The combined oral contraceptive pill, often referred to as "the Pill", is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal fertility. Combined oral contraceptives were first approved for contraceptive use in the United States in 1960, and are a very popular form of birth control. They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States.^[1][2] Usage varies widely by country,^[3] age, education, and marital status: one quarter of women aged 16 – 49 in Great Britain currently use the Pill (combined pill or minipill),^[4] compared to only 1% of women in Japan.^[5] Image File history File linksMetadata Download high resolution version (2148x1324, 1279 KB) fr: Plaquettes de pilules contraceptives. ... Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ... This article is about Deep-vein thrombosis. ... Stroke is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Estriol. ... Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... A progestin is a synthetic progestagen. ... Progestagens (also spelled progestogens or gestagens) are hormones similar in effect to progesterone, the only natural progestagen. ... Oral contraceptives are contraceptives which are taken orally and inhibit the bodys fertility by chemical means. ... Birth control is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of a woman becoming pregnant or giving birth. ... Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestogens (progestins) and do not contain oestrogen. ...

History

By the 1930s, scientists had isolated and determined the structure of the steroid hormones and found that high doses of androgens, estrogens or progesterone inhibited ovulation, but obtaining them from European pharmaceutical companies produced from animal extracts was extraordinarily expensive.^[6] Steroid skeleton of lanosterol. ... Hormone is also the NATO reporting name for the Soviet/Russian Kamov Ka-25 military helicopter. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates. ... Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ... A pharmaceutical company is a licensed drug company, licensed to discover, develop, markets and distribute drugs. ...

In 1939, Russell Marker, a professor of organic chemistry at Pennsylvania State University, developed a method of synthesizing progesterone from plant steroid sapogenins, initially using sarsapogenin from sarsaparilla which proved too expensive. After three years of extensive botanical research he discovered a much better starting material, diosgenin from inedible Mexican wild yams found in the jungles of Veracruz near Orizaba. Unable to interest his research sponsor Parke-Davis in the commercial potential of synthesizing progesterone from Mexican yams, Marker left Penn State and in 1944 co-founded Syntex with two partners in Mexico City before leaving Syntex a year later. Syntex broke the monopoly of European pharmaceutical companies on steroid hormones, reducing the price of progesterone almost 200-fold over the next eight years.^[7][8][9] Russell Marker (1902 – 1995) was an American chemist who invented the octane rating system when he was working at the Ethyl Corporation. ... Organic chemistry is a specific discipline within chemistry which involves the scientific study of the structure, properties, composition, reactions, and preparation (by synthesis or by other means) of chemical compounds consisting of primarily carbon and hydrogen, which may contain any number of other elements, including nitrogen, oxygen, halogens as well... The Pennsylvania State University (commonly known as Penn State) is a state-related, land-grant university. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Binomial name Smilax regelii Killip & Morton Sarsaparilla (Smilax regelii and other closely related species of Smilax) is a vine that bears roots with many useful properties. ... This article, image, template or category should belong in one or more categories. ... Binomial name Dioscorea villosa This is a species that is found wild in the United States. ... The state of Veracruz de Ignacio de la Llave is one of the 31 states that comprise Mexico. ... Orizaba is a city in Veracruz, Mexico. ... Parke-Davis was a pharmaceutical company which was previously a subsidiary of Warner-Lambert prior to Warner-Lamberts acquisition by Pfizer in 2000. ... Laboratorios Syntex SA was a pharmaceutical company formed in Mexico City in 1944 by Russell Marker to manufacture therapeutic steroids from the Mexican yam. ... Nickname: Location of Mexico City in central Mexico Coordinates: Country Mexico Federal entity Federal District Boroughs The 16 delegaciones Founded (as Tenochtitlan) c. ...

Midway through 20th century, the stage was set for the development of a hormonal contraceptive, but pharmaceutical companies, universities and governments showed no interest in pursuing research.^[10] Hormonal contraception refers to birth control methods that act on the hormonal system. ...

Studies of progesterone to prevent ovulation

In early 1951, reproductive physiologist Gregory Pincus, a leader in hormone research and co-founder of the Worcester Foundation for Experimental Biology (WFEB) in Shrewsbury, Massachusetts, first met American birth control movement founder Margaret Sanger at a Manhattan dinner hosted by Abraham Stone, medical director and vice president of Planned Parenthood (PPFA), who helped Pincus obtain a small grant from PPFA to begin hormonal contraceptive research. Research started on April 25, 1951 with reproductive physiologist Min Chueh Chang repeating and extending the 1937 experiments of Makepeace et al. that showed injections of progesterone suppressed ovulation in rabbits. In October 1951, G. D. Searle & Company refused Pincus' request to fund his hormonal contraceptive research, but retained him as a consultant and continued to provide chemical compounds to evaluate.^[6][11] Physiology (in Greek physis = nature and logos = word) is the study of the mechanical, physical, and biochemical functions of living organisms. ... Gregory Goodwin Pincus (April 9, 1903 - August 22, 1967), American physician, biologist, and researcher, was co-inventor of the contraceptive pill. ... The Worcester Foundation for Experimental Biology is a now-defunct research center where the birth control pill was developed by Gregory Pincas and Min Chueh Chang. ... Location in Massachusetts Coordinates: Country United States State Massachusetts County Worcester County Settled 1722 Incorporated 1727 Government  - Type Representative town meeting  - Town    Manager Daniel J. Morgado  - Board of    Selectmen Bruce Card Maurice DePalo Thomas Fiore John Lebeaux James A. McCaffrey Area  - Town  21. ... Margaret Higgins Sanger (September 14, 1879 – September 6, 1966) was an American birth control activist, an advocate of negative eugenics, and the founder of the American Birth Control League (which eventually became Planned Parenthood). ... Manhattan is a borough of New York City, USA, coterminous with New York County. ... Planned Parenthoods Logo Planned Parenthood is the collective name of organizations worldwide who are members of the International Planned Parenthood Federation (IPPF). ... Wikipedia does not have an article with this exact name. ... G.D. Searle & Company was a company focusing on life sciences, specifically pharmaceuticals, agriculture, and animal health. ...

