health care

Five Questions With: Dr. Sandra Carson

PHOTO COURTESY WOMEN & INFANTS
"IF A WOMAN stays on birth control pills until she’s 35, of course her fertility will be different than it was at 25 – but that's age-related, not because she took the pill for so many years," said Women & Infants expert Sandra Carson.
Posted 6/7/10

Every day, nearly 11 million U.S. women take birth control pills, the nation’s most popular contraceptives, according to the National Survey of Family Growth. For three generations of women, the pill has been a reliable resource, but it wasn’t available until June 1960.

As part of a slew of public discussions on the pill’s 50th anniversary, Dr. Sandra A. Carson, director of the Division of Reproductive Endocrinology and Infertility and the Center for Reproduction and Infertility at Women & Infants Hospital and a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, spoke at a national panel with former Surgeon General Dr. M. Joycelyn Elders and activist Gloria Steinem.

Carson later answered questions about the pill for Providence Business News.

PBN: How good is the pill in the larger scheme of birth control options for women?

CARSON: In general, most purchased birth control methods cost about the same over the course of a year. But the birth control pill offers many non-contraceptive benefits, too – such as decreased dysmenorrhea [severe menstrual pains], the ability to have menstrual periods when – and even if – a woman wants, and endometrial and ovarian cancer prevention. Of course, natural family planning is free if cost is the only motivating factor. It’s not nearly as effective, however.

PBN: How much better are birth control pills these days than when they first came out? Have the dosages come down a lot? What else has changed?

CARSON: The hormone doses have come down, and we now know more about altering the progestin in the pill to decrease some of the side effects. We’ve also learned more about how to best use birth control pills to decrease side effects, like bloating, and increase the advantages, such as cancer prevention.

PBN: How safe is the pill? Do we have enough longitudinal data to have a good sense of its potential impact on cancer? What about cardiovascular risks?

CARSON: Birth control pills are safer than aspirin! There has been a lot of longitudinal data that shows that the pill almost halves the risk of endometrial and ovarian cancers, and that risk stays down for 10 years after discontinuation. The risk of heart disease is not directly increased, although research has shown that birth control pills can lead to an increased risk of clotting.

PBN: You specialize in reproductive endocrinology. Are there connections between taking the pill and women’s fertility in the long run?

CARSON: Birth control pills offer the advantage of decreasing the presence of male hormones in patients who may have higher levels of testosterone, which could actually help some women to conceive when they are ready. If a woman stays on birth control pills until she’s 35, of course her fertility will be different than it was at 25 – but that’s age-related, not because she took the pill for so many years.

PBN: How good are women’s newer birth control options? Do you see the pill being replaced by better alternatives in the next few years?

CARSON: The most important advantage of hormonal contraceptives is that they can be given in a variety of ways – orally with the pill, thru the skin with a patch, and through the vagina with a ring. For women who don’t want to use hormones, the IUD is also a great method of birth control. But the major benefit of all hormonal and non-hormonal contraception is the choices that women are given to control their fertility effectively.

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