Talk:Combined oral contraceptive pill/Archive 2

This is an archive of past discussions about Combined oral contraceptive pill. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Archive 2

Percy Julian again

71.182.107.102:

01:02, 23 October 2008 (→External links)

and
70.16.52.193:

have repeatedly added a June 24, 2007 personal blog post by Usha Alexander (http://blog.shunya.net/shunyas_blog/2007/06/percy-julian-ch.html) to the external links section of this article.

This is an inappropriate external link. Please see WP:LINKSTOAVOID:

Except for a link to an official page of the article subject—and not prohibited by restrictions on linking—one should avoid:
11. Links to blogs and personal web pages

13. Sites that are only indirectly related to the article's subject

This has prompted Zodon to repeatedly substitute an inappropriate "See also" section with a link to the Percy Lavon Julian article:

A "See also" section for a link to the Percy Julian article is inappropriate—because Percy Julian did not play a role in the history of the Pill.
Please see:

Russell Marker

Marker invented the chemistry (the Marker degradation) in 1938 to synthesize progesterone and other steroids from sapogenins, including diosgenin from Dioscorea
Marker discovered in 1942 that the inedible Mexican wild yams cabeza de negro (Dioscorea mexicana) and the more remote barbasco (Dioscorea composita) were exceptionally rich sources of diosgenin and excellent raw materials from which to synthesize progesterone and other steroids
Marker synthesized 3 kg of progesterone from cabeza de negro in 1943, founded Syntex in 1944, founded Botanica-Mex (which became Hormonosynth then Diosynth) in 1945, and thereby founded the Mexican steroid industry
Syntex, using the Marker degradation and the raw material (Mexican barbasco) discovered by Marker, reduced the bulk price of progesterone almost 200-fold over 8 years -- from $80/g in 1943 to $0.48/g in 1951
Syntex supplied the progesterone used by Pincus and Chang when they began their contraceptive research in 1951 by repeating the 1937 experiments in rabbits of Makepeace et al.
Syntex supplied the progesterone used by Pincus and Rock in their clinical trials of progesterone in 1953
Djerassi et al. at Syntex in 1951 synthesized (from steroids using the Marker degradation and the raw material (Mexican barbasco) discovered by Marker) the first (norethisterone) of the three progestins used in Pincus and Rock's clinical trials of progestins beginning in 1954
Almost all of the oral contraceptives manufactured in the 1960s were produced from Mexican steroids using the Marker degradation and the raw material (Mexican barbasco) discovered by Marker
Most of the oral contraceptives manufactured in the 1960s were produced either by Syntex for Syntex or produced by Syntex for Ortho and Janssen (norethisterone) or under license from Schering for Schering and Parke-Davis (norethisterone acetate)

Percy Julian

Julian did not play a role in the history of the development of the Pill
The Glidden Company did not play a role in the history of the development of the Pill
Julian Laboratories, Inc. did not play a role in the history of the development of the Pill
Smith Kline and French did not play a role in the history of the development of the Pill (and never developed any contraceptives)

I also removed an inappropriate external link added on July 22, 2008 by 12.106.237.2:

13:57, 22 July 2008 (→External links) Long-Term Birth Control Pill Use Linked to Possible Heart Risks

an anonymously authored article on a personal commercial website (http://www.myproductalert.com) with an objectionable amount of advertising.

This is an inappropriate external link. Please see WP:LINKSTOAVOID:

Except for a link to an official page of the article subject—and not prohibited by restrictions on linking—one should avoid:
4. Links mainly intended to promote a website

5. Links to sites that primarily exist to sell products or services, or to sites with objectionable amounts of advertising.

Lynn4 (talk) 15:56, 26 October 2008 (UTC)

What affects Birth Control?

What medications/supplements can cause the birth control pill to be ineffective? 69.248.200.210 (talk) 01:58, 30 November 2008 (UTC)

Anti-tuberculosis meds - Rifampicin and rifabutin

Systemic antifungal - Griseofulvin, theoretically might reduce OC efficacy.

Anticonvulsants - barbituates, carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, topiramate and felbamate

Anti-HIV protease inhibitors

Saint John’s Wort - not well studied, but some expertes some experts recommend increasing dose of EC by 50% in women using it.

[Source for all of the above - Contraceptive tech, 18th ed, page 436-7]

Others:

Tretinoids - Accutane, Soriatane

Ginseng, or black cohosh may also. Zodon (talk) 02:53, 30 November 2008 (UTC)

Grapefruit and juice? —Preceding unsigned comment added by 118.90.57.238 (talk) 00:56, 11 January 2009 (UTC)

Carl Djerassi, Der Standard, The Guardian, and CathNews.com

CathNews.com and Catholic News Agency.com are not WP:Reliable sources:

Djerassi, Carl (December 13, 2008). Warum wir bald sehr alt ausschauen. Der Standard, Album A 3.
Connolly, Kate; Hooper, John (January 7, 2009). Church grabs chance to attack birth control pill. The Guardian, p. 23, reprinted January 8, 2009 on p. 6 of the Taipei Times.
. (January 8, 2009). Pill inventor slams ... pill. CathNews.com
. (January 11, 2009). Birth control pill inventor laments demographic 'catastrophe'. Catholic News Agency.com
. (January 24, 2009). Corrections and clarifications. The Guardian, p. 34.
Butterworth, Siobhain (January 26, 2009). Open door: The readers' editor on ... pills, spills and the wrong kind of splash. The Guardian p. 33.
Djerassi, Carl (January 27, 2009). Response: I never blamed the pill for the fall in family size. The Guardian, p. 33.

75.57.127.117 (talk) 15:54, 3 March 2009 (UTC) 75.57.127.117 (talk) 16:22, 3 March 2009 (UTC)

Thanks for the references 75.57.127.117

In response to Geremia's questions in edit summary about poorly sourced and undue weight. The above covers the former question (the edit in question just cited a brief item in CathNews).

Undue weight because recent reductions in fertility rate are driven by many factors - public health improvements, the reduction of childhood mortality, scarcity of resources, economic pressures, etc. Also, the pill is only one of the major techniques used to achieve lower fertility rates, and it does not account for the desire to do so. So while coverage of trends in fertility and role of the pill not unreasonable, coverage would need more balance in terms of what happened, why, and the roles of various contraceptives. Zodon (talk) 18:57, 3 March 2009 (UTC)

Duplicate sections

The new "health benefits" section largely duplicates the information in the "noncontraceptive uses" section. I'd suggest that these two sections be merged. Lyrl^Talk _C 13:23, 7 March 2009 (UTC)

Agree. Zodon (talk) 21:28, 7 March 2009 (UTC)

Price?