In March 1952, Sanger wrote a brief note mentioning Pincus' research to her longtime friend and supporter, suffragist and philanthropist Katharine Dexter McCormick, who visited the WFEB and its co-founder and old friend Hudson Hoagland in June 1952 to learn about contraceptive research there. Frustrated when research stalled from PPFA's lack of interest and meager funding, McCormick arranged a meeting at the WFEB on June 6, 1953 with Sanger and Hoagland where she first met Pincus who committed to dramatically expand and accelerate research with McCormick providing fifty times PPFA's previous funding.^[11][12] The term womens suffrage is a social, economic and political reform movement aimed at extending suffrage — the right to vote — to women. ... A philanthropist is someone who engages in philanthropy; that is, someone who donates his or her time, money, or reputation to a charitable cause. ... Katharine Dexter McCormick (August 27, 1875 – December 28, 1967) was a U.S. biologist, suffragette, philanthropist and, after her husbands death, heir to a substantial part of the McCormick fortune. ...

Pincus and McCormick enlisted Harvard clinical professor of gynecology John Rock, chief of gynecology at the Free Hospital for Women and an expert in the treatment of infertility, to lead clinical research with women. At a scientific conference in 1952, Pincus and Rock, who had known each other for many years, discovered they were using similar approaches to achieve opposite goals. In 1952, Rock induced a three-month anovulatory "pseudo-pregnancy" state in eighty of his infertility patients with continuous gradually increasing oral doses of estrogen (diethylstilbestrol 5 – 30 mg/day) and progesterone (50 – 300 mg/day) and within the following four months an encouraging 15% became pregnant.^[11][13][14] Harvard Medical School (HMS) is one of the graduate schools of Harvard University. ... The current version of the article or section is written like a magazine article instead of the formal tone expected of an encyclopedia. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Boston Lying-In Hospital building, part of Brigham and Womens Hospital, view from Longwood Avenue. ... Infertility is the inability to naturally conceive a child or to carry a pregnancy to full term. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ... Estriol. ... Diethylstilbestrol (DES) is a drug, a synthetic nonsteroidal estrogen that was first synthesized in 1938. ...

In 1953, at Pincus' suggestion, Rock induced a three-month anovulatory "pseudo-pregnancy" state in twenty-seven of his infertility patients with an oral 300 mg/day progesterone-only regimen for 20 days from cycle days 5 – 24 followed by pill-free days to produce withdrawal bleeding. This produced the same encouraging 15% pregnancy rate during the following four months without the troubling amenorrhea of the previous continuous estrogen and progesterone regimen. But 20% of the women experienced breakthrough bleeding and in the first cycle ovulation was suppressed in only 85% of the women, indicating that even higher and more expensive oral doses of progesterone would be needed to initially consistently suppress ovulation.^[15] Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ...

Studies of progestins to prevent ovulation

Pincus asked his contacts at pharmaceutical companies to send him chemical compounds with progestogenic activity. Chang screened nearly 200 chemical compounds in animals and found the three most promising were Syntex's norethindrone and Searle's norethynodrel and norethandrolone.^[16] A progestin is a synthetic progestagen. ... Norethynodrel was the progestin used in Enovid, the first oral contraceptive. ... Norethandrolone is an anabolic steroid. ...

Chemists Carl Djerassi, Luis Miramontes, and George Rosenkranz at Syntex in Mexico City had synthesized the first orally highly active progestin norethindrone in 1951. Chemist Frank B. Colton at Searle in Skokie, Illinois had synthesized the orally highly active progestins norethynodrel (an isomer of norethindrone) in 1952 and norethandrolone in 1953.^[6] This article or section is not written in the formal tone expected of an encyclopedia article. ... Luis E. Miramontes ca. ... George Rosenkranz (born August 20, 1916, in Budapest) is a Mexican Ph. ... Frank Benjamin Colton (March 3, 1923 - November 25, 2003), American chemist who first synthesized norethynodrel, the progestin used in Enovid, the first oral contraceptive, at G. D. Searle & Company in Skokie, Illinois in 1952. ... Incorporated Village in 1888. ...

In December 1954, Rock began the first studies of the ovulation-suppressing potential of 5 – 50 mg doses of the three oral progestins for three months (for 21 days per cycle — days 5 – 25 followed by pill-free days to produce withdrawal bleeding) in fifty of his infertility patients in Brookline, Massachusetts. 5 mg doses of norethindrone or norethynodrel and all doses of norethandrolone suppressed ovulation but caused breakthrough bleeding, but 10 mg and higher doses of norethindrone or norethynodrel suppressed ovulation without breakthrough bleeding and led to a 14% pregnancy rate in the following five months. Pincus and Rock selected Searle's norethynodrel for the first contraceptive trials in women citing its total lack of androgenicity versus Syntex's norethindrone's very slight androgenicity in animal tests.^[17][18] Nickname: Location in Massachusetts Coordinates: Country United States State Massachusetts County Norfolk County Settled 1638 Incorporated 1705 Government  - Type Representative town meeting Area  - Town  6. ...

