Medical legend has it that when scientists were developing the first contraceptive pill, they developed it so that women taking the pill would have the reassurance of a monthly bleed. No matter that the bleed had no other purpose (it doesn’t even tell you you’re not pregnant as if you happen to fall pregnant on the pill, you will still bleed during your pill free week) – these guys thought that most women liked having periods, and morever, they hoped that the Catholic Church would find their new contraceptive more acceptable if women experienced a regular bleed. We don’t need to bleed, of course. If we’re on the pill we can quite happily take it two or three packets at a time, or even indefinitely with breaks for your bleed tailored exactly to you and your physiology. I tell my patients that if we were living a traditional lifestyle (starting intercourse young, having babies and breastfeeding them for a few years) we might have only a couple of dozen periods in our lifetimes – as the breastfeeding and pregnancies happening back to back would suppress ovulation and lead women to have on average ten children over a reproductive lifetime. It’s contraception, in fact, together with reduced rates of breastfeeding, that have given women the “reassurance” of a monthly period for years on end.
Can you tell I find this fascinating? One of the reasons for my temporary break from blogging has been because I have been doing a bit of extra training, so that I can get a postgraduate qualification in Family Planning. Yes, even though I am thirty-cough, I am still studying. It’s never ending. But one of the joys of general practice, is that you can develop a special interest, and mine is family planning and sexual health. I am fiercely in favour of women being able to take control over their sexual and reproductive health, and mine is the perfect profession to advise and counsel. I never fail to be amazed at how few women really appreciate the range of options available to them. The Family Planning Association (who have now wisely rebranded as “FPA”) publish a fantastic leaflet that I use with my patients, to show them just how many forms of contraception we have available to us. So when my patients come in and say, “I want to go on the pill” I can say, “No problem, shall we go through all the options, so we can see whether the pill is the right contraceptive for you?” – then I unfurl this huge leaflet which details all twelve (yes twelve) commonly used contraceptive methods.
To recap: the pill, the progesterone only pill, the contraceptive patch, the contraceptive ring, the coil, the Mirena coil, the injection, the implant, male and female condoms, a cap or diaphragm, male and female sterilisation, natural family planning methods. All bona fide, and all have their place. Impressive, isn’t it? And my patients, without fail, are suprised just how many options they have. (Sadly, the Catholic church only approves of one of them.) It takes more than ten minutes to discuss the real pros and cons of each of these methods with my patients, of course, but I do my best. One of the most satisfying aspects of these contraceptive consultations is knowing that if I do my job correctly, the implications could be huge. I could and should be preventing unwanted pregnancies. I could and should be helping a women or a couple plan when and how often they become pregnant; I could and should be helping my patient take advantage of medical technology to control her cycles, prevent PMS, minimise the physical and psychological impact of endometriosis or heavy painful periods. And the bigger picture: I could and should be having an impact on the environment by helping prevent overpopulation; I could and should be helping women have unnecessary abortions.
Marie Stopes tells us that one in five pregnancies in the UK will end in abortion. Their fascinating leaflet on why UK women find themselves with an unwanted pregnancy is well worth a read. Whilst I remain a strong supporter of easy access to abortion for my patients, I, like most people, wish there were fewer of them. If I can, in my small way, give my patients a proper choice of contraception – education, support, and practical help – all this extra work will be well worth it.