Talk:Oral contraceptive/Archive - Discussions prior to 2006

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Contents 1 Warning removed 2 hormones and societal neuropsychology 3 I did it!!! 4 pov changes 5 The pension issue 6 Smelling odd and caffeine 7 NPOV 8 Combined vs Progesterone-only pills 9 Unsourced sentence - abortions due to birth control failure 10 Side effect references 11 History: reconcile both parts 12 Possible addition to this section

Warning removed

The following was removed because it cannot be substanciated as well as information found contradicts its validity.

It also takes at least one complete menstrual cycle for the pill to become effective; many young women have found themselves unexpectedly pregnant during that window.

From planned parenthood[1]:

Planned Parenthood report that if you start the combination pill within five days after the start of your period, take the first active pill of the first pack. You will not need to use a back up method of birth control. You are protected against pregnancy immediately.

If you start the combination pill at any other time during your menstrual cycle, take the first active pill of the first pack. Use another method of birth control if you have vaginal intercourse during the first week of combination pill use — protection will begin after seven days.

You may start the progestin-only pill at any time. Use another method of birth control if you have vaginal intercourse during the first 48 hours of progestin-pill use — protection will begin after two days.
--Catskul 00:40, 15 Nov 2004 (UTC)

hormones and societal neuropsychology

through inference: the use of birth control pills has been responsible for a great change in modern societies' hormonal balance. and if it may increase promiscuity, it may also increase hormonal mutation of humanity, through the human intercourse act. the balance and exchange of hormones in a sexual relationship (and let us not forget pheromones) is not at that which is regular (eg. without the pill). this has caused a change in the perceived and actual role of women, mothers, children, and men in complex social relationships, which are effectually regulated by hormones and their interpplay in the psychology and biology of our perceived realities. interesting the lack of research on this topic. - geronimo inutiq (geronimoinutiq@hotmail.com) let us not forget the use of the pill in child labor factories (handed out as "vitamins") in order to keep the young workers in bondage conditions and away from traditional family practices. the last poets has a great song about the pill called "the pill"

I did it!!!

I changed part of it to read "to 20% of the months spent on the pill" because it makes makes more sense that "20% of the months" and is more understandable. I don't know if this is correct though - feel free to change it!!!

Selphie 14:38, 11 Feb 2005 (UTC) *talk*

pov changes

• pill uses synthetic hormones, the claim that it contains hormones from horses can only stay in the text if you can quote sources
  • Being unattested is not the same as being POV. Either claim ought to be documented, yes? eritain 17:58, 20 September 2005 (UTC)
• if someone takes the pill, a pregnancy is unwanted - I am actually very curious on what your comments on that one could be.
• clinical evaluation does not mean that the pill was used in a clinic or something. It refers to a scientific method of doing the study. I have included a remark that the Alan Guttmacher institutes claims that the incorrect use is typical.--Fenice 09:37, 10 May 2005 (UTC)

Pill hormones were originally from horse urine. No longer. Sometimes the pill is taken for dysfunctional bleeding or PCOS symptoms, and pregnancy is not unwanted.

Clinical evaluation can mean several things. In the pharmacological setting is it the testing of new drugs on patients with the disease (i.e. Phase III trials). In medical use, it means starting a form of medication and checking later whether it's doing its job.

I agree some edits are partisan, and that the anon should show his colours by logging in and using edit summaries. JFW | T@lk 20:09, 11 May 2005 (UTC)

Anon: horse urine has been removed from the text; 'unwanted' is redundant - first of all, this article is clearly about contraceptives (already indicating pregnancy is undesired), and secondly, drugs are not purposefully taken to eradicate a desired state - the word 'unwanted' is redundant. Moreover, the NPOV medical facts about the drug have nothing to do with whether a pregnancy was wanted. The pill can prevent pregnancy even in a woman who wants a child. Finally, why on earth do you need to know who I am? I am a netizen and my comments stand on their own - if I was a 90 year old phychiatrist and grandmother, Madame Curie or Hillary Clinton, my information should be judged on its own merit, not what I choose to tell you by logging in.

