no way your doctor can predict whether you will have an aversive reaction to the pill! If you experience serious side effects, you will have symptoms, which should be a sign to go to your doctor's office. Potentially serious side effects are described in the literature which U.S. law requires to be packaged with birth control pills.

2. It's true that certain women shouldn't take the pill. Risk factors for complications are described in the literature packaged with birth control pills. However, it is also true that medications such as aspirin and tylenol can be deadly for people with certain medical conditions, but I doubt anyone would suggest that these medications be available only by prescription.

3. I know it sounds kind of wacky to use birth control pills as an excuse to entice women to get pap smears and pelvic exams, but I really do think it's valid. For one thing, women who are on the pill are more likely to be having sex, and are thus more at risk for STDs, so they really ought to be having regular gyn. exams to check for these problems which are associated with the medication.

Finally, I would like to invoke the old cliche of "if it ain't broke, don't fix it!" And I would say that the current system definitely isn't "broke": the invention of the pap smear has clearly decreased the rate of cervical cancer mortality.

-- Anonymous, July 07, 2000

It may be paternalistic to make women get a yearly exam to get birth control pills, I dunno. It just seems like a good idea to me.

But the answer I see isn't to make them OTC drugs but to have more clinics where women can get them, more easily.

-- Anonymous, July 07, 2000

I think it's a good idea to make people get at least a cursory physical before getting the pill. I'm under 30 and don't smoke, but I have borderline high blood pressure. The doctor checked me over and recommended Depo-Provera instead of the pill. A doctor's advice on the matter was welcome and useful. Sure, you can slap warnings all over the label, but people may not really *know* they have high blood pressure, or how high is too high, or how great the risk is, or what alternatives they have. Maybe the incidence of serious effects from teh Pill is low in young, healthy people, but I dont' think it's unreasonable to give you a once-over to make sure you qualify as such. It's a good side-effect that it makes people come back for a Pap and such, but I think the elements of health that are or can be directly affected by the Pill are the ones that the yearly physical shoudl concern itself with. What if being on the Pill made your blood pressure shoot up? You wouldn't know it without a medical exam. I think enough can be told from a pre-prescription exam to make it worthwhile. Giving it OTC without monitoring will only increase the number of people who get it and really shouldn't be on it.

-- Anonymous, July 07, 2000

I'm surprised that no one has addressed what I think is the REAL reason for considering making so many prescription drugs available OTC:

BECAUSE THEN INSURANCE PLANS DON'T HAVE TO PAY FOR THEM!!!!!

"There are two tragedies in life. One is not getting what you want. The other is getting it."

-- Oscar Wilde.

-- Anonymous, July 10, 2000

Encouraging women to get annual or semi-annual exams isn't "paternalistic", it's MATERNALISTIC. Both women and men should see a doctor orother medical person regularly.

In my case, my Victorian mother never said boo to me, when I was growing up, about seeing a gynecologist. When I expressed a teen's normal curiousity about sex, she got very upset and shrieked, "don't do it until you're married!!!" So I could never count on her for any info on sexualityor women's health. When I was in college, I developed a rather large cyst near my vagina, which I proceeded to ignore for several years (the cyst, not the vagina). Eventually I made myself go to Planned Parenthood because I wanted to go on the Pill. Turned out the cyst was a benign Bartholin cyst, but I also had whopping big ovarian cysts too, from endometriosis. Should have gone to a doctor sooner, but who knew?

Since then (13 years), I've had surgery twice because of endometriosis, gone on the pill, then off, and am now back on. I am being treated for mildly high blood pressure, which is apparently hereditary, not related to the pill.

The Pill is not for everybody, and I think it should stay prescription only. The idea that a women getting it over the counter, who has side effects, would go to a doctor about the side effects? I'm not sure that would work. Someone who doesn't want to go to a doc in the first place might not go in the second place either.

-- Anonymous, July 15, 2000