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After a half-century of research and refinement, many doctors agree that the birth-control pill -- whatever its sociological ramifications -- is safer than its predecessors and helps stave off ovarian cancer and regulate menstrual cycles. Other positive side effects include reducing the risk of ovarian cysts, ectopic pregnancies and fibrocystic breast disease.

As with any medication, negative side effects can occur. The pill can cause weight gain and slightly increase chances of blood clots. But some users have experienced more serious consequences. Lisa (a pseudonym provided at her request) began taking birth-control pills 10 years ago as a contraceptive and to prevent a recurrence of ovarian cysts. "I wondered if it was healthy to be on it so long," she recalls.

Her doctors assured her the pill's benefits outweighed potential complications, but they noticed something was wrong while she was undergoing blood tests for an unrelated acid-reflux condition. One of her liver enzymes was elevated, which prompted further tests. Eventually, she learned she had a tumor, which now measures 2.8 inches long, growing on her liver.

"Because it is so rare, the immediate thought was that it was liver cancer," says Lisa, who spent a weekend mulling over that devastating possibility until her gastroenterologist, Tony Ringold, learned of her long-term pill usage. Ringold sees about three or four similar cases a year. "It's unpredictable, but clearly related to the birth-control pill," he says. "Before 1960, this was unheard of."

After subsequent testing, Lisa's tumor appears to be benign. She'll have it removed in a few months. "This is a pretty major operation on the horizon," she says, more than a bit concerned about its consequences, including a large scar across her mid-section.

Merck & Co., a pharmaceutical products and services company based in Upper Gwynedd, Pa., notes on its Website that benign tumors similar to Lisa's have "increased in prevalence because of widespread use of oral contraceptives." The tumors, the site says, often shrink if the medication is stopped. Most doctors agree that such situations are rare with pill usage, which began about 40 years ago, when the medication first earned the Food and Drug Administration's (FDA's) approval.

A new study published in The Journal of the American Medical Association recently reported that women taking the pill are nearly twice as likely to suffer strokes. But since women during their reproductive years rarely suffer strokes, researchers concluded that doubling the figures still represents a fraction of a risk to the pill-taking population -- one additional stroke yearly per 24,000 women for low-dose pill users and one per 12,000 women for higher dosages.

John Larsen, professor of obstetrics and gynecology at the George Washington University Medical Center in Washington, says the pill puts ovaries at rest, which causes a "big drop" in the chances for ovarian cancer. But women on birth-control pills should "flat out stop smoking" and take the pill at the same time each day for maximum effectiveness.

The amount of time a woman is on birth-control pills has no bearing on any potential side effects, says Karen Perkins with Mercy Medical Center in Baltimore. Negative side effects, such as blood clotting, a risk that increases if users smoke, typically happen within the first year of use and most often involve women older than 40. Perkins suggests that women taking birth-control pills for the first time report any symptom, from cramping to shortness of breath, to be safe. "It's one of the safest birth-control methods we have, in terms of long-term side effects," she says.

Age emerges as a key factor in a report released last month from Dutch researchers at the University of Groningen linking long-term use of birth-control pills at menopause to increased risk of cardiovascular and kidney disease. Obese patients already are at risk for high blood pressure, so their pill usage can be cause for greater scrutiny.

Women experiencing side effects on the Depo-Provera shot, an injectable birth-control medication, must wait three to six months for the medication to leave their bodies. Women who take birth-control pills can stop taking the hormones and the effects will lessen in a few days.

The birth-control pills come in packets of 28 and contain various amounts of synthetic hormones akin to the body's estrogen and progesterone, depending upon the brand. The medication prevents pregnancy by stopping a woman's ovaries from ovulating, or releasing an egg. Modern versions of the pill, on average, contain about 20 micrograms of estrogen, down from about 50 micrograms in their earliest incarnation. That means fewer hormones, fewer side effects.

Carl Djerassi, the Bulgarian chemist who at age 26 invented the pill, says he doesn't see much debate about his creation these days, particularly compared with the late 1950s, before it received FDA approval. "For every epidemiological study saying one thing, there is another saying almost the opposite" writes Djerassi, whose new book, This Man's Pill: Reflections on the 50th Birthday of the Pill, walks readers through the years since its creation. "Suppose, for instance, that you accept `a higher incidence of strokes.' What is this `higher' incidence by comparison to say, the well-documented reduction in ovarian cancer in pill users, which saves thousands of lives per annum?"

Djerassi, now a chemistry professor at Stanford University in California, suggests that women contact the Centers for Disease Control and Prevention (www.cdc.gov) for the most reliable information on contraception.

Christian Toto writes for Insight's sister publication, The Washington Times.

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