Development of an effective combined oral contraceptive

Norethynodrel (and norethindrone) were subsequently discovered to be contaminated with a small percentage of the estrogen mestranol (an intermediate in their synthesis), with the norethynodrel in Rock's 1954-5 study containing 4-7% mestranol. When further purifying norethynodrel to contain less than 1% mestranol led to breakthrough bleeding, it was decided to intentionally incorporate 2.2% mestranol, a percentage that was not associated with breakthrough bleeding, in the first contraceptive trials in women in 1956. The norethynodrel and mestranol combination was given the proprietary name Enovid.^[18][19] Mestranol is the 3-methyl ether of ethinylestradiol. ...

The first contraceptive trial of Enovid led by Edris Rice-Wray began in April 1956 in Río Piedras, Puerto Rico.^[20][21][22] A second contraceptive trial of Enovid (and norethindrone) led by Edward T. Tyler began in June 1956 in Los Angeles.^[9][23] On January 23, 1957, Searle held a symposium reviewing gynecologic and contraceptive research on Enovid through 1956 and concluded Enovid's estrogen content could be reduced by 33% to lower the incidence of estrogenic gastrointestinal side effects without significantly increasing the incidence of breakthrough bleeding.^[24] Edris Rice-Wray Carson, M.D. attended Cornell University where she was a member of the Alpha Phi sorority. ... Río Piedras was a town in Puerto Rico which was absorbed by the city of San Juan and is now one of its districts. ... Flag Seal Nickname: City of Angels Location Location within Los Angeles County in the state of California Coordinates , Government State County California Los Angeles County Mayor Antonio Villaraigosa (D) Geographical characteristics Area     City 1,290. ...

Public availability

In June 1957, the FDA approved Enovid 10 mg (9.85 mg norethynodrel and 150 µg mestranol) for menstrual disorders based on data from its use by more than 600 women. Numerous additional contraceptive trials showed Enovid at 10, 5, and 2.5 mg doses to be highly effective. On July 23, 1959, Searle filed a supplemental application to add contraception as an approved indication for 10, 5 and 2.5 mg doses of Enovid. The FDA refused to consider the application until Searle agreed to withdraw the lower dosage forms from the application. On May 9, 1960, the FDA announced it would approve Enovid 10 mg for contraceptive use, which it did on June 23, 1960, by which time Enovid 10 mg had been in general use for three years during which time, by conservative estimate, at least half a million women had used it.^[20][25][26] FDA logo The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food, dietary supplements, drugs, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics in the United States. ...

Although FDA-approved for contraceptive use, Searle never marketed Enovid 10 mg as a contraceptive. Nine months later, in February 1961, the FDA approved Enovid 5 mg for contraceptive use. In July 1961, Searle finally began marketing Enovid 5 mg (5 mg norethynodrel and 75 µg mestranol) to physicians as a contraceptive.^[25][27]

Although the FDA approved the first oral contraceptive in 1960, contraceptives were not available to married women in all states until Griswold v. Connecticut in 1965 and were not available to unmarried women in all states until Eisenstadt v. Baird in 1972.^[10][27] Holding A Connecticut law criminalizing the use of contraceptives violated the right to marital privacy. ... Eisenstadt v. ...

The first published case report of a blood clot and pulmonary embolism in a woman using Enovid did not appear until November 1961, four years after its approval, by which time it had been used by over one million women.^[20][28][29] It would take almost a decade of epidemiological studies to conclusively establish an increased risk of venous thrombosis in oral contraceptive users and an increased risk of stroke and myocardial infarction in oral contraceptive users who smoke or have high blood pressure or other cardiovascular or cerebrovascular risk factors.^[25] These risks of oral contraceptives were dramatized in the 1969 book The Doctors' Case Against the Pill by feminist journalist Barbara Seaman who helped arrange the 1970 Senate hearings called by Senator Gaylord Nelson.^[30] The hearings were conducted by Senators who were all men and the witnesses in the first round of hearings were all men, leading Alice Wolfson and other feminists to protest the hearings and generate media attention.^[27] Their work led to mandating the inclusion of patient package inserts with oral contraceptives to explain their possible side effects and risks to help facilitate informed consent.^[31][32][33] Today's standard dose oral contraceptives contain an estrogen dose that is one third lower than the first marketed oral contraceptive and contain lower doses of different, more potent progestins in a variety of formulations.^[25][27][34] A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... A venous thrombosis is a blood clot that forms within a vein. ... Stroke is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... The cigarette is the most common method of smoking tobacco. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Seaman is a women’s health activist who, through persistent investigative journalism, reporting, and social organizing, has brought about significant changes in the relationship between the medical and pharmaceutical establishments and women in America. ... Seal of the U.S. Senate Federal courts Supreme Court Chief Justice Associate Justices Elections Presidential elections Midterm elections Political Parties Democratic Republican Third parties State & Local government Governors Legislatures State Courts Counties, Cities, and Towns Other countries Politics Portal      Senate composition following 2006 elections The United States Senate is... Gaylord Nelson Gaylord Anton Nelson (June 4, 1916 – July 3, 2005) was a Democratic American politician from Wisconsin. ... Alice Wolfson, a Barnard graduate and former Fulbright Scholar, is a veteran political activist in womens reproductive health issues, a lawyer, and a co-founder of the National Womens Health Network. ... A package insert or patient package insert (PPI) (in Europe, Patient Information Leaflet) is a document provided along with a prescription medication to provide additional information about that drug. ... Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. ...