It would be nice to give an approximate price of a month's worth of the COCP, e.g in dollars or in euros.--Roentgenium111 (talk) 21:51, 12 March 2009 (UTC)

See Birth control pill - planned parenthood But it varies quite a bit by location - e.g. in the United States, medications are much more expensive than in many other countries.

Also there are the cost of side effects (estimated at $14/year for COC) and the cost of contraceptive failures (medical costs estimated at about $130/year). [By comparison, Copper-T IUD, failure costs $8/year, side effect costs $0/year; or No method $0 method cost, 0 side effect cost, failure cost $950/year (or $1900/year if assume don't want any more children)]

Estimates from James Trussell, Anjana Lalla, Quan Doan, Eileen Reyes, Lionel Pinto, Joseph Gricar (2009). "Cost effectiveness of contraceptives in the United States". Contraception. 79 (1): 5-14. PMID 19041435.{{cite journal}}: CS1 maint: multiple names: authors list (link) [Failure costs include just the medical cost of ectopic pregnancy, spontaneous abortion, induced abortion and birth, in proportions typical to the United States. Does not client costs, time, etc. Also, except for the last, failure costs assume that 60% of births are misstimed by 2 years, rather than being unwanted. Costs in 2007 US$.]

The comparison by Trussell, et al. is from point of view of health insurer, and only goes through a few months after birth, it does not include cost of medical care for the child. The cost of raising a child is much higher (typically a few hundred thousand dollars), so failure costs for the user are much higher. Zodon (talk) 06:29, 13 March 2009 (UTC)

Happened across another bit in some other reading. In developing countries "Estimates of the cost (in 2001 dollars) for a woman’s first visit to obtain oral contraceptives average about $8.00: $1.00 for drugs and supplies, $0.50 for labor, $6.50 for overhead"

Source: Susheela Singh, Jacqueline E. Darroch, Michael Vlassoff, Jennifer Nadeau (2003). Adding it Up: The Benefits of Investing In Sexual and Reproductive Health Care (Report). The Alan Guttmacher Institute and UNFPA. ISBN 0-939253-62-3.{{cite report}}: CS1 maint: multiple names: authors list (link) Page 13, which cites an UNFPA review. Zodon (talk) 08:14, 13 March 2009 (UTC)

24-July edits

An editor recently made a number of copyediting changes to this article (diff). Some of these changes improved the readability of the article, and I appreciate the editor taking the time to do these copyedits. However, I reverted a few of the changes:

I changed all instances of "side-effect" to "side effect". Every dictionary I consulted (Mirriam-Webster, Definr, Wiktionary) showed the correct usage to be a space between the words, not a hyphen. Adding many hyphens to articles has been an issue with this editor before, and it was discussed at the Manual of Style: Wikipedia talk:Manual of Style/Archive 96#Hyphens. While few people participated in that discussion, the consensus seems to be against such use of hyphens. Wikipedia follows convention in grammar, not logic.
The Wikipedia Manual of Style says, "Values and unit symbols are separated by a non-breaking space." I put non-breaking spaces between values and units to bring this article in compliance with this Wikipedia guideline.
According to Mirriam-Webster's definition of "who", definition #2, the word who is used in place of the word that when referring to a person. I made this change in three sentences.

In addition to those three reversions, I made additional copyedits to the article:

I removed extraneous wording from the lead.
I broke a long sentence describing a chemical reaction and the source of the raw material into two sentences: one sentence describing the source material, followed by a second sentence describing the chemical reaction.

The editor restored their version of the article, which included reversion of my copyedits unrelated to the three items I reverted, with the explanation "logic" (diff). As I have explained here, to me their action was not logical. I would like to understand the basis for the edits; perhaps we could come to an understanding on this issue. Lyrl^Talk _C 18:51, 24 July 2009 (UTC)

With due respect, I put forth that the "undo" on my edits of this referred page is a demonstration of nonrecognition of what the Wikipedia Manual of Style has intended on the respective issues, not to mention the logic of language, resulting in incorrect edits.

The discussion on the spelling of side-effect is past wearisome within Wikipedia, especially with those that neither understand language and its history nor take the time to research the very dictionary sources that they cite. The dictionary is not a bible on language, but rather a reporter on the usage of language, both correct and incorrect. The written word was innovated to reflect the meaning of the idea, and English, because of its Anglo-Saxon ancestry, has affinity for transferring the accent of a word or group of words to its primary syllable when the idea becomes a one-word idea. That is, we now make distinction between mail man and mailman, each with its current distinct meaning, the former of which pronounced with equal accentuation of both syllables, the latter of which pronounced with accent on the first syllable, reflecting the one-word idea. In similar manner, our current pronunciation of side-effect with accent on side illustrates that side-effect is, in fact, complying with Anglo-Saxon tradition of the spelling-idea relationship, and, therefore, its transitional spelling, cited at various dictionary and reference sources: http://dictionary.reference.com/browse/side-effect.
In support of the concept, the above-stated sentence "I appreciate the editor taking the time to do these copyedits" reflects the tendency of historical English to take the two substantives copy and edit and fuse them, rendering a spelling reflecting the meaning of a one-word idea, also reflected in the pronunciation, whose accent is on copy. [Moreover, the sentence is illogical: You do not appreciate me, but rather my taking the time. So the corrected statement, denoting the meaning trying to be conveyed by the speaker/writer, is: "I appreciate the editor's taking the time to do these copyedits."]
It is the case that, in the phrase "A dose of 5 mg of norethindrone," a space between the value 5 and the unit mg is required because 5 is a modifier of the substantive mg. So the spelling of the words complies with the meaning conveyed, which is reflected through the modifier-substantive relationship. However, from the same article, in "a 5-mg [or 5mg] dose of norethindrone," there must not be a space between 5 and mg because the one-word idea represented by 5-mg is itself an adjective modifying the substantive dose. In like manner, no edit was performed on the phrase "21 pills are taken," but an edit was required on the phrase "28-pill packet," illustrating through spelling the modifier-substantive relationship, rendering the correct statement: "For the 28-pill packet, 21 pills are taken..."
In general, as the dictionary cites, who refers to people, and which, contracted form of who-like, refers to non-people, but not in an indiscriminate manner; that is, who refers to people, but not all people are expressed as who (all oranges are citrus fruits, but not all citrus fruits are oranges). That, however, is a relative pronoun that (note: not which here in order to make distinction between the relative pronoun that and other relative pronouns) enables English speakers and writers to distinguish between two scenarios. From the article, in its incorrect form:

"... in women who have a familial tendency to form blood clots"

should be stated in order to reflect the meaning intended by the author

"... in women that have a familial tendency to form blood clots"

so that "women that have a familial tendency to form blood clots" can be differentiated from "women that do not have a familial tendency to form blood clots." It should be noted that the meaning of "...Women who have a familial tendency to form blood clots" can be taken as "all women, in general, have a tendency to form blood clots," not the intended meaning by the author. Various dictionary sources reflect the historical usage of that in this manner. Drphilharmonic (talk) 00:21, 25 July 2009 (UTC)

You are correct in representing your views as having a logical framework. If I understand correctly, your belief is that "side-effect" is a transitional form that will become the norm in the future, and that in the further future the correct form will be "sideeffect" or some similar rendering without any space or hyphen. If this comes to pass, "side-effect" should be the form in the future version of this article. In the current version of this article, however, the current normative practice should be followed. The current normative practice is to have a space between the words.

