The Pill: Is it right for your teenage daughter?
See also The Pill, a teenager time-bomb published within the same feature.
The Pill has become the great cure-all for menstrual and hormonal problems and is prescribed liberally to soothe our collective fears about teen sexuality and pregnancy. Of the 90 percent of Western women who have at some time taken the Pill, a great many started before their eighteenth birthday. Some were as young as twelve.1,2
The younger a girl is when she goes on the Pill the more likely it’s been prescribed for therapeutic purposes—for irregular periods, heavy periods, period pain, polycystic ovarian syndrome, acne—or even simply to eliminate periods. Using the Pill to regulate periods is, however, a misunderstanding of the action of the Pill and of the intricacies of the menstrual cycle. Many girls’ cycles can naturally take two years or so to settle into a regular pattern after their onset. If irregularity persists or is distressing there are many effective alternative therapies that can help to establish hormonal balance. The Pill, on the other hand, eliminates the natural menstrual cycle and replaces it with a false state like early pregnancy, interrupted at regular intervals by a withdrawal bleed during the placebo pill days. Even the mini Pill—which doesn’t prevent ovulation—regulates the menstrual cycle with synthetic hormones and inhibits a girl’s body from achieving its own natural hormonal balance.
While heavy periods, period pain, polycystic ovarian syndrome and acne can certainly be distressing and many girls have gratefully taken the Pill hoping to alleviate these symptoms when nothing else is offered, nonetheless the Pill cannot solve the underlying problem.
Contraception
The other reason teenagers go on the Pill is, of course, for contraception. Either a girl who is considering, or is in, a sexual relationship will visit a doctor for the Pill to manage this step in her life responsibly, or her parents, guardian or doctor may put her on the Pill ‘just in case’. Certainly availability of contraception is critical for those wanting to explore sexual relationships, and unplanned teen pregnancy is best avoided wherever possible. However, the effort to manage this complex situation has at times resulted in oversimplified, heavy-handed and dangerous solutions. In this way we expose girls to myriad physical and emotional problems at a time in their life when they may not yet know themselves well enough to assess or understand the underlying causes. And as they mature, they only know themselves on the Pill.
Young women who have been on the Pill and decide to seek other contraceptive methods rarely, if ever, report having received sufficient information about the Pill, adequate check-ups or information about alternatives. In other words, they’re not able to make truly informed choices.
Best practice
The accepted best practice in paediatric medicine is to start from the least invasive therapy and to move cautiously to those that are more invasive, and only as absolutely necessary. This common sense approach acknowledges that drugs and medical procedures, while they can of course be very helpful, do have undesirable or dangerous side-effects and all the more so for young bodies.
In direct contrast to this young girls are often given the Pill on the first presentation of menstrual or hormonal problems—like acne, irregular, heavy or painful periods or polycystic ovarian syndrome—despite there being a variety of effective non-invasive treatments for these ailments.
A heavy chemical load for young bodies
A great many of the estimated 300 million women worldwide who have been or still are on the Pill began while not only legally children but, more importantly, when their bodies, and reproductive systems, were still developing. As such they’re not only vulnerable to all the usual side-effects—a heavy enough load for any girl or woman—but in addition there are further dangers associated with ongoing use of these drugs from such a young age.
Let’s be clear; the Pill carries serious risks to a teenager’s health. It’s metabolised in the liver and causes more than 150 chemical changes in a girl’s body, many of which are still not fully understood.3
Heightened risk of fracture
If a girl begins to use the Pill while she’s still growing, it may prevent her from reaching her full height as the increased oestrogenic load speeds up the closure of her long bones. A recent US study found that when girls ‘at risk of becoming too tall’ were given the Pill their growth was effectively stopped but their fertility was also considerably compromised.
The use of Depo-Provera™ injections has been associated with significant loss of bone mineral density, increasing with duration of exposure and without necessarily being reversible.