Luis E. Miramontes signed laboratory notebook. October 15, 1951

Image File history File links Download high resolution version (653x808, 92 KB) Summary This is the historical page of a laboratory notebook where Luis Miramontes describes the invention and synthesis of the chemical that would became into the first contraceptive pill. ... Image File history File links Download high resolution version (653x808, 92 KB) Summary This is the historical page of a laboratory notebook where Luis Miramontes describes the invention and synthesis of the chemical that would became into the first contraceptive pill. ...

France

In 1967, the Neuwirth Law legalized contraception in France, including the pill.^[35] The pill is the most popular form of contraception in France, especially among young women. The abortion rate has remained stable since the introduction of the pill.^[36]

Japan

In Japan, lobbying from the Japan Medical Association prevented the Pill from being approved for nearly 40 years. Two main objections raised by the association were safety concerns over long-term use of the Pill, and concerns that the Pill use would lead to diminished use of condoms and thereby potentially increase sexually transmitted infection (STI) rates.^[37] As of 2004, condoms accounted for 80% of birth control use in Japan, and this may explain Japan's comparably low rates of AIDS.^[38] Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ...

The Pill was approved for use in 1999; the Pill prescription guidelines the government endorsed require Pill users to visit a doctor every three months for pelvic examinations and undergo tests for sexually transmitted diseases and uterine cancer. In the United States and Europe, in contrast, an annual or bi-annual clinic visit is standard for Pill users. ^[5] 1999 (MCMXCIX) was a common year starting on Friday, and was designated the International Year of Older Persons by the United Nations. ...

Use and packaging

Combined oral contraceptive pills must be ingested at the same time each day. Contraceptive effectiveness may be reduced if a pill is taken more than 12 hours late.^[39] Most brands of combined pills are packaged in one of two different packet sizes, with days marked off for a 28 day cycle. For the 21-pill packet, a pill is consumed daily for three weeks, followed by a week of no pills. For the 28-pill packet, 21 pills are taken, followed by week of placebo or sugar pills. A woman on the pill will have a withdrawal bleed sometime during the placebo week. Photograph of a half-used blister pack of Levlen®ED oral contraceptive pill. ... “Placebo effect” redirects here. ...

Placebo pills

The purpose of the placebo pills is that the user, out of habit, can take a pill on every day of her menstrual cycle, instead of calculating the date she should start the next dose. Placebo pills may contain an iron supplement, as iron requirements increase during menstruation. General Name, Symbol, Number iron, Fe, 26 Chemical series transition metals Group, Period, Block 8, 4, d Appearance lustrous metallic with a grayish tinge Standard atomic weight 55. ...

Failure to take pills during the placebo week has no effect on the effectiveness of the pill provided that daily ingestion of active pills is resumed at the end of the week.

The presence of placebo pills is thought to be comforting, as menstruation is a physical confirmation of not being pregnant. The 28-day pill package also simulates the average menstrual cycle, though the hormonal events during a pill cycle are completely different from those of a normal ovulatory menstrual cycle, and the bleeding is triggered by different hormonal cues. Breakthrough bleeding also becomes a more common side effect as a woman attempts to go longer periods of time between menstrual periods. Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ...

Less frequent placebos

If the pill formulation is monophasic, it is possible to skip menstruation and still remain protected against conception by skipping the placebo pills and starting directly with the next packet. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. It will not, however, increase the risk of getting pregnant. Menstrual cycle. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ...

Starting in 2003, women have also been able to use a three-month version of the Pill.^[40] Similar to the effect of using a constant-dosage formulation and skipping the placebo weeks for three months, Seasonale gives the benefit of less frequent periods, at the potential drawback of breakthrough bleeding. Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen. Seasonale® (levonorgestrel/ethinyl estradiol) is a brand of birth control pill that reduces the frequency of menstrual periods from 13 per year to four per year. ...

A version of the combined pill has also been packaged to completely eliminate placebo pills and withdrawal bleeds. Marketed as Anya or Lybrel, studies have shown that after seven months 71% of users no longer had any breakthrough bleeding, the most common side effect of going longer periods of time without breaks from active pills.^[41]

Effectiveness

The Pearl Index is often used to compare the effectiveness of various methods of contraception.^[42] It is expressed as the "number of unintended pregnancies in 100 normally fertile women over the period of one year". Each method of birth control has two Pearl index numbers: The Pearl Index, also called the Pearl rate, is a technique used in clinical trials for measuring the effectiveness of a birth control method. ...

• method effectiveness: is the Pearl index number for use under perfect conditions. The method effectiveness Pearl index for the Pill has been measured as low as 0.3 and as high as 1.25, which means that under ideal conditions, anywhere from 0.3 to 1.25 out of 100 users will become pregnant during one year of perfect use (Pearl index = 0.3 to 1.25).
• user effectiveness or typical effectiveness: is the Pearl index number for use that is not consistent or always correct. The user effectiveness measured by the Pearl index for the Pill has been measured as low as 2.15 and as high as 8.0, which means that anywhere from 2.15 to 8.0 out of 100 women will become pregnant during the first year of typical use (Pearl index = 2.15 to 8.0).^[43][44]

If a woman just starting the pill begins taking them within five days of the beginning of her menstrual cycle (the menstrual cycle begins on the first day of red bleeding), she will have pregnancy protection from the very first pill. If a woman begins taking the pill at another time in her menstrual cycle, she must use a different form of contraception for seven days.^[45] A pregnant woman Pregnancy is the process by which a mammalian female carries a live offspring from conception until it develops to the point where the offspring is capable of living outside the womb. ... A pregnant woman Pregnancy is the process by which a mammalian female carries a live offspring from conception until it develops to the point where the offspring is capable of living outside the womb. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ...