Wikipedia's MoS appreciates that many number/unit combinations are one-word ideas. Its approach to this situation is to put a non-breaking space between these combinations. In cases where the number is a modifier of the unit, the non-breaking space is not required. Your logical argument in favor of hyphens over non-breaking spaces is something to bring to the Manual of Style talk page, not this one. Again, for the current article the current version of the MoS should be followed.

There is an important difference in meaning between "... in women who have a familiar tendency to form blood clots..." and "... in women, who have a familiar tendency to form blood clots, ..." The first sentence will not be mistaken for the later sentence by any significant number of readers. While "that" is just as grammatically correct as "who", "that" often has a negative connotation when used to refer to a person.

Also, did you have an objection to my modification of the lead paragraph or my dividing the long sentence about saponin origin and processing into two sentences? I ask because you reverted these changes. Lyrl^Talk _C 00:56, 25 July 2009 (UTC)

There is no objection to the clarification of the lengthy sentences of the lead paragraph.

Non-breaking space versus the hyphen is irrelevant; the point is that the value-unit term should not be two words if together they comprise a one-word idea that modifies the substantive. It should be understood very well by writers of English that "a dose of 5 mg" equates to "a 5-mg dose" or "a 5mg dose," and "a period of 12 hours" equates to "a 12-hour period."

Note that "side-effect" is offered as a current alternative spelling in the various dictionary and reference sources above-referenced, whose usage is reflected in many Wikipedia articles. Drphilharmonic (talk) 04:11, 25 July 2009 (UTC)

The Manual of Style is irrelevant?

I am used to debates on whether edits are in line with Wikipedia guidelines. If your belief is that Wikipedia guidelines are subordinate to your personal opinions, there is not any common ground on which we can meet. Lyrl^Talk _C 11:28, 25 July 2009 (UTC)

It is not a matter of personal opinion, but rather a matter of abiding logic and the Wikipedia Manual of Style. Try to be receptive of both my meaning and that of the Wikipedia Manual of Style, which offers the non-breaking space in the value-unit relationship with respect to the modifier-substantive relationship. That is:

"a dosage of 5SPACEmg" is written in this manner - with forced space - because 5 is an adjective that MODIFIES the substantive mg. The same phrase, as is described by the Manual of Style, which should be understood by those that put pen to paper, equates to "a 5HYPHENmg dosage" OR "a 5NO-SPACEmg dosage" because the entity 5-mg OR 5mg is an adjective that MODIFIES the substantive dosage.

This is the point that I claim to be irrelevant: that of hyphen versus no-space, not hyphen [or no-space] versus space, because whether one spells the substantive print-out or printout today is a matter of personal preference, for the word whether spelled with hyphen or no-space is a compound word whose meaning is a one-word idea, but a space is enforced in the verbial printSPACEout. So we print out a print-out [or printout]. Note, also, the difference in pronunciation between the verbial, whose accent is equal on both syllables, and the substantive, whose accent is on print, moreover lending credence to the discussion on side-effect.

The same logic and writing style from the Wikipedia Manual of Style apply to the following:

"a period of 12SPACEhours" [wherein 12 modifies hours]

equates to

"a 12HYPHENhour period"

OR

"a 12NO-SPACEhour period" [wherein 12-hour OR 12hour modifies period].

The Wikipedia Manual of Style in no form states that a complete washing of terms of the value-unit relationship be conducted to employ a forced space between the value and the unit irrespective of the relationship between the value and unit. Therefore, again, in abiding both logic and the Wikipedia Manual of Style, the phrase

"a dose of 5 mg is recommended" is correct

as are the phrases

"a 5-mg dose is recommended" and "a 5mg dose is recommended"

but the phrase

"a 5 mg dose is recommended" is incorrect. Drphilharmonic (talk) 18:06, 26 July 2009 (UTC)

I don't think we're going to convince each other on the issue of hyphenating a compound word. In your example of printout, I would consider "print-out" to be incorrect in a Wikipedia article.

We both find our interpretations of the MoS to be obvious. I think the wording of the MoS should be modified to prevent disagreements such as ours; I have started a discussion on this and hope you will join in with your opinion. Lyrl^Talk _C 22:44, 26 July 2009 (UTC)

I believe Drphilharmonic's attempt to apply the logic and grammar of the English language to quantities such as "5 mg" is misguided, because "5 mg" is not part of the English language, it is part of the International System of Units (SI). Unlike the English language, which is guided by a consensus of English-speaking individuals; SI is governed by an entity created by international treaty, the General Conference on Weights and Measures, as interpreted and enforced by the authorities of each nation. In the case of the United States, SI is interpreted by the Secretary of Commerce and that interpretation is embodied in NIST Special Publications 330 and 811.

On the other hand, the relevant treaties and interpretations allow language-dependent variations when the names of units are spelled out, so normal logic and grammar of the English language would apply to "five milligrams". --Jc3s5h (talk) 23:33, 26 July 2009 (UTC)

Drphilharmonic has been asked in the past, by myself and by others, to comply with the house style and the conventions of standard English instead of with his own personal (i.e., logically consistent) notions. The previously addressed issues line up very neatly with the complaints here.

I'll add, however, that Drphilharmonic does not introduce any grammar errors in preferring that instead of who (both of which can be correctly used in these sentences). He is merely being rude and violating the principles behind WP:RETAIN by imposing his personal preference instead of following the system established in the article. WhatamIdoing (talk) 23:38, 27 July 2009 (UTC)

Dubious sentence

I found this in the subsection "Placebo Pills"

"The withdrawal bleeding that occurs during the break from active pills is thought to be comforting, as a physical confirmation of not being pregnant." This is rather POV and it seems, well, dubious. Can someone back this up with a survey result or something? When was it established that the bleeding is generally "comforting"? I feel like this is just one person's opinion and perhaps needs removal if it can't be established as fact. --Pstanton (talk) 22:18, 4 February 2009 (UTC)

It doesn't say that bleeding in general is comforting, but that the confirmation that one is not pregnant may be comforting. Quick Google search finds a lot of places that say similar (not all copies of this article) - haven't found one I like as an RS yet. One might also look at some of the references in the article on extended cycle use (another place such issues likely to be discussed). Zodon (talk) 01:46, 5 February 2009 (UTC)

Added a citation that supports the sentence (with the change of saying was).