• No one asked you who you are. You should just choose a nickname, because to talk to you, a name is better than a number. Most people here are anonymous in that they do not give their real names, but choose a nickname. By the way an IP is really much less anonymous than a nick, because experts can tell all sorts of things from an IP, like the area in which you are, I believe. A nick says nothing about your real identity other than what you want. The edit summary JFW refered to is the line on the buttom below the editing box. In this line, you are supposed to summarize what you changed, so that people do not have to open the history every time.--Fenice 06:06, 12 May 2005 (UTC)

I removed 'what some call' before 'unwanted pregnancies'... what do other people call them?! (genuinely curious)Rachbubs 13:39, 16 July 2005 (UTC)

• Surely a pregnancy despite Pill could easily be wanted - or at least not unwanted. The family that wants children but not immeadietly may still be ecstaatis when she becomes pregnant; not really an unwanted pregnancy. If I misunderstand please say..

The pension issue

I have removed the following part: The Pill's wide acceptance in the West has dramatically decreased birth rates. In the United States this decreased birth rate is the primary reason for the insufficient payroll tax revenue that is causing the looming insolvency crisis for Social Security (United States). In Europe, similar problems have developed as fewer people are paying into the system per each person drawing benefits.

• First of all the pension issue really belongs into the article pension. (I would recommend putting it on the talk page of pension first.)
• No matter where you insert these sentences, they are at best misleading in any context. The pension system is a fairly new invention, so you cannot actually say that it has worked well for centuries before the pill arrived. Then, the development of population size depends on other factors as well, notably antibiotics. Before the arrival of antibiotics about a century ago infectious deseases, tuberculosis and the like, were the major cause of death. Particularly old people and children fell victim to it. So the birth rate may have been higher, but the children did not become old. --Fenice 08:29, 12 May 2005 (UTC)

If impact on society is on the page, then the impact of lower birth rates (directly tied by all academics and commentators to the wide use of the Pill) on social welfare schemes surely is an impact on society. And one that was never planned for.

As I said above, if you can put together a decent paragraph on this issue that at least attempts to be objective we can add that information. We can put in "Some believe that the pill might have lowered the birth rates in some countries.". If there is no other way I will agree to that sentence. But that is quite nonsensical isn't it.--Fenice 10:13, 12 May 2005 (UTC)

Smelling odd and caffeine

I oppose the paragraph that goes on about caffeine metabolism and body odour. These are the results of very small studies which do not justice to the enormous amount of women taking the Pill. Let's just say that neither are of a big concern to many users, and being put off by someone's newfound mate after stopping the pill is pure inference. Please do not reinsert it. JFW | T@lk 13:53, 12 May 2005 (UTC)

I agree with you completely. I didn't mean to revert that this morning.--Fenice 15:55, 12 May 2005 (UTC)

NPOV

I'd like to remove the POV tag, so could all involved please register the contentious points? If there are none, shall we remove the tag. JFW | T@lk 22:06, 14 May 2005 (UTC)

I removed the tag.--Fenice 22:58, 14 May 2005 (UTC)

And now it's back. Fenice, please inform us of the points you disagree with, so we can settle the issue. I agree that the Pearl index is a serious omission (I can try to insert it later, but lack the time now to research it, e.g. original citation). I agree that "natural state of fertility" is POV.

I was mildly surprised not to find a SourceWatch entry on the Alan Guttmacher Institute. If there remain POV problems, a RFC is necessary. JFW | T@lk 11:55, 15 May 2005 (UTC)

Fenice, please inform us of the points you disagree with, so we can settle the issue.
Believe it or not it's the same as ever, again, as stated above, and by jfdwolff, the pearl index (also its correct presentation, a source is on fr.wiki, I can translate) and the natural state of fertility.