Many women occasionally forget to take the Pill daily, impairing its effectiveness. Correct use of 21-day packaged preparations of combined oral contractraceptive pills means taking a pill every day at approximately the same time of day for 21 days, followed by a pause of seven days.

Use of other medications can prevent the Pill from working, due to interactions with the metabolism of the hormonal constituents. Diarrhea can also stop the Pill from working, because it causes the hormones to not be properly absorbed by the bowels. Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a...

Mechanism of action

Prefertilization effects

The combined Pill primarily prevents pregnancy by preventing ovulation. In women who take the pills correctly, ovulation is prevented in 98-99% of cycles. Forgetting to take one or more pills increases ovulation rates; one study found skipping two pills in a row resulted in ovulation in 29% of cycles.^[46] (In women not taking the Pill, pregnancy occurs in approximately 25% of ovulatory cycles.)^[47] Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ...

In the event of breakthrough ovulation, secondary contraceptive mechanisms are believed to come into play. Proposed secondary mechanisms active before fertilization include thickening of cervical mucus, which can prevent or slow sperm entry into the uterus, and changes in tube transport inhibiting sperm migration to the fallopian tubes.^[48] Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges (singular salpinx), are two very fine tubes leading from the ovaries of female mammals into the uterus. ...

Postfertilization effects

Mechanisms that act after fertilization are controversial; according to those who define pregnancy as beginning at fertilization such mechanisms make the method abortifacient. Postfertilization effects of combined oral contraceptives (COCs) could involve any 1 or more of the following 3 mechanisms of action:^[48] Controversy over the beginning of pregnancy usually occurs in the context of the abortion debate. ... An abortifacient is a substance that induces abortion. ...

• Alteration of the endometrium, such that an embryo that reached the uterus was unable to successfully implant into the endometrial lining of the uterus.
• Alteration of the endometrium not sufficient to prevent implantation but unfavorable for maintenance of the pregnancy; an unattached embryo or embryo already implanted in the endometrial lining of the uterus would be unable to maintain itself long enough to result in a clinically recognized pregnancy. (Clinically recognized miscarriage rates are not higher in women who became pregnant while taking oral contraceptives.)^[49]
• Slower transport of the embryo through the fallopian tube, preventing the embryo from implanting in the uterus; this could result either in the unrecognized loss of the embryo or in an ectopic (tubal) pregnancy if the embryo had slower tubal transport and ended up implanting in the fallopian tube.

Thinning and other changes to the endometrium are well-documented. Experience with in vitro fertilization has shown that similar changes are detrimental to implantation rates.^[48][50] However, some physicians are unconvinced that these pill-induced changes truly decrease the likelihood that an embryo will implant itself in the uterine lining. In women who do not take the Pill, the uterine lining is usually unreceptive to implantation prior to ovulation. The purpose of the hormones released by the corpus luteum is to cause the endometrium to thicken and become receptive to implantation (which occurs between six and twelve days after ovulation if the ovum is fertilized). Thus, simple observations that the uterine lining is too thin to support implantation during a cycle where no ovulation has occurred is insufficient to support the claim that there is a reduced likelihood of implantation in ovulatory Pill cycles. Currently, very little research has been conducted on the behavior of the endometrium in ovulatory Pill cycles.^[51] Others point to studies showing reduced volume of menstrual flow for several cycles after discontinuing use of COCs, suggesting that the endometrium is slow to recover from its COC-induced atrophy. They also present studies demonstrating luteal phase defect in ovulatory pill cycles. These two effects would support the existence of a postfertilization mechanism of action.^[48] In vitro fertilization (IVF) is a technique in which egg cells are fertilized outside the mothers body in cases where conception is difficult or impossible through normal intercourse. ... The luteal phase is the latter phase of the estrous cycle in animals. ...

The theoretical increased rate of miscarriage among post-implantation but pre-clinically recognized pregnancies could be tested with serial ultrasensitive assays for human chorionic gonadotropin. To date, no such trials have been conducted in women taking combined oral contraceptive pills.^[48] Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). ...

The theory that the pill has a postfertilization effect due to slowed tube transport holds that the ratio of extrauterine to intrauterine pregnancies is increased in women using the pill. Supporting this theory, one study found that women who became pregnant while taking the combined pill were 13.9 times more likely to have an ectopic pregnancy than women who became pregnant while not using a contraceptive method (only pregnancies that were ectopic or ended in live birth were included in this study; not including pregnancies that ended in abortion possibly introduced error into the ratio calculation).^[52] A study by the World Health Organization found no such increased risk.^[53] The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ...

Drug interactions

Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or increased chance of pregnancy. These include drugs such as rifampicin, barbiturates, phenytoin and carbamazepine. In addition cautions are given about broad spectrum antibiotics, such as ampicillin and doxycycline, which may cause problems "by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel" (BNF 2003).^[54] It has been suggested that Blockbuster drug be merged into this article or section. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ... Rifampicin (INN) (IPA: ) or rifampin (USAN) is a bacteriocidal antibiotic drug of the rifamycin group. ... Barbiturates are drugs that act as central nervous system depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... Carbamazepine (sold under the brand-names Biston, Calepsin, Carbatrol, Epitol, Equetro, Finlepsin, Sirtal, Stazepine, Tegretol, Telesmin, Timonil, sometimes abbreviated CBZ) is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. ... Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... The human body contains a large number of bacteria, most of them performing tasks that are useful or even essential to human survival. ... Ethinylestradiol, also ethinyl estradiol (EE), is a synthetic derivative of estradiol. ... Otherwise known as the doctors prescribing Bible the British National Formulary (BNF) contains a wide spectrum of information on prescribing and pharmacology, among others indications, side effects and costs of the prescription of all medication drugs available on the National Health Service. ...

