To Pill or not to Pill.
It is, for many young women, the dilemma of the age.
The availability in the late '50s of the oral contraceptive seemed to be the key to feminine freedom, releasing women from inadvertant procreation, a boon no less political than economic.
But the very women's movement the Pill tended to foster began to take a hard look at a male-dominated medical establishment that had for decades tended to regard female complaints as merely that: female complaints. There began to be a suspicion, transformed for many by the thalidomide tragedy into conviction, that women were cosseted and comforted, to be sure, but also over-medicated and under-researched.
So when reports linking long-term use of the pill to cancer and cardiovascular problems began to emerge, the medical establishment, no longer so complacent nor as uniformly male, began to get its act together.
The latest major effort to determine what it is about oral contraceptives--if anything--that relates to eventual cardiovascular problems is being undertaken in the Washington metropolitan area by the George Washington University Medical Center. It is the only study of its kind in the country at this time.
The GW Lipid Research Clinic, under contract to the National Institute of Child Health and Human Development, is attempting to gather 400 healthy young women who have decided to use an oral contraceptive but have not yet begun to do so.
Dr. Ace Lipson, who is heading the study, says that there have been between 80 and 120 studies on the relationship of oral contraceptives to changes in lipids, the fatty substances in the body, in lipoproteins, the substances that help metabolize cholesterol, among other things, and in glucose tolerance.
"But," he says, "these have been like comparing apples and oranges." Oral contraceptives are generally made up of a combination of estrogen and an agent like progesterone, designed to fool the body's delicate, cyclical feed-back system into producing no eggs.
The various brands of the Pill vary in the amounts of estrogen or progesterone-like substances. Says Lipson, "You'll find that certain studies used contraceptive 'x' with one amount of estrogen and then somebody else does a study and uses another one with a different amount of progestational agent."
Moreover, he says, few of the studies followed subjects for more than a few months, and at most they included 30, 40 or 50 women. "You end up drawing all kinds of sweeping conclusions, many of which are probably inaccurate because they've been done on very small numbers of people with very different designs."
What Lipson, Dr. Carole Horn of the Lipid Clinic Staff, and Nancy Stoy, the project's recruiting nurse, are looking for are 300 young women to take one of three oral contraceptives for a year, plus 100 women who will be provided with other means of contraception (but not an IUD) to serve as the study's control group.
Women accepted for the study will be randomly selected for one of the groups.
In return, the women will receive:
* Two elaborate screening examinations: a physical and extensive blood workups.
* Free contraceptive devices:either the pill or an alternative such as the diaphragm,
* Elaborate medical monitoring and blood testing, every eight weeks. Over the 14 to 15 months of the study, the participants will have five glucose tolerance tests, for example.
What the doctors and GW's team of laboratory technicians and biostatisticians hope to discover are minute changes in lipids, lipoproteins, blood sugar and insulin resistance that will permit accurate projections on long-term use of oral contraceptives and its relationship to heart and artery disease and diabetes, in itself linked to heart disease.
(Other scientists in other centers are looking at possible links between the Pill and various cancers.)
Lipson and Horn emphasize that although the physicians on the study will not serve as primary-care doctors, any abnormalities turned up either during the preliminary screening exam or subsequent monitoring will be promptly communicated so that treatment can begin at once. It is likely, for example, that some women will be identified who ought not to take an oral contracepitve at all. They will, of course, be so advised.
They expect no abnormalities from the tests themselves. The contraceptives used, they also stress, are not experimental. They are standard, approved oral contraceptives containing identical amounts of estrogen, but varying in the amounts of progestational agent.
Women interested in participating should:
* Be 18-32 years old.
* Be planning to take an oral contraceptive.
* Not be taking an oral contraceptive now, nor have done so in the past six months.
* Not have been pregnant during the past six months.
* Not have diabetes or a parent with any kind of diabetes.
* Not have varicose veins, hyperlipidemia or classic migraine headaches.
Diane Stoy, R.N., who is in charge of recruitment, estimates that to find 400 women who will meet these criteria, about 600 will be screened.
The women also will have free counseling on birth control, nutrition and other health matters. Diet and smoking habits will be monitored, but there will be no attempt to change them. Part of the study will determine how they relate to the Pill.
Women interested in participating should phone 676-4152 from 8:30 a.m. to 4 p.m