The Affordable Care Act contraceptive coverage currently being debated in the US Congress could allow institutions that provide health insurance to opt-out of covering birth control pills for religious or moral reasons. Such policies have, in the past, raised difficulties for women prescribed the drugs for noncontraceptive uses, such as the treatment of pain from ovarian cysts. On 23 February, a law student at Georgetown University named Sandra Fluke testified before the US House Committee on Oversight and Government Reform that when insurance coverage doesn’t cover contraceptives, it can deny women such a friend of Fluke’s with polycystic ovarian syndrome access to birth control prescribed to treat the condition. And although such treatments do not cure the underlying causes of such conditions—oral contraceptives do not shrink ovarian cysts—there is accumulating evidence that they can be used as analgesics, allowing women to avoid invasive surgeries to remove abnormal tissue from the uterus or ovaries. The debate over limiting coverage by private insurance for contraceptives raises the question of whether denying access will cause real, physical pain to women in the US.
Prescription for pain from ovarian cysts is just one of many noncontraceptive uses of popular combination hormonal birth control pills such as Yaz, Orthocept and Ortho Novum, which prevent pregnancy by suppressing ovulation or blocking proliferation of the endometrial lining of the uterus, deterring implantation of an egg. “Birth control is also a widely prescribed treatment for pain from endometriosis and fibroid tumors in the uterus,” says Joyce King, a nurse at Emory University in Atlanta who studies the benefits of contraceptives.
Women who take birth control also reap long-term benefits, including an approximately 50% decrease in the rate of ovarian and endometrial cancers, perhaps because the drugs decrease blood flow to the ovaries and shrink the endometrial lining, helping to starve potential tumors. “Because ovarian cancer is so difficult to diagnose, the protection against that particular kind of cancer is a big benefit for women,” says King, pointing out that longitudinal studies show such positive effects can last well into old age, beyond when the woman stops taking the contraceptive. Ongoing studies continue to investigate just how long those benefits last and how they relate to the amount of time a woman takes contraceptives. Further research is being conducted on the potential benefits of the drugs for preventing breast cancer, treating migraines, reducing seizure frequency in epileptics, and decreasing the severity of the symptoms from sickle cell disease.
There are limitations to how far the benefits might extend, though. An ongoing lawsuit against New Jersey-based Bayer HealthCare Pharmaceuticals, maker of the popular pill Yaz, says the company overstated the drugs efficacy in treating acne and premenstrual syndrome and understated its side-effects in television commercials targeting teens. And lest we forget, the myriad benefits of birth control are accompanied by a host of possible side-effects, including increased risk of stroke and heart attack. “Oral contraceptives do have potentially serious side-effects,” says Karla Maguire, a gynecologist at the University of Miami, although she also points out, “ lesser problems such as nausea have decreased with new low-dose formulations,” referring to the decreased doses of the hormones estrogen and progestin in modern pills such as Yaz.
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