The traditional medicinal herb St John's Wort has also been implicated due to its upregulation of the P450 system in the liver. Binomial name Hypericum perforatum L. St Johns wort (IPA pronunciation: , rhyming with hurt, or ) used alone refers to the species Hypericum perforatum, also known as Klamath weed or Goat weed, but, with qualifiers, is used to refer to any species of the genus Hypericum. ... Cytochrome P450 Oxidase (CYP2E1) Cytochrome P450 oxidase (commonly abbreviated CYP) is a generic term for a large number of related, but distinct, oxidative enzymes (EC 1. ... The liver is an organ present in vertebrates and some other animals. ...

Side-effects

Different studies have found different risks of side effects. Some sources have found that the majority (about 60%) of women report no side effects at all, and the vast majority of those who do, have only minor effects.^[55] Other studies have found that up to half of women who try the pill discontinue due to side effects.^[56]

Weight

A 1992 French review article noted that one study found that 20-25% of women reported they stopped taking the Pill because of either acne or weight gain.^[56] A 1986 Hungarian study comparing two high-dose estrogen (both 50 µg ethinyl estradiol) pills found that women using a lower-dose biphasic levonorgestrel formulation (50 µg levonorgestrel x 10 days + 125 µg levonorgestrel x 11 days) reported a significantly lower incidence of weight gain compared to women using a higher-dose monophasic levonorgestrel formulation (250 µg levonorgestrel x 21 days).^[57]

Many clinicians consider the public perception of weight gain on the Pill to be inaccurate and dangerous. The aforementioned 1992 French review article noted that one study of 550 women found that 23% of the 6% of women who discontinued the Pill because of poor cycle control experienced subsequent unwanted pregnancies.^[56] A 2000 British review article concluded there is no evidence that modern low-dose pills cause weight gain, but that fear of weight gain contributed to poor compliance in taking the Pill and subsequent unintended pregnancy, especially among adolescents.^[58]

Sexuality

The Pill may have a positive effect on a woman's sexuality. Because neither the woman (who uses the Pill) nor her partner need take any special action before or during intercourse, it makes birth control "invisible" and sex spontaneous, more natural, or both.

However, some say the Pill can also have a negative effect on a woman's sexuality. Dr. John Bancroft (a senior research fellow at the Kinsey Institute at Indiana University) estimates that one in four women on the pill experience some negative sexual effect. These effects may include a decreased frequency of sexual thoughts, increased difficulty in becoming aroused, or decreased lubrication, which can make sex painful. Recent research co-authored by Dr. Irwin Goldstein (a urologist in Boston) suggests such effects may continue for up to four months after a woman stops taking the Pill.^[59]

Depression

Low levels of serotonin, a neurotransmitter in the brain, have been linked to depression. High levels of estrogen, as in first-generation COCPs, and progestin, as in some progestin-only contraceptives, have been shown to promote the lowering of brain serotonin levels by increasing the concentration of a brain enzyme that reduces serotonin.^[1] Progestin-only contraceptives are known to worsen the condition of women who are already depressed.^[60] Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ...

Current medical reference textbooks on contraception^[34] and major organizations such as the American ACOG,^[61] the WHO,^[62] and the United Kingdom's RCOG^[63] agree that current evidence indicates low-dose oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women who are currently depressed. Contraceptive Technology states that low-dose COCPs have not been implicated in disruptions of serotonin or tryptophan.^[1] The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. ... The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... Tryptophan is an amino acid and essential in human nutrition. ...

Some medical professionals, however, believe that use of modern combined oral contraceptives does increase a woman's risk of developing depression.^[64] A 2005 study by Professor Jayashri Kulkarni of Australia’s Monash University found the average pill user had an average depression rating scale score of 17.6, compared to 9.8 in the non-user group. (The women involved in the study were aged over 18, not pregnant or lactating, had no clinical history of depression and had not been on anti-depressant medication in the previous 12 months.)^[60]

Other effects

Other possible side effects are: vaginal discharge, changes in menstrual flow, breakthrough bleeding, unusual build-up of the uterine lining, nausea, headaches, vaginitis, urinary tract infection, changes in the breasts, changes in blood pressure, skin problems, skin improvements, and gum inflammation. The insert included with each pill packet usually has a more extensive list of recognized side effects. Wikipedia does not have an article with this exact name. ... Menstrual cycle. ... Breakthrough bleeding is bleeding between regular menstrual cycles. ... For the Beck song, see Nausea (song). ... A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Vaginitis is an inflammation of the vaginal mucosa and often associated with an irritation or infection of the vulva leading to vulvovaginitis. ... A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ... A pregnant womans breasts. ... A sphygmomanometer, a device used for measuring blood pressure. ... Dermatology (from Greek derma, skin) is a branch of medicine dealing with the skin and its appendages (hair, nails, sweat glands etc). ... This article or section does not adequately cite its references or sources. ...