The pearl index is actually included in this version. Still it is obviously distorted by IP 214.13.4.151. If the reader happens to ever have taken a statistics class he will quickly realize its distorted, it's a simple calculation. (i. e. the rate of women who are actually taking the pill correctly - which IP here thinks must be a terrible chore almost no-one can accomplish - must be aproximately 90 percent. ) I have no idea why the guttmacher institute thinks that some form of incorrect use is typical (I checked that, it's really on the page given by IP 214.13.4.151) - I would never cite such an obviously implausible thing.

The problem and the reason for the npov-tag is the distortions are really embarassing to wikipedia because they're so obvious. That's why it is necessary to keep on marking it as pov even if we cannot solve the problem. It is plain old embarrassing to have false information in the text. Also there is a link to the source - every reader can check if we're presenting the information right. The problem is that there is nothing we can do about editors who distort the information, but we can let the reader know, that we know.--Fenice 14:07, 15 May 2005 (UTC)

Here we go:

• • I took out "natural state of" and replaced with "normal." Fertility is not a disease, but a sign of good health. It does readers a service to include that information, and I agree that using "normal" sufffices and removes any hint of POV.
  • It is not POV to assume that some of the most important information a person researching birth control options seeks is the effectiveness and benefits, and the risks or cautions associated with that method. As such, both should be included in an objective fashion. The effectiveness under typical use is the most relevant information, as clinically monitored perfect use is unlikely to happen in real life. Alan Gutmacher Institute (AGI) is closely allied with the very pro-contraception Planned Parenthood Federation. The AGI data that 8 of 100 women using the pill under typical conditions for a year get pregnant is NPOV. It is also NPOV to inform the reader of what her own effectiveness is likely to be before providing info about the effectiveness under unrealistic perfect conditons. Women and men who choose to contracept deserve to know the chance of pregnancy. What would be embarassing to Wikipedians is to ignore what data provided by the AGI (a higly respected research institute that is extremely in favor of "reproductive freedom"), knowing that the last thing AGI would do is distort information about the pill's effectiveness.user:214.13.4.151

This again proves my point that there is little chance of taking the npov-tag off - also: I do not quite understand the necessity to take it of this page - it is on so many pages, for months.
From the history of 214.13.4.151 it is fairly obvious that the condition isn't going to improve. IP will very likely continue disruptive behaviour and it is very likely that IP will not answer to the questions on talk, as this one displays live. (Just for the record in case anyone could possibly not have noticed: IP is not even bothering to include the term pearl index or perfect use in the answer. And again: it is more relevant what the large public does than how the small group of first time users might act (as I said, I even doubt the Guttmacher term 'typical use' Guttmacher uses, and would not quote it, but that's not the issue). That clinical evaluation could mean use in a clinic is simply idiotic, insisting doesn't change that fact, and, as always, it's been said before. Also: what Ip 214.13.4.151 is trying to sell us here as unlikely to happen in real life is not some sort of miracle. He or she is trying to claim that women typically are unable to take a pill every day - most of us manage to take a shower every day, don't we.)
RFC seems to be a good idea - can anyone add people there?--Fenice 14:46, 15 May 2005 (UTC)

• • Fenice, not sure why you are hurling insults at me. Or why you reject the typical effectiveness info of the leading "reproductive freedom" think tank/research institute (AGI). The AGI webpage I point to is their "Facts in Brief" section on "Contraceptive use". When researchers monitor drug use, it is called clinical monitoring, and implies frequent monitoring of the proper method. Not sure why you have branded me as 'idiotic' for using the word 'clinical' properly. At this point I sense open hostility toward my contributions on your part.user:214.13.4.151

Or why you reject the typical effectiveness info of the leading "reproductive freedom" think tank/research institute (AGI). If you are oh so interested in the anser to that question: Might just be a good idea to read my text above, it is also an alternative, IP, ever thought about it? But again: it cannot be correct. The average rate of pregnancy without conception is about 85 percent. So if 100 percent or so (=typical) of your teenagers would use the pill incorrectly the pregnancy rate would be way higher.) And mind you again as said two times above: this is not the point.