During adolescence the usual large gains in bone mass have been found to be slowed down by these hormonal injections as well as some forms of oral contraception. The degree of bone loss—or lack of bone gain—is more pronounced in adolescence than in young adult women who typically have smaller changes in bone mass. While relative bone density can be tested for, the outcome of increased brittleness and the heightened risk of fracture doesn’t usually manifest until several decades later, by which time the damage has well and truly been done.4
Heightened risk of cancer
Studies have found that the increased risk of breast cancer among Pill users is predominant in women who used it for at least four years before their first pregnancy. Since the breast tissue of teenage girls is still developing, it’s particularly sensitive to overstimulation by synthetic oestrogen. Studies have found that using the Pill before 20 years of age doubles the risk of breast cancer.5 And one study found that the younger the women were at the time of diagnosis of breast cancer, the greater the possibility that they would be dead within five years.6
Another study found that women who started using the Pill at an earlier age were at increased risk of cervical cancer than those who started later. The risk of developing a severe cancer was 50 per cent greater for Pill users as well as for women who had a cervical smear indicating pre-cancerous cells and continued to use the Pill.7
Parental consent
The Pill is generally available to teenage girls without parental consent, or without them needing to be informed. The age when this right to privacy kicks in varies from country to country and is often at the dis-cretion of the doctor. While many of us have enjoyed our own right to privacy as teenagers and there are some good reasons to make it available, there is a downside. Teenagers may easily make omissions in giving personal and family history during a medical appointment and this can have serious consequences.
Education
Critics of sex education claim that talking with teenagers about sex will lead to increased sexual activity and unplanned pregnancies; however, there is no evidence for this. On the contrary, in Western countries where sex education is comprehensive, teen pregnancy is well below that of other Western countries where sex education is restricted, nonexistent or only teaches abstinence. In fact studies have shown that first full sexual experiences occur later where sex education is most comprehensive, as is the case in the Netherlands and Sweden.
On a global level and across cultures it’s been found that the single most powerful way to reduce population growth is to educate women. Availability of contraception alone won’t do it and nor will forced steril-isation. However, educating women who are then empowered to plan their lives and families has been shown to make the greatest difference of all. The Chinese one-child policy is perhaps the exception to this, but no other country has as yet been inclined to follow their heavy-handed lead.
So, what do you do about your teenage daughter?
At the risk of oversimplifying and overgeneralising the issues, it will nonetheless help if you can actively make a positive connection with your daughter as she changes from a little girl into a pubescent one. Through exploring and understanding your own experience of your first period you can offer her a graceful and positive passage into her cyclical life. You can support her ongoing learning about her cycle and healthy ways to manage it. As her interest in boys deepens, keep the communication channels open in a non-judgemental, non-fearful way.
Throughout this process—no less a journey for a parent—seek to be well informed, including consulting helpful health professionals. When it comes to contraception, at whatever age this need arises, if you’ve kept communication between you open and supportive, you’ll have an active role in helping your daughter work out what’s best for her. At the very least you’ll have provided her with a positive model of how to go about making her own informed choice.
Excerpted from the recently released book The Pill: Are you sure it’s for you? by Jane Bennett and Alexandra Pope, published by Allen & Unwin.
Footnotes
1 Sherrill Sellman, Mothers Prevent Your Daughters From Getting Breast Cancer, GetWell International, Tulsa, OK, 2003.
2 Jane Bennett, ‘Hormonal Contraception Survey 1997–2006’ <www.nfmcontraception.com> [2007].
3 Jan Roberts (ed.), ‘The Pill and sex—risks to health and fertility’, The Foresight Association Newsletter, Australia, 1995.
4 F. Polatti et al., ‘Bone mass and long-term monophasic oral contraceptive treatment in young women’, Contraception, 51: 221–4, 1995.
5 The Lancet, 347: 1713–27, 1996.
6 D.B. Thomas, ‘Oral Contraceptives and Breast Cancer’, Journal of the National Cancer Institute, 85: 359–64, 1993.
7 American Journal of Obstetrics and Gynaecology, 1992.
www.nfmcontraception.com>
Published in Kindred, Issue 28, Dec 08
Article by Alexandra Pope
Alexandra Pope has a background in education and since 1988 has worked in private practice as a psychotherapist and coach. Alexandra has been running workshops and lecturing in Australia and the UK on the power of the cycle for women’s creative, psychological and physical wellbeing since 1993. Alexandra is the author of The Wild Genie (Sally Milner Publishing, 2001) and The W... read more
Article by Jane Bennett
Jane Bennett facilitates workshops for girls, and their mums, celebrating their approaching menarche and fertility, and for dads on how to handle the changes and stay close to their daughters. She is the author of The Pill and A Blessing Not a Curse (Sally Milner Publishing, 2002) and co-author of The Natural Fertility Management Kits for Contraception and Conception with Franc... read more
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