Formulations

Main article: oral contraceptive formulations

Oral contraceptives come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills. Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestin changes from week to week. Oral contraceptives come in a variety of formulations. ... Estriol. ... A progestin is a synthetic progestagen. ... Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestogens (progestins) and do not contain oestrogen. ...

Cautions and contraindications

Oral contraceptives may influence coagulation, increasing the risk of deep venous thrombosis (DVT) and pulmonary embolism, stroke and myocardial infarction (heart attack). Combined oral contraceptives are generally accepted to be contraindicated in women with pre-existing cardiovascular disease, in women who have a familial tendency to form blood clots (such as familial factor V Leiden), women with severe obesity and/or hypercholesterolaemia (high cholesterol level), and in smokers over age 35. Coagulation is a complex process by which blood forms solid clots. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... Stroke is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Factor V Leiden (sometimes Factor VLeiden) is the name given to a variant of human factor V that causes a hypercoagulability disorder. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... The cigarette is the most common method of smoking tobacco. ...

Research into the relationship between breast cancer risk and hormonal contraception is complex and seemingly contradictory.^[65] The large 1996 collaborative reanalysis of individual data on over 150,000 women in 54 studies of breast cancer found that: "The results provide strong evidence for two main conclusions. First, while women are taking combined oral contraceptives and in the 10 years after stopping there is a small increase in the relative risk of having breast cancer diagnosed. Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use. The cancers diagnosed in women who had used combined oral contraceptives were less advanced clinically than those diagnosed in women who had never used these contraceptives."^[66] This data has been interpreted to suggest that oral contraceptives have little or no biological effect on breast cancer development, but that women who seek gynecologic care to obtain contraceptives have more early breast cancers detected through screening.^[67][68] Breast cancer is cancer of breast tissue. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ...

It is generally accepted by medical authorities that the health risks of oral contraceptives are lower than those from pregnancy and birth."^[69] Some organizations have argued that comparing a contraceptive method to no method (pregnancy) is not relevant - instead, the comparison of safety should be among available methods of contraception.^[70]

Non-contraceptive uses

The hormones in "the Pill" can be used to treat some medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, anemia related to menstruation, and painful menstruation (dysmenorrhea). In addition, oral contraceptives are often prescribed as medication for mild or moderate acne.^[71] The pill can also induce menstruation on a regular schedule for women bothered by irregular menstrual cycles and certain disorders where there is dysfunctional uterine bleeding. Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ... Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). ... Dysmenorrhea (or dysmenorrhoea), cramps or painful menstruation, involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen. ... Dysfunctional Uterine Bleeding (DUB) is the most common cause of functional abnormal uterine bleeding, which is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable organic pathology. ...

Combined oral contraceptive use reduces the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to never users. The risk reduction increases with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. The risk reduction for both ovarian and endometrial cancer persists for at least 20 years.^[34] Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ...

Although the FDA does not officially condone the use of the Pill as a minor breast enhancer, many women have gone on the pill in order to increase their breast size.^{[citation needed]} This results from the low doses of estrogen present along with the progestin. Results vary widely.

Social and cultural impact

Introduced at the beginning of the tumultuous decade of the 1960s, the Pill had an enormous social impact. In the first place, it was far more effective than any previous method of birth control, giving women unprecedented control over their fertility. Its use was separate from intercourse, requiring no special preparations at the time of sexual activity that might interfere with spontaneity or sensation. This combination of factors served to make the Pill immensely popular within a few years of its introduction.^[7][27] The 1960s decade refers to the years from January 1, 1960 to December 31, 1969, inclusive. ...

Because the Pill was so effective, and soon so widespread, it also heightened the debate about the moral and health consequences of pre-marital sex and promiscuity. Never before had sexual activity been so divorced from reproduction. For a couple using the Pill, intercourse became purely an expression of love, or a means of physical pleasure, or both; but it was no longer a means of reproduction. While this was true of previous contraceptives, their relatively high failure rates and their less widespread use failed to emphasize this distinction as clearly as did the Pill. The spread of oral contraceptive use thus led many religious figures and institutions to debate the proper role of sexuality and its relationship to procreation. The Roman Catholic Church in particular, after studying the phenomenon of oral contraceptives, re-emphasized traditional Catholic teaching on birth control in the 1968 papal encyclical Humanae Vitae. The encyclical, reiterated the traditional Catholic teaching that artificial contraception distorted the nature and purpose of sex.^[72] This article is primarily about religious attitudes to sexual morality. ... The Roman Catholic Church or Catholic Church (see terminology below) is the Christian church in full communion with the Bishop of Rome, currently Pope Benedict XVI. It traces its origins to the original Christian community founded by Jesus Christ and led by the Twelve Apostles, in particular Saint Peter. ... 1968 (MCMLXVIII) was a leap year starting on Monday. ... Humanae Vitae (Latin of human life, but typically translated as On the Regulation of Human Birth) is an encyclical written by Pope Paul VI and promulgated on July 25, 1968. ...

A backlash against oral contraceptives occurred in the early and mid-1970s, when reports and speculations appeared that linked the use of the Pill to breast cancer. Until then, many women in the feminist movement had hailed the Pill as an "equalizer" that had given them the same sexual freedom as men had traditionally enjoyed. This new development, however, caused many of them to denounce oral contraceptives as a male invention designed to facilitate male sexual freedom with women at the cost of health risk to women.^[73] At the same time, society was beginning to take note of the impact of the Pill on traditional gender roles. Women now did not have to choose between a relationship and a career; singer Loretta Lynn commented on this in her 1974 album with a song entitled "The Pill," which told the story of a married woman's use of the drug to liberate herself from her traditional role as wife and mother. Breast cancer is cancer of breast tissue. ... Feminism is a social theory and political movement primarily informed and motivated by the experience of women. ... Loretta Lynn (born Loretta Webb April 14, 1934) is an American country singer and was one of the leading country female vocalists during the 1960s and 1970s. ...

