50th Anniversary of the Oral Contraceptive Pill
One small pill was able to change history by giving females the ability to make decisions about family planning. Now, around 100 million women worldwide use an Oral Contraceptive Pill. If used correctly combination oral contraceptives (COCs) have a 99% success rate, making them one of the most effective forms of birth control.Historical Milestones of the Pill
Since it was first made available 50 years ago, the oral contraceptive pill has played an important role in the lives of women, allowing them to make choices in their lives, affecting education, career and family. The following timeline charts the historical milestones and the social context leading to the development of the Pill and its evolution to meet differing needs of women.
"No woman can call herself free who does not own and control her own body. No woman can call herself free until she can choose consciously whether or not she will be a mother." Margaret Sanger, 1883 - 1966, American social reformer and Founder of the Birth Control Movement
In ancient times: The ancient Greeks and Egyptians used a variety of suppositories including ground up pomegranate seeds and crocodile dung to try to prevent pregnancy.
The Middle Ages: People used condoms made from a variety of materials including animal intestines and sometimes even linen.
1850s: The rubber condom was first invented. Although it was known they could prevent pregnancy, they were primarily used as protection against sexually transmitted diseases such as gonorrhoea and syphilis.
1870s: German biologist Oskar Wilhelm August Hertwig was the first person to observe the process of fertilisation - the penetration of a sperm into an egg.
1880s: The first rubber diaphragm was developed which covered the cervix and creates a barrier that prevents sperm from reaching the egg.
Early 1900s: The start of research, the start of a movement
In 1901, physiologist Ludwig Haberlandt first understood the connection between ovulation and pregnancy. Haberlandt is sometimes referred to as the "Grandfather of the Pill? due to his pioneering research.
In the 1915s, American social reformer Margaret Sanger coined the term "birth control" and began her decades-long crusade to bring safe and effective contraception into the mainstream.
In 1919, Haberlandt demonstrated that when the ovaries of pregnant rabbits were transplanted into non-pregnant animals, ovulation was inhibited and therefore pregnancy was prevented. This was the first indication that hormonal contraception was a viable option.
1920s - More than 80 years of hormone research
Walter Schoeller took over the main laboratory at Bayer Schering Pharma (then Schering AG) in 1923 and began research into sex hormones with Dohrn. The first intrauterine devices (IUDs) were developed in Germany. Initially, IUDs were made from various materials including silkworm intestines and silver. In England, reformer Marie Stopes opened birth control clinics and, in the same decade, the diaphragm was introduced in Australia.
1930s - Discoveries that paved the way for success
In 1933 the first birth control clinic in Australia was set up in Sydney.
In 1938, Hans Herloff Inhoffen and Walter Hohlweg at Schering developed the first synthetic oestrogen (female sex hormone) - ethinyl estradiol - which remains the most effective and widely used oestrogen component in oral contraceptives. Research on a second sex hormone, progesterone, was also underway. The first oral progestin (a synthetic hormone that acts in a similar way to progesterone when administered orally and a common ingredient in modern contraceptive pills), was discovered by Inhoffen and Hohlweg in the same year.
1940s - A discovery in Mexico
In 1942, American chemist Russell Marker found that diosgenin, a compound extracted from the wild yam roots, Dioscorea that grew in Mexico could be efficiently manufactured into a progestin. Marker was able to achieve a remarkable reduction in the cost of producing synthetic progesterone (now called progestin) which provided other biologists with ready access to the hormone for experimentation.
1950s - A change is on the way
In the early 1950s, American birth control movement founder Margaret Sanger introduced reproductive physiologist and leader in hormone research, Gregory Pincus to suffragist Katherine McCormick. McCormick provided financial support for developing a medicinal method of contraception. Both Sanger and McCormick were central figures in the fight for birth control and were driven by a vision to help alleviate the misery that unwanted pregnancy caused, particularly in poor and immigrant populations.
In 1952, Djerassi synthesises norethisterone, an orally extremely active progestogen. Pincus along with John Rock, an American gynaecologist from Harvard became a major developer of the Pill. Because Massachusetts law banned the use of contraceptives, the first large-scale clinical trials of the modern-day Pill - a combination of hormones oestrogen and progestin - took place in Puerto Rico in 1956. In this decade things were also changing in Australia. In the 1950s, women made up 23 per cent of the Australian workforce. Additionally television, another significant innovation, was first broadcast to Australians on 16 September 1956.
1960 - A new era begins
On 11 May 1960, American Searle Pharmaceutical Corporation introduced the first oral contraceptive pill Enovid (norethynodrel and an estrodial called mestranol) to the US market. Nine months later on 1 February 1961, Australia was the first country in Asia Pacific to launch the oral contraceptive pill Anovlar®. This Pill was launched by Schering Australia now part of Bayer Schering Pharma. At the time the Pill was first made available in Australia, it was only accessible by married women.
Interview with Dr Edith Weisberg
Dr Edith Weisberg has been working in reproductive and sexual health for 35 years, both as a clinician and a researcher. She is recognised both in Australia and internationally as an expert in the area. Dr Weisberg is the author of more than 60 publications in peer reviewed journals.