The following items from Contraceptive Technology, 19th ed, pages 228-229. Also seem apropos.

The 27/7 cycle provides a "predictable, coordinated withdrawal bleed that women will interpret to be a normal (although lighter) menses. The pill's inventors touted this feature as a distinct benefit for women, which it was at the time."
"Unless the patient wants to use bleeding as a reassurance that she is not pregnant, monthly cycling is not necessary"

So seems probable that at least one of the persons who were of that opinion was John Rock, one of the co-developers of the pill.

Article still could use improvement in coverage of cycle length, but does that provide enough to remove the dubious tag? Thanks for bringing this up (it was fun reading up on this). Zodon (talk) 06:58, 5 February 2009 (UTC)

Yes, it does. I'm removing the dubious tag. The reason for the week of placebo pills being "mental comfort" on the part of early users is well-attested.... Elatb (talk) 20:25, 4 September 2009 (UTC)

Canada

1. The reference to the quiet revolution, just above this section, probably belongs in it.

2. The reference to Alesse should be to its website, www.alesse.ca, which shows its provocative T-hirt designs. Cobylub (talk) 16:47, 8 September 2009 (UTC)

interaction

i wanted to find out if Combined Oral Contraceptive Pills (COCP) interacts with choloroquine and ketoconazole or not. —Preceding unsigned comment added by 113.199.254.160 (talk) 08:38, 24 May 2010 (UTC)

Breast cancer risk review

http://www.medicalnewstoday.com/articles/175394.php was posted 07 Jan 2010. It is a report on a 2009 study by Jessica Dolle (et al. of the Fred Hutchinson Cancer Research Center) which concluded "that women who start OCs before age 18 multiply their risk of TNBC by 3.7 times and recent users of OCs within the last one to five years multiply their risk by 4.2 times." TNBC being "an aggressive form of breast cancer associated with high mortality." Does this merit a revisal of the "Cautions and contraindications" section? —Preceding unsigned comment added by 207.5.151.71 (talk) 16:51, 10 June 2010 (UTC)

scientific findings/iarc/ stroke journal/etc

I will be including the findings that are found here:

http://stroke.ahajournals.org/cgi/content/abstract/33/5/1202

Conclusions— Third-generation oral contraceptives (containing desogestrel or gestodene) confer the same risk of first ischemic stroke as second-generation oral contraceptives (containing levonorgestrel).

http://www.iarc.fr/en/media-centre/pr/2005/pr167.html

An IARC Monographs Working Group has concluded that combined estrogen-progestogen oral contraceptives and combined estrogen-progestogen menopausal therapy are carcinogenic to humans (Group 1), after a thorough review of the published scientific evidence.At the same time, the Working Group stressed that there is also convincing evidence that oral contraceptives have a protective effect against some types of cancer.There are both beneficial and adverse effects for oral contraceptives and menopausal therapy. Each woman who uses these products should discuss the overall risks and benefits with her doctor. The Working Group, comprising 21 scientists from 8 countries, was convened by the IARC Monographs Programme of the International Agency for Research on Cancer (IARC), the cancer research agency of the World Health Organization.

http://jcem.endojournals.org/cgi/content/abstract/90/7/3863

In conclusion, a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events, including a significant risk of vascular arterial complications with third generation OCs.

Kleinbell (talk) 02:28, 12 September 2010 (UTC)

For the last article the rest of their conclusion goes on to say that.

"The modern use of low-dose OCs, limited to healthy women and restricted in time, should not increase noticeably the incidence of these adverse outcomes, which might be outweighed by the benefits of contraception. However, prolonged exposure to low-dose OCs in a population at higher risk may significantly increase the incidence of cardiovascular outcomes and prompt consideration of alternative therapeutic or contraceptive interventions."Jean-Patrice Baillargeon, Donna K. McClish, Paulina A. Essah, and John E. Nestler (2005). "Association between the Current Use of Low-Dose Oral Contraceptives and Cardiovascular Arterial Disease: A Meta-Analysis". Journal of Clinical Endocrinology & Metabolism. 90 (7). The Endocrine Society: 3863–3870. doi:10.1210/jc.2004-1958. PMID 15814774.{{cite journal}}: CS1 maint: multiple names: authors list (link) Zodon (talk) 07:26, 6 October 2010 (UTC)

Thanks for this. The term they used is should and might and so these are hopeful and tentative words in comparison to the categorical scientific conclusion above. Klughilton4 (talk) 03:22, 7 October 2010 (UTC)

No idea what you mean - they are all part of the conclusion, they are no more tentative than the rest, and they provide necessary context to understand what the finding means in practice. Zodon (talk) 05:26, 7 October 2010 (UTC)

NPOV problems

This article now (Oct 2010) has big NPOV problems. Coverage of cancer is way out of balance, needs to give perspective/compare risk to other risks (e.g. of not using contraceptive or using less effective contraceptives), and magnitude of cancer effect. When dealing with something with as much emotion tied with it as cancer just saying it is carcinogenic is sensationalizing. (Many chemicals in everyday things like cosmetics and air fresheners are carcinogenic. Just like saying something is poison - it is always a question of dose. How much, etc.)

Likewise coverage of cardiovascular risk needs more balance. Most women in the age groups that take OCs are not at much risk of stroke/MI, so the risk while elevated is still very small (compared to other preventable risks, or to common risks like driving a car).

The coverage of mechanism of action was way out of balance also, with addition of what appeared to be original synthesis of material giving undue weight. Zodon (talk) 05:16, 6 October 2010 (UTC)

I have reworked it to improve these issues, but out of time at the moment.

The coverage of cancer still needs less generality and more what cancers, how much, compare to other risks. (Less general quotes.)

Coverage of cardiovascular still needs some work.

Need to improve arrangement to separate actual contraindications from general risks.

Put the mechanism back to a previous more neutral state, think that part mostly dealt with for moment. Zodon (talk) 07:18, 6 October 2010 (UTC)

I added a "cite needed" in your statement on "The controversy is currently unresolved." What I wrote was based on mere chronology, and so I thought it was better and more neutral. Can you kindly give me a reason why you think your version is more neutral? I can see that it makes Wikipedia take a stand (without any citation), while my version, does not make Wikipedia take a stand. It only informs the public what is the latest in a peer reviewed journal of the American Medical Association, which has a very high credibility and notability character.