Environmental impact

Ethinylestradiol, the synthetic oestrogen used in most combined hormonal contraceptives, is excreted in the urine of women users. Sewage treatment processes do not remove these chemicals, and they are discharged into the water system. This form of pollution has been proven to have reproductive and other effects on aquatic organisms, including fish, frogs, and zooplankton. Feminization of male fish, even to the point of producing eggs, is one common effect. Both male and female fish experience delays in reproductive development, and changes are seen in their kidneys and livers.^[74] Ethinylestradiol, also ethinyl estradiol (EE), is a synthetic derivative of estradiol. ...

Footnotes

See also August 19, 2004 - August 2004 - August 21, 2004 US Airways, struggling to avoid a second bankruptcy, asks pilots to accept a 16. ... For the Manfred Mann album, see 2006 (album). ... June 12 is the 163rd day of the year in the Gregorian calendar (164th in leap years), with 202 days remaining. ... For the Manfred Mann album, see 2006 (album). ... September 7 is the 250th day of the year (251st in leap years). ... A news release, press release or press statement is a written or recorded communication directed at members of the news media for the purpose of announcing something claimed as having news value. ... For the Manfred Mann album, see 2006 (album). ... August 23 is the 235th day of the year in the Gregorian calendar (236th in leap years), with 130 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 23 is the 235th day of the year in the Gregorian calendar (236th in leap years), with 130 days remaining. ... Organon International, Inc. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... For the Manfred Mann album, see 2006 (album). ... November 9 is the 313th day of the year (314th in leap years) in the Gregorian Calendar, with 52 days remaining. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... December 28 is the 362nd day of the year (363rd in leap years) in the Gregorian Calendar, with 3 days remaining. ... For the Manfred Mann album, see 2006 (album). ... December 23 is the 357th day of the year in the Gregorian calendar (358th in leap years). ... The Guttmacher Institute (formerly the Alan Guttmacher Institute) is a research institute that provides global and U.S.-specific demographic statistics on reproductive matters such as birth control and abortion. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... May 10 is the 130th day of the year in the Gregorian calendar (131st in leap years). ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... January 27 is the 27th day of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... December 23 is the 357th day of the year in the Gregorian calendar (358th in leap years). ... For the Manfred Mann album, see 2006 (album). ... December 23 is the 357th day of the year in the Gregorian calendar (358th in leap years). ... The American Association of Pro-Life Obstetricians and Gynecologists or AAPLOG was originally put together in 1957 by a group of Gynecologists in Pittsburgh lead by Dr. William Hartherford. ... For the Manfred Mann album, see 2006 (album). ... August 30 is the 242nd day of the year in the Gregorian Calendar (243rd in leap years), with 123 days remaining. ... This article is being considered for deletion in accordance with Wikipedias deletion policy. ... The largest pro-life organization in the United States, the American Life League, or ALL, opposes all forms of abortion, birth control, stem cell research, and euthanasia. ... For the Manfred Mann album, see 2006 (album). ... August 30 is the 242nd day of the year in the Gregorian Calendar (243rd in leap years), with 123 days remaining. ... The American Association of Pro-Life Obstetricians and Gynecologists or AAPLOG was originally put together in 1957 by a group of Gynecologists in Pittsburgh lead by Dr. William Hartherford. ... For the Manfred Mann album, see 2006 (album). ... June 12 is the 163rd day of the year in the Gregorian calendar (164th in leap years), with 202 days remaining. ... For the Manfred Mann album, see 2006 (album). ... December 23 is the 357th day of the year in the Gregorian calendar (358th in leap years). ... The University of New Mexico (UNM) is a public university in Albuquerque, New Mexico. ... For the Manfred Mann album, see 2006 (album). ... October 17 is the 290th day of the year (291st in leap years) in the Gregorian calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... March 2 is the 61st day of the year (62nd in leap years) in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... September 7 is the 250th day of the year (251st in leap years). ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... March 20 is the 79th day of the year in the Gregorian Calendar (80th in leap years). ... The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. ... The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... March 31 is the 90th day of the year in the Gregorian calendar (91st in leap years), with 275 days remaining. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... February 12 is the 43rd day of the year in the Gregorian calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... April 19 is the 109th day of the year in the Gregorian calendar (110th in leap years). ... The Family Planning Association, also known as fpa, is a UK registered charity (number 250187) working to promote sexual health. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the CE era. ... January 8 is the 8th day of the year in the Gregorian calendar. ... The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ... For the Manfred Mann album, see 2006 (album). ... October 7 is the 280th day of the year in the Gregorian calendar (281st in leap years). ... For the Manfred Mann album, see 2006 (album). ... July 23 is the 204th day (205th in leap years) of the year in the Gregorian calendar, with 161 days remaining. ...

External links

• The Birth Control Pill CBC Digital Archives
• The Pill. American Experience. Public Broadcasting Service. Retrieved on 2006-08-14.
• A new pill that completely suppresses menstruation

This article or section does not cite any references or sources. ... For the Manfred Mann album, see 2006 (album). ... August 14 is the 226th day of the year in the Gregorian calendar (227th in leap years), with 139 days remaining. ...

See also