Why do you think the Oral Contraceptive Pill, is one of the most popular contraceptives for women, worldwide? Dr Edith Weisberg
: It was the first effective contraceptive available. It has been the most researched and has had the most information available for women. Taking a pill for any problem is well established so that for most women starting contraception for the first time the pill is the obvious choice
What other contraceptive options, with this many benefits, do females have? Dr Edith Weisberg
: There are many contraceptive options for women now. The long acting methods such as Implanon and Mirena have teh advanatge of not having to remember anything daily but do not suit all women and require a doctor to insert and remove them. The NuvaRing has similar benefits to teh pill but not all women like the idea of putting something into their vagina.
What advantages does the Oral Contraceptive Pill have over other contraceptive methods? Dr Edith Weisberg
: It is a very effective contraceptive which is under the control of the user. If she no longer requires contraception all she needs to do is stop taking it and fertility returns. It also has non contraceptive benefits : decrease in period pain and menstrual blood loss,. improves acne and allows women to acurately predicty when a period will start or delay or avoid a period. It reduces the risk of cancer of the womb and ovary by 50%, a protection which lasts at least 10 years after stopping the pill. It can be used by women wiith endomretriosis to reduce pain and perevent progression.
How has the Oral Contraceptive Pill changed over the past 50 years? Dr Edith Weisberg
: Because noone knew what the effective contraceptive dose was the original pill was very high dose.Over the years the dose of both oestrogen and progestogen has been reduced ; oestrogen to about a tenth of the original dose and progestogen much more. Also new and improved progestogens have been developed so that now there are a number of different combinations of oestrogen and progestogen on the market so that women are more able to find a pill which suits them. The latest development is to use a different oestrogen, oestradiol which is less potent than ethinyl oestradiol the usual oestrogen. Oestradiol is the main oestrogen produced by the ovary in women in the reproductive years. It is hoped that by using oestradiol instead of ethinyl oestradiol the major serious side effect of the pill, clotting in a vein will be reduced. Even with present low dose pills the risk is low 1/1000 users and usually in women with an heredited abnormality of their clotting system.
As sex is more commonly accepted now, do you believe it is easier for women to talk about their contraceptive options, compared with 30 to 50 years ago? Dr Edith Weisberg
: Certainly contraception in the first half of the 20th Century was regarded by many as bad and to be discouraged. The advent of the pill made it possible to talk about contraception without talking about sex as this was the first method which did not require action either just before or during sexual intercourse. In the 70s it was still difficult for unmarried women to get the pill. Many doctors would only prescribe it for married women. Now i believe women are more knowledgable, look things up on the internet and go armed with knowledge to discuss contraceptive options with doctors.
What impacts has the Oral Contraceptive Pill had on Australian women, now and in the past? Dr Edith Weisberg
: Before the advent of the pill contraceptive methods were mainly under the control of the man ie condoms and withdrawal. The diaphragm and spermicide were available to women but hard for unmarried women to obtain. If an unmarried womean became pregnant it was a disgrace and she was whipped away by the family often out of school.. At Crown street women's Hospital there was a place where unmarried pregnant girls were sent to await the birth , in the meantime hired out to families as mothers help or doing domestic work at teh hospital. Immediately after delivery teh baby was usually whisked away for adoption without the mother seeing it. The only other alternatives were a shotgun wedding or an abortion which was illegal. Only well off women could afford an abortion by safe doctors, the others resorted to back yard unsafe abortions which often resulted in infection and infertility and sometimes even death.
The advent of the pill gave women an opportunity to effectively control their fertility so that unintended pregnancy did not stop their education. They were able to plan their lives, develop careers and plan their pregnancies when if and when they wanted them
Apart from the obvious what benefits does the Oral Contraceptive Pill have on women and their body? Dr Edith Weisberg
: The modern woman with 300 periods in a lifetime is unnatural. Naturally women would have only about 50 periods in a lifetime as she would be pregnant or breast feeding for much of her reproctive life. Having so many natural periods increases the modern woman's risk of ovarian and uterine cancer, breast cancer and endometriosis. The pill reduces the risk of uterine and ovarian cancer and reduces the pain of endometriosis and its spread.
Is it okay to delay your period, or skip it all together, using the Oral Contraceptive Pill? Dr Edith Weisberg
: Its fine. There is no good reason to have a monthly bleed. Menstruation is not a cleaning out of the body. It is just natires way of preparing the womb for pregnancy so is not needed if no pregnancy is planned.
Is it a myth that women need to have breaks from the Oral Contraceptive Pill? Dr Edith Weisberg
: A total myth. Having a break will only expose the woman to risk of pregnancy. There is no adverse effect from taking the pill for as long as a woman needs it.
Is there any evidence to confirm that the contraceptive pill can affect a women's fertility? Dr Edith Weisberg
: None. Women who have difficulty falling pregnant after stopping the pill would have had this problem even if they never took the pill. By producing regular artificial periods the pill just masks these underlying problems.
In the future will we see a male contraceptive pill? Dr Edith Weisberg
: Its unlikely to be a pill but we will probably have a male injection or implant. There is a greart deal of research being undertaken on male hormonal contraception. Its quite easy to stop sperm production with progestogens but this also stops production of the male hormone testosterone affecting potency so that replacement testosterone needs to be given as well and can only be given as an injection or implant.
Is it common for the Oral Contraceptive Pill to affect a women's libido? Dr Edith Weisberg
: It may affect some women but some women find there libido actrually increases. Libido is a very complex thing involving the relationship, feelings towards the partner, feelings about pregnancy etc.