Not sure why you have branded me as 'idiotic' for using the word 'clinical' properly. Please do try and be less disruptive, IP. I have branded the use of clinical evaluation to mean use in a clinic idiotic because it is, the use of the word, not you. I do not think you are idiotic, if that's your question, by the way, (you have called yourself foolish in another place).

(To clarify: clinically monitored perfect use is unlikely to happen in real life if that doesn't imply clinical monitoring is happening in a clinic where then - on the moon??)

At this point I sense open hostility toward my contributions on your part. We are in general working towards better texts, not towards pr-statements of your organization. If your question is whether I am enjoying your avoiding giving answers to the point (it's pearl index - remember, or would you claim again to be too foolish to notice that it's been mentioned about ten times before) - no I am not happy about that.--Fenice 15:28, 15 May 2005 (UTC)

Due to the unlikelyness of any decent outcome of this discussion I will not answer here any longer. I have other work here which is productive as opposed to this. Sorry. But if this npov-article absolutely has to stay without npov-tag, so be it. My statement is given above. I will move the tag to the appropriate section and explicitely oppose its removal but also realize that there cannot be a solution. --Fenice 15:40, 15 May 2005 (UTC)

The Pearl index is used worldwide to measure efficacy of contraceptives. If it is not described in this article it should at least be put in a seperate article and linked from here.

Fertility is natural in people of a fertile age. However, to point out that oral contraceptives interfere with "the natural state of fertility" does have a tinge of POV to it. It can be taken to imply that contraception is "unnatural", which nowadays is a very loaded term.

As for the contentious number of women getting pregnant on the pill, this is a matter of choosing the source. I think 8/100 is very high. Quoting the AGI without mentioning more conservative numbers from other sources is indeed POV and should be avoided.

214.13.4.151, please understand that your edits on a large number of articles are seen by many contributors as biased. Please consider that consistently making biased edits can lead to requests for comment, requests for mediation and requests for arbitration. Biased editors have been banned from editing Wikipedia in the past, and I can image you would not like you to join this illustrious group of NPOV victims. JFW | T@lk 17:46, 15 May 2005 (UTC)

PS the Pearl index is "Pearl index - the number of unwanted pregnancies that occur during one year of 100 normally fertile women having regular coitus". 214.13.4.151, quoting the AGI, asserts that the PI of oral contraceptives combined is 8. This is a very high number, and it is reasonable to also insist on a more conservative estimate. JFW | T@lk

Please explain how guoting the most relied upon "reproductive health" institute can be considered POV? 214.13.4.151

Please read my above comments. If you insist on quoting such an unrealistic estimate, I'd like it balanced with a conservative figure, or this "unbiased" quote effectively becomes POV. Please learn, or go away. JFW | T@lk 06:31, 16 May 2005 (UTC)

• • If we are using the pearl index as the gospel of effectiveness, then lets see some links that explain what it is and prove that it is valid and accurate -and the industry standard. Otherwise its POV to even refer to the pearl index. What is the basis for claiming Planned Parenthood's research wing, AGI, has inaccurate data? At present the only basis is Fenice's complaints. Where are the sources?
  • Is there a crdible source for: A) referring to the pearl index at all; and B) the figures Fenice quotes?
  • Should readers first be introduced to the effectiveness rate of typical users, or the ideal (and elusive) perfect use figure? 214.13.4.151

The Pearl index is mentioned in every gynaecology textbook as the efficacy measure of contraceptives. The figure you have (8/100/year) is the Pearl index according to the AGI.

I think the perfect use should be mentioned first, because this is how the doctors would like their patients to use their medication.

Fenice does not quote a figure at all, but any method of contraception with a Pearl index over 1 will probably be unmarketeable. JFW | T@lk 12:18, 16 May 2005 (UTC)

PMID 14644823 gives a good example of the use of the Pearl index, and I reckon you'd like PMID 12574181. The FDA uses the Pearl index for the labelling of contraceptive products. And finally one from the AGI itself.

The original reference is: Pearl R. Factors in human fertility and their statistical evaluation. Lancet 1933;2:607-611. JFW | T@lk

There is a data conflict. Data here (a contraception advocacy group website) http://www.contraceptiononline.org/slides/slide01.cfm?q=pearl+index&dpg=6 to places the pearl index for OC at 1.25. I will make the necessary edits. 214.13.4.151

Good edits. Could you turn the above into a reference? JFW | T@lk 15:08, 16 May 2005 (UTC)

I think it presents a balance. I seperated the paragraph about how women can forget to take it to keep the format consistent for each section. I will make the source mentioned a reference. 214.13.4.151

Fenice, at this point, the Pearl index data listed is from extremely "pro-contraceptive" sources. Your data is there, other valid data is there. Is there a dispute with the data? What is it? If you do not satisfactoriyl explain the dipsute you have with the actual data - besides it being surprising or disappointing to you - to gain concensus, then I will pursue other means to remove the POV tag you have placed. RIght now its placement violates the rule and spirit of Wikipedia. (This comment was originally posted privately to Fenice's talk page in a related section in order to dailaogue, but she erased it and repsonded by calling me a vandal. That's the ol' Wiki spriit, Fenice! - I am removing the POV tag unless she responds).214.13.4.151 05:54, 2 Jun 2005 (UTC)

I endorse the removal of the sectPOV template, but I still urge you to find more conservative estimates, as a 1:12 failure per year is simply not borne out by factual experience. JFW | T@lk 13:21, 2 Jun 2005 (UTC)

On a matter of NPOV, the article lists indications which presumably, if the pill works, are 'benefits' and also lists side effects. But this distorts the cost/benefit analysis as there are other benefits that are not part of its indication. The reduction in endometrial & ovarian cancers (I'm given to understand respectively 750 & 1500 women annually in the UK) far outweighs DVTs+Breast cancer risks. One could also include the reduction in ectopic pregnancies and post-partum haemorrhage for being on the pill and avoiding pregnancy. These surely should be included in a section to balance the risks of side effects. Too controvertial though would be to overtly mention pill use vs unwanted pregnancies and all the issues that trouble the Abortion entry. David Ruben 02:01, 6 Jun 2005 (UTC)

Heavens, you're up late (and I'm on night shift)! If you think these sections are unbalanced, please revise them accordingly. I don't think there's much of a problem now. JFW | T@lk 02:21, 6 Jun 2005 (UTC)

I'm a little confused as to this disucssion but I wanted to point out that I recently went on The Pill and Planner Parenthood's fliers told me most women take it incorrectly at some oint in their lives (skip a pill, double up accidentally, whatever) and are thus unprotected for at least a small window of time... at least that was my understanding. So it's not unreasonable to say there's a high rate of user error... just my $.02 Kuronue 00:52, 3 June 2006 (UTC)

Combined vs Progesterone-only pills

This oral contraceptive page mostly addresses combined oral contraceptive pill (COCP) and only brief mention is made at the start about some pills not containing oestrogen, i.e. Progesterone Only Pills (POP). The issues of breast cancer, DVTs, cardiac risk, migraines & strokes and additional risks if a smoker, are mostly a result of oestrogens. POP are therefore indicated (in the UK) for those with past history of DVT, predisposition to DVTs, smokers, diabetics, valvular heart disease and migraine sufferers.

Further the comparison of pros & cons with other contraceptive methods is confused by having both COCP & POP in the one page. Specifically long acting progesterone injections (Depo Provera) will have similar side effect profile to progesterone-only pills, but both differ from combined oestrogen-containing pills.

