The Pill & Strokes

Among the millions of words that have been written about oral contraceptives, none have been more alarming than charges that the pill causes a wide variety of illnesses, some of them serious, and a few of them fatal. Solid statistics have been lacking, but now reliable data are being assembled about two possible major dangers:

sbTHROMBOPHLEBITIS. Women on 20-day pills that combine a progestin (a synthetic that acts like a pregnancy hormone) with a minute quantity of estrogen react as though they were "a little bit pregnant." Changes in the blood resemble those of pregnancy--including, for some women, an increased tendency for blood clots to form in inflamed leg veins. From there, they may travel to the lungs. A committee on drug safety studied every suspected case it could find in Britain and concluded that a woman taking such pills "incurs a slightly increased risk of developing thromboembolic disorders, but that risk is small, and less than the risks from ordinary pregnancy and delivery that these contraceptives are intended to prevent."

sbCEREBROVASCULAR DISORDERS. At Columbia University's Neurological Institute in the last year before the pill came into wide use, only two women between the ages of 20 and 40 were admitted with strokes; one was pregnant, the other case was apparently unrelated to hormone changes. Last year, Dr. Richard T. Bergeron and Dr. Ernest H. Wood report, they had nine such cases in this age range, and all but one of these patients were on the pills. Some had been taking them for years, some for only a few weeks. Dr. Monroe Cole of Wake Forest College has reported five similar cases within one year. The nature of nearly all these strokes was confirmed by X rays. Also subject to physical proof are cases of damage to retinal arteries and inflammation of the optic nerves. Not precisely measurable are the more numerous cases in which women complain that they have developed migraine headaches since starting on the pills, or that previously rare attacks have become more frequent and severe. But enough such instances have been reported to convince physicians that there is a cause-and-effect relationship.

Among about 7,000,000 U.S. women now on the pills, and more than 1,000,000 who have been, the incidence of these clotting and arterial disorders is small. The trouble lies not so much in the pills or their makers and takers as with doctors who prescribe them without doing a thorough physical examination and getting a good case history. One of the severely disabled patients at the Neurological Institute had never had a stroke, but both her mother and father had died of strokes. Many doctors would say that she should never have been put on the pills.

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