I will also add a "cite needed" in the phrase "small increase" in some cancers. Kindly give the basis for this statement, since the IARC did not make that qualification.

I also do not understand the removal of all the lede points, including the abortifacient issues. Kindly explain. Thanks. Kleinbell (talk) 08:44, 6 October 2010 (UTC)

Since you reverted my edits, it would be nice for us to be reminded of this and this.

From what I know of my edits, I have been merely quoting, so I do not understand your comments about "sensationalizing" and "original synthesis." Kindly explain further. Kleinbell (talk) 09:02, 6 October 2010 (UTC)

Thanks to Prari for bringing back my edits on mechanism. =) However, I am still not in agreement with this phrase: "Other possible secondary mechanisms have been hypothesized." The latest respectable data shows quite categorically that there is no hypothesis involved but that ""the medical literature does not support the hypothesis that postfertilization effects of OCs do not exist." So it will be obvious to readers that Wikipedia has taken a stand and is in fact contradicting actual studies. Sorry, Wikipedia is Wikipedia... Klughilton4 (talk) 03:01, 7 October 2010 (UTC)

Klughilton4 - On what basis do you object to "Other possible mechanisms have been hypothesized?" The second quotation you give says nothing about whether such effects exist or do not, or whether they have been hypothesized or not. (Just because something can't be ruled out doesn't mean it exists, Etc.)

Even if such mechanisms had been proven to exist (which they haven't) it would still not contradict that they had been hypothesized. Zodon (talk) 05:14, 7 October 2010 (UTC)

Lead - already covered risks and benefits in the information box, no need to repeat them. The lead is supposed to summarize major points - possible (and debated) secondary mechanisms of action, minor secondary effects, etc. are not major points. Expanding coverage of them in the lead doesn't follow standard for lead and suggests undue weight. (WP:lead) Zodon (talk) 05:14, 7 October 2010 (UTC)

Cancer

I agree that citation/more detail needed on cancer. It must perforce be small because if it was huge then would not have a net decreased mortality, would have questions of pill safety, etc. As I indicated in my original comment, to just say carcinogen is meaningless without saying what cancers, how much, etc.

To say something is carcinogenic might be thought to mean that it poses a major increased risk of cancer. Like saying that water is poisonous. In fact, water is poisonous, however the LD50 is so high that this is not usually a major concern. So to just say it is a carcinogen without qualification/explanation is potentially sensationalizing - making something appear more significant than it is. Hence moving away from WP:NPOV. Zodon (talk) 05:14, 7 October 2010 (UTC)

Found one citation on small - already in the article. PMID 8656904 Zodon (talk) 07:03, 7 October 2010 (UTC)

Mechanism

Putting together items from different sources and claiming that they form an "evolution of ideas" is original research, and is specifically prohibited on Wikipedia. See WP:NOR, specifically WP:SYNTHESIS. Mere chronology does not prove relationship (consider Post hoc ergo propter hoc).

What sources support the view that this is an evolution/change of idea/view (as compared to different individuals or groups holding differing opinions, for instance)?

Don't know what you mean about making a stand - just saying that different opinions exist does not take a stand for or against any of them. Claiming that this is an evolution of ideas suggests that the later ideas are more widely accepted, have supplanted or refute the previous ones, etc. (Hence less neutral.) Just because something is recent doesn't mean it is more widely accepted (often converse is true), or better researched, etc. Zodon (talk) 05:14, 7 October 2010 (UTC)

Side Effects

The Side effects part of this article seems to be slightly out of date? thathere have been new studies which have found other side effects like the link between use of the pill and sexual disfunction which have been published:'The study, conducted by American endocrinologist, Claudia Panzer, included 124 premenopausal women who had experienced long-term sexual dysfunction. The women were divided into three groups: continued birth control pill users, former pill users, and women who had never used the pill before. SHBG levels for all three groups were taken on three separate occasions: at the commencement of the study, 80 days after pill discontinuation, and 120 after pill discontinuation etc'seperate similar studies have shown that these side effects maintain also after the discontinuation of the pill. incidentally there was an articlke in metro about how woman on the pill seemed to prefer the smell of men who were genetically more similar over the scent of man who are genetically more dissimilar to themselves (87.192.128.174 (talk) 18:33, 5 July 2009 (UTC)) Regarding the first part of the topic ,apologies for the typo's i have some urls support this observation below.

(87.192.128.174 (talk) 19:14, 7 July 2009 (UTC))

The pill's effect on libido is discussed in the side effect subsection sexuality. The effect on smell is discussed under other effects.

The specific study on SHBG levels is not currently in the article. (The first few links all refer to the same one study. The later links talk about women's sex drive and testosterone without specifically mentioning the pill, while the last one talks about sex among the elderly without mentioning either the pill or testosterone.) While this study may be incorporated into the article (the study itself should be cited - PMID 16409223 - not a journalist reporting on the study), it should remain clear that it is not accepted as accurate by mainstream medicine. Lyrl^Talk _C 23:01, 7 July 2009 (UTC)

A 2011 survey of the worldwide scientific literature by the World Health Organization’s International Agency for Research on Cancer concluded with their highest level of confidence (Category 1) that: "There is sufficient evidence in humans for the carcinogenicity of combined estrogen–progestogen oral contraceptives. Combined estrogen–progestogen oral contraceptives cause cancer of the breast, in-situ and invasive cancer of the uterine cervix, and cancer of the liver.

For cancer of the endometrium, ovary, and colorectum, there is evidence suggesting lack of carcinogenicity. An inverse relationship has been established between exposure to combined estrogen–progestogen oral contraceptives and cancer of the endometrium, ovary, and colorectum.

There is sufficient evidence in experimental animals for the carcinogenicity of several combinations of estrogen–progestogen used in oral contraceptives.

Combined estrogen–progestogen oral contraceptives are carcinogenic to humans (Group 1).”

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 100A (2011) http://monographs.iarc.fr/ENG/Monographs/vol100A/index.php

A Review of Human Carcinogens: Pharmaceuticals: Combined Estrogen–Progestogen Contraceptives <http://monographs.iarc.fr/ENG/Monographs/vol100A/mono100A-18.pdf>

Also note that Hypertension is the heightening of blood pressure, not lowering as stated in this article —Preceding unsigned comment added by 123.243.196.35 (talk) 06:26, 23 March 2011 (UTC)

Moved point of view of author to here

For the 2006 study on SHBG in the sexuality section, I removed the following text, because I doubt it is encyclopaedic to have so much text dedicated to study authors' comments, which are not necessarily neutral point of view, especially in this case where a 2007 study (mentioned earlier in that section) didn't find a change in sexual satisfaction.

The study called for prospective research. However, study author Dr. Irwin Goldstein indicated that this study followed "7 years of observational research in which we noted in our practice many women with sexual dysfunction who had used the oral contraceptive but whose sexual and hormonal problems persisted despite stopping the birth control pill," Lead author Dr. Claudia Panzer stressed that doctors prescribing the Pill should "point out to their patients potential sexual side effects, such as decreased desire, arousal, decreased lubrication and increased sexual pain. Also if women present with these complaints, it is crucial to recognize the link between sexual dysfunction and the oral contraceptive and not to attribute these complaints solely to psychological causes."

Mikael Häggström (talk) 16:43, 22 July 2011 (UTC)

Percy Julian yet again

Reverted inappropriate Percy Lavon Julian edits (and WP:Copyright violations) by anonymous 71.182.100.111 / 71.240.244.35 editor (aka 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75). See: Talk:Combined oral contraceptive pill#Percy Julian again. Percy Julian did not play a role in the history of the Pill. Lynn4 (talk) 21:41, 19 February 2012 (UTC)

I reverted the reintroduction into the History section of two paragraphs of WP:Copyright violations and WP:OR by anonymous editor 71.123.31.25 (aka 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75 / 71.182.122.21 / 71.182.100.111 / 71.240.244.35).

WP:COPYVIOs:

In the 1930s chemists recognized the structural similarity of a large group of natural substances—the steroids. These include cholesterol, bile acids, sex hormones, and the cortical hormones of the adrenal glands. The medicinal potential of various steroids quickly became obvious, but extracting sufficient quantities of steroids, which exist in minute amounts in animal tissue and fluids, was prohibitively expensive. As with other scarce or difficult-to-isolate natural products, chemists were called upon to mimic nature by creating these steroids in the lab, and later by modifying them to make them safer and more effective as drugs. Chemists found starting materials in certain plant substances that were also steroids. Percy Lavon Julian (1899–1975), Russell Earl Marker (1902–1995), and Carl Djerassi (b. 1923) were among those scientists who participated actively in the synthesis and large-scale production of steroids—both cortisone and the sex hormones—from plant compounds.^{[http://www.chemheritage.org/discover/online-resources/chemistry-in-history/themes/pharmaceuticals/restoring-and-regulating-the-bodys-biochemistry/julian--marker--djerassi.aspx]}

Percy Lavon Julian is most noted for his synthesis of cortisone from soybean sterols used to treat inflammatory conditions such as rheumatoid arthritis which laid the foundation for the steroid drug industry's production of corticosteroids and birth control pills.^{[http://www.ars.usda.gov/research/publications/publications.htm?seq_no_115=215771]}
The soy stigmasterol was easily converted into commercial quantities of the female hormone, progesterone, and the first pound of progesterone he made, valued at $63,500 was shipped to the buyer in an armored car!^{[http://lipidlibrary.aocs.org/history/Julian/index.htm]}

WP:OR (see: Talk:Percy Lavon Julian#USDA "recognition" of Percy Julian and Talk:Soybean#USDA "recognition" of Percy Julian):

It took the USDA until June 13, 2008 to recognize Dr. Julian; Giants of the past: Percy Lavon Julian, a forgotten pioneer in soy.^{[http://www.ars.usda.gov/research/publications/publications.htm?seq_no_115=215771]}

Lynn4 (talk) 18:34, 20 February 2012 (UTC)

Clinical trials in Puerto Rico

The first tests in Purto Rico were done without informing the women that they were the guinea pigs. It was one of the biggest medical scandals of the 20th century. I think this is worth mentioning! Some info on that can be found here: http://www.thebatt.com/2.8485/anger-over-puerto-rico-s-pill-test-lingers-1.1205789 and here: https://elbohemio.wordpress.com/2007/06/07/puerto-rico-and-the-advent-of-the-pill/ 178.114.10.140 (talk) 17:29, 24 February 2012 (UTC)

Mechanisms of Action

In the Mechanisms of Action section there is a missing or broken citation.

The reference [62] (Crockett, Susan A.; Donna Harrison, Joe DeCook, and Camilla Hersh (April 1999). Hormone Contraceptives Controversies and Clarifications. American Association of Pro Life Obstetricians and Gynecologists. http://www.aaplog.org/decook.htm. Retrieved on 2008-02-26.) goes to a dead link. I searched for the paper on Pubmed and scholar.google and found nothing but citations of this paper, but no paper itself. I went to the publisher's page and found a pro-life advocacy group, not a medical journal. I don't believe this is a valid citation. Not only does it appear to be an un-peer-reviewed source, it is also apparently missing from the internet.

Furthermore, the citation is given in support of this statement: "Others make more complex arguments against the existence of [endometrial effects that prevent implantation of an embryo in the uterus]." I am not sure that a pro-life advocacy group would want to refute claims of endometrial effects, since they generally take the position that this is a form of chemical abortion. Therefore, even if this paper could be found, I wonder how likely it is to be a good supporting paper for the claim that there are "complex arguments against" these effects. —Preceding unsigned comment added by 0dimensional (talk • contribs) 15:48, 11 May 2009 (UTC)

I have updated the link. Note that another place to look for text of links that have gone dead is through the Internet Archive (http://www.internetarchive.org). This paper is available at the old address through the Archive: http://web.archive.org/web/20080203114728/http://www.aaplog.org/decook.htm

A pro-life advocacy group composed exclusively of MDs specializing in obstetrics and gynecology carries more credibility than the average pro-life group. The members of AAPLOG disagree on whether or not combined hormonal contraceptives are abortifacient, and the group has published position papers arguing both sides. They explain themselves some more here. Lyrl^Talk _C 21:54, 13 May 2009 (UTC)

According to the PDR and numerous other undisputed sources (including manufacturer inserts), there are 3 mechanisms of action. 1) preventing ovulation, 2) altering cervical mucus, 3) altering the endometrial lining. The exact wording varies slightly, but these 3 are the accepted MOA's. Items 2) and 3) are not anymore theoretical that item 1) is. Another statement in the article that "Some groups that oppose abortion consider such a mechanism to be abortifacient" is a subjective statement that seems to cast doubt on the objectivity of a judgement that the MOA is abortifacient. What someone or some group believes about the ethics of induced abortion is irrelevant in any discussion on the MOA of a medication. If fact, one could just as easily argue that groups or individuals who oppose abortion would prefer to believe that the MOA is not abortifacient so that they would have one less thing to concern themselves with. Frankgyn (talk) 04:00, 16 March 2012 (UTC)