I suggest two possible options:

1. Constantly distinguishing between these two throughout the various sections of this page, or
2. Changing this page to just a brief description (i.e. of being orally taken hormonal tablets) and then linking to separate pages for combined and progesterone-only pills

Whilst my prefered option is (2), this is a major reorganisation of this topic. So please add your thoughts below. David Ruben 28 June 2005 20:20 (UTC)

Unsourced sentence - abortions due to birth control failure

This sentence "This can be partially attributed to abortions sought due to birth control failure." was added by an anon (here). I removed it as it lacked a source. Feel free to find a source and re-add it. JesseW 19:58, 13 August 2005 (UTC)

Thanks for removing that line. I am one of the many people keeping an eye on 214.13.4.151 since she has a long history of adding POV statements into abortion related articles. See for yourself. --Quasipalm 16:54, 14 August 2005 (UTC)

I deleted sentences about the pill and abortion. Since there are no statistics about abortions performed before the introduction of the pill in the early sixties, it is impossible to draw any conclusion about any correlation between availability of oral contraceptives and per-capita abortion rates. Any increase in the recorded per-capita rate of abortion since 1964 would be a result of legalization; before 1969, abortion was illegal everywhere, and no one was keeping statistics. Any decrease since 1980, as observed by CDC's morbidity and mortality report (see reference 4) doesn't necessarily correlate with greater use of oral contraceptives, nor would there necessarily be a causal relationship. This is a hotly debated topic amongst politicos, but the statistics don't support any particular argument. --Defenestrate 22:01, 30 November 2005 (UTC)

Side effect references

I removed the link to http://www.birthcpills.com/birth_control_choices.html as it would seem to be a comercial pharmacy site - a general family planning patient advice site would be more appropriate, if it is felt any link is required. eg the UK Family Planning Association is at http://www.fpa.org.uk and its links to the various methds: http://www.fpa.org.uk/guide/contracep/index.htm . The link, if really required for advice on combined pills and weight gain is: http://www.fpa.org.uk/guide/contracep/compill.htm#7 --David Ruben^talk 13:15, 21 September 2005 (UTC)

History: reconcile both parts

The part labelled "The invention" (section 11.1) consists of two separate and partly overlapping accounts, the first of which is four lengthy paragraphs, the second two short ones; this is not good! Someone needs to let us know how the pieces fit together.

Samsara 01:19, 16 November 2005 (UTC)

Possible addition to this section

I think it would be interesting if one of wikipedias resident doctors would help add a section on what would happen if women were to take a fertility drug while taking an oral contraceptive. I know it may sound strange at first, but there could be countless reason why she might do this, the most prominent to my mind being that she might take the first for her boyfriend and the second because she truelly wants a child. Chooserr 01:46, 26 December 2005 (UTC)

• I think you mean that she takes former for partner who wants a child and the second because she does not want a child. I think in practice she would only need to pretend that she is taking the fertility drug and not need to bother with any contraception. Fertility drugs work in 2 main forms (a) to inhibit the natural cycle to allow timing for stage b (hence no clash with aim of contraceptives) and to then override any natural interference during stage b. In stage (b) drugs that directly stimulate the ovary to produce eggs - the combined pill's effect on the brain's production of LH/FSH is thus mitigated. One would need ask an expert in Gynaecology whether this overall results in egg production (I suspect so). However interesting such question is, and certainly its anserwing requires a confidence in the understanding of the basic topics of fertility treatment & contraception, it is so hypothetical and, more importantly, dependant on which drug combinations are used, that the answer will not be appropraite for a general encyclopedia such as Wikipedia. The best that might be said to the woman is that she could not rely upon the contraceptive to prevent pregnancy nor that the fertility treatment will be as successful, but that she is in great need of a confidential appointment with her fertility specialist, and an honset discussion with her partner. davidruben 16:00, 26 December 2005 (UTC)

This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.