It's not an abortifacient because it doesn't fit the standard medical definition of abortifacient, which would require pregnancy first. Anti-abortion groups may consider life to begin at conception, but medically pregnancy doesn't begin until implantation, and if an inferior lining precludes implantation, then it's not been implanted. Furthermore, you are wrong when you say that item 1) is theoretical--tests have shown ovarian activity to be eliminated as a result of contraceptives. But while an altered endometrial lining has been observed, and it has been theorized that it might prevent pregnancy, it has not been observed to do so, or to cause abortion--if you know of any such papers that contradict that, then name them. QuizzicalBee (talk) 04:39, 16 March 2012 (UTC)

The PDR is manufacturer inserts. It may not specify the details of whether a given mechanism of action is theoretical or there is actual evidence to support it. (That is more detail than a package insert usually gives). So those are not particularly high quality sources for that sort of information. Something like Contraceptive Technology would be a much higher quality source. Interfering with implantation is not abortifacient, so casting doubt on such claims is reasonable and consistent with NPOV. (They are using non-standard definitions, which makes their conclusions questionable.) If you have sourced examples of prominent anti-abortion groups that assert that such mechanism is not abortifacient, please provide so can work them in. Zodon (talk) 04:47, 16 March 2012 (UTC)

True, PDR or manufacturer inserts may not always be the best reference since by nature they are designed to portray their product in the best light while also protecting themselves from legal action from harmful side effects. The best scientific paper that most thoroughly reviews the research on this issue is already referenced and I reference it again here: ^ Larimore WL, Stanford JB (2000). "Postfertilization effects of oral contraceptives and their relationship to informed consent" (PDF). Arch Fam Med 9 (2): 126–33. doi:10.1001/archfami.9.2.126. PMID 10693729. Retrieved 2008-02-26. To ensure NPOV, we need to keep this qualifiers like "anti-abortion groups" or "groups that oppose abortion" out of the discussion because such statements are not only irrelevant, but worse that disparage the argument with the ad hominum logical fallacy. Think for example of the corollary statement "pro-abortion groups or groups that support abortion believe that the pill does not have an abortifacient mechanisms of action." As to the definition of pregnancy beginnng at implantation, that statement is highly controversial and such a re-definition appears to be fare more on politics than biologic science. We've long understood that a unique human life comes into being at fertilization. I've not heard any scientific justification for such a redefining of terms that would necessitate changing the meaning of conception and "start of pregnancy" to implantation rather than fertilization. This very discussion of MOA, however, is more than ample reason to redefine such terms.Frankgyn (talk) 16:51, 17 March 2012 (UTC)

The standard medical definition of pregnancy is beginning at implantation. Certainly there are other definitions, and confusion in lay audiences because of that. But discussion of those issues do not belong in this article. (See pregnancy and (see ACOG, BMA definitions in Beginning of pregnancy controversy)). (If one takes pregnancy as starting at fertilization, then you have all sorts of other semantic problems, since it becomes unclear who or what is pregnant. You pretty much have to give up on any sensible notion of a female "being pregnant.")

Using qualifiers like "anti-abortion groups," etc. is no more disparaging, etc. than introducing "groups that support abortion." (By the way the reverse of anti-abortion groups is not groups that support abortion. There may be those neutral to abortion as well.) Zodon (talk) 02:37, 18 March 2012 (UTC)

To the extent it is now believed that pregnancy begins at implantation, rather than the long agreed upon, embryologic, and genetic science based understanding as the pregnancy beginning at that moment of a complete and unique complement of genes, we should at least agree that the issue is controversial and yet unresolved. I don't see how there could be any confusion about who (the woman) or what (an adult human being) is pregnant. For this article, we shouldn't be persuing esoteric metaphysical theories about the semantics of who is pregnant. The genetics and science of the matter are quite clear. A unique human being's existence begins at the moment of fertilization. To argue that the morula, blastocys, zygote, or embyro is not a human being until implantion is a religious belief that defies science and logic. My reason for putting in "groups that support abortion" in was to make a point about the importance of leaving such qualifiers out of the definition for those who might simply undo the edit. I was hoping that a revision would have taken note of this and left such qualifiers out altogether when discussing the proposed mechanisms of action. I'll edit it with such revision now.Dr. Frank 01:49, 19 March 2012 (UTC) — Preceding unsigned comment added by Frankgyn (talk • contribs)

Off-topic History section paragraph

I removed this off-topic (this is an encyclopedia article about the combined oral contraceptive pill—not about Carl Djerassi, or Syntex, or cortisone or Upjohn) History section paragraph added by IP-hopping anonymous editor 71.123.25.175 (aka 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75 / 71.182.100.111 / 71.240.244.35 / 71.123.31.25 / 71.240.247.110 / Special:Contributions/70.16.49.24870.16.49.248 / 71.182.108.43 / 71.182.98.194):

The successful synthesis of cortisone from the saponin diosgenin had permanently placed
the small Mexican pharmaceutical firm Syntex on the scientific map of steroid research.
It was moreover, Upjohn's requirements for ten tons of progesterone for the biosynthesis of cortisone—
a quantity that at the time could be satisfied only from diosgenin through the Marker degradation—
that started Syntex on the path to an erstwhile pharmaceutical powerhouse.
"This is why I assign Marker a branch, even if only a remote one, on the Pill's family tree,
because our initial success with cortisone, and the huge order from Upjohn
were followed almost immediately by our synthesis—
a few months later, again in Mexico City—of an orally active progestational steroid.

taken from: Djerassi, Carl (2001). This man's pill: reflections on the 50th birthday of the pill. Oxford: Oxford University Press. ISBN 0-19-860695-8, p. 42:

Still, our successful synthesis of cortisone from diosgenin had permanently placed
Mexico on the scientific map of steroid research.
It was, moreover, Upjohn's requirements for tons of progesterone—
a quantity that at that time could be satisfied only from diosgenin through the Marker process—
that started Syntex on the way to becoming a pharmaceutical heavyweight.
So without Marker's synthesis, it is doubtful that any of Syntex's later successes would have been possible—
for economic, if not for scientific reasons.
This is why I assign Marker a branch, even if only a remote one, on the Pill's family tree,
because our initial scientific success with cortisone, and the huge order from Upjohn,
were followed almost immediately by our synthesis—
a few months later, again in Mexico City—of an orally active progestational steroid.

Lynn4 (talk) 18:41, 15 April 2012 (UTC)
Lynn4 (talk) 01:32, 21 April 2012 (UTC)

Japan

1. The 2nd version of the guidelines has already issued. 2. The reasons why only 1 % of women takes the pill in Japan are unclear. So I think to be edited as below:

The pill prescription guidelines the government endorsed required an excessive inspection and frequence visit to the hospital in the 1st version in 1999. Although they are revised in the 2nd version in 2005, the unique rules for the missed pills are not revised. According to the rules women need indispensably taking a double method with a condom. This is a reason why contraceptive pills are used almost only for treatment of the medical conditions. http://finedays.org/pill/e/ — Preceding unsigned comment added by 123.226.119.31 (talk) 13:33, 24 April 2012 (UTC)

More COPYVIOs and SYNTH by disruptive IP-hopping anonymous editor

I reverted the addition of these tangential WP:COPYVIO and WP:SYNTH paragraphs to the "History" section by persistently disruptive IP-hopping anonymous editor 71.240.253.202 / 132.236.120.83
(aka 71.182.111.225 / 71.123.25.175 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75 / 71.182.100.111 / 71.240.244.35 / 71.123.31.25 / 71.240.247.110 / 70.16.49.248 / 71.182.108.43 / 71.182.98.194):

WP:COPYVIO paragraphs added 22:43, 24 July 2012:

Unfortunately, corporate competition and difficult labor conditions eventually forced him to close his plant.
But Marker's method of synthesizing progesterone continued to be used, bringing the price down drastically and helping to pave the way for the modern birth control pill.
Progesterone continued to be manufactured from wild yam for decades, until a cheaper source of raw material was found in cultivated soybeans.

After too many price hikes in the barbasco, the steroid industry largely went to semisynthetic modification of the phytosterols from soybeans.
There are two common sources of sterols: the production of soybean oil leaves a waste rich in stigmasterol and sitosterol; the roots of Mexican barbasco contain diosgenin.
Progesterone could be obtained in good yields (about 50%) from diosgenin extracted from the Mexican yam Dioscorea species (barbasco) (page 239) or stigmasterol from soybean (page 256).

from: (anonymous) (2011) "Wild Yam". Ipswich, Mass.: EBSCO Publishing:

Unfortunately, corporate competition and difficult labor conditions eventually forced him to close his plant.
But Marker's method of synthesizing progesterone continued to be used, bringing the price down drastically and helping to pave the way for the modern birth control pill.
Progesterone continued to be manufactured from wild yam for decades, until a cheaper source of raw material was found in cultivated soybeans.

and from Duke, James A. (1993). "Medicinal plants and the pharmaceutical industry". in Janick, Jules.; Simon, James E. (eds.) New crops; Proceedings of the Second National Symposium New Crops—Exploration, Research, and Commercialization, Indianapolis, Indiana, October 6-9, 1991. New York: Wiley, ISBN 0471593745, pp. 664–669:

After too many price hikes in the barbasco, the steroid industry largely went to semisynthetic modification of the phytosterols from temperate soybeans.

and from Trehan, Keshav (1990). Biotechnology. New Dehli: New Age International, ISBN 8122401295, p. 24:

There are two common sources of sterols: the production of soybean oil leaves, a waste product rich in stigmasterol and sitosterol; the roots of the Mexican barbasco plant contain diosgenin.

and from Dewick, Paul M. (2002). Medicinal natural products : a biosynthetic approach, 2nd ed. Chichester: John Wiley & sons, ISBN 0471496405, p. 264:

Progesterone could be obtained in good yields (about 50%) from diosgenin extracted from Mexican yams (Dioscorea species; Dioscoreaceae) (see page 239) or stigmasterol from soya beans (Glycine max; Leguminosae/Fabaceae) (see page 256).

The WP:SYNTH is the stringing together of dated and poor sources to produce undue emphasis on soya sterols as THE replacement to Mexican diosgenin in the commercial production of steroids.
Current and better sources:

Soto Laveaga, Gabriela (2009). Jungle laboratories: Mexican peasants, national projects and the making of the Pill. Durham, N.C.: Duke University Press, ISBN 9780822346050
Evans, William Charles (2009). Pharmacognosy, 16th ed. Edinburgh: Saunders Elsevier, ISBN 9780702029332

list soya sterols as merely one of many replacements for Mexican diosgenin in the commercial production of steroids (with others including Chinese diosgenin, hecogenin, total synthesis, etc.).

The anonymously-authored EBSCO "Wild Yam" fact sheet is not a reliable source. The only historical reference it cites is a 31-year-old pharmacognosy textbook:

Tyler, Varro E.; Brady, Lynn R.; Robbers, James E. (1981). Pharmacognosy, 8th ed. Philadelphia: Lea & Febiger, ISBN 0812107934, p. 185.

which does not support the EBSCO "Wild Yam" fact sheet's statement that:

Progesterone continued to be manufactured from wild yam for decades, until a cheaper source of raw material was found in cultivated soybeans.

A more current pharmacognosy textbook:

Evans, William Charles (2009). Pharmacognosy, 16th ed. Edinburgh: Saunders Elsevier, ISBN 9780702029332, p. 308, says:
Until 1970 diosgenin isolated from the Mexican yam was the sole source for steroidal contraceptive manufacture. With the nationalization of the Mexican industry, however, prices were increased to such an extent that manufacturers switched to hecongenin for corticosteroids, to other sources of diosgenin and to the use of steroidal alkaloids of Solanum species. Total synthesis also became economically feasible and is now much used. More recently, the economics of steroid production have again changed in that China is now exporting large quantities of diosgenin; it is of high quality, being free of the 25β-isomer yamogenin, although this is of no commercial significance, and is reasonably priced. Three of the many Dioscorea spp. found in China and used commercially are given in Table 23.2; the tubers yield 2% diosgenin, with the average content of diosgenin for the main areas of production (Yunnan Province and south of the Yangtze River) being 1%.

The 21-year-old 1991 conference proceedings paper by James A. Duke, which said:

After too many price hikes in the barbasco, the steroid industry largely went to semisynthetic modification of the phytosterols from temperate soybeans.

also conflicts with above current pharmacognosy textbook.

The anonymously-authored EBSCO "Wild Yam" fact sheet also said:

Unfortunately, corporate competition and difficult labor conditions eventually forced him [Russell Marker] to close his plant.

which is true, but out of context:

Marker co-founded Syntex in March 1944, left Syntex in May 1945 to found Botanica-Mex, which produced progesterone from July 1945 to March 1946, then sold the assets of Botanica-Mex to the Hungarian firm Gedeon Richter, which renamed it Hormonsynth, which Marker advised until 1949 when he quit doing chemistry. Gedeon Richter sold Hormonsynth to the Dutch firm Organon in 1951, which renamed it Diosynth (with headquarters in the United States) with its Mexican subsidiary named Quimica Esteroidal, S.A. de C.V. Organon was part of KZO, which became AKZO in 1969, which became AkzoNobel in 1994, was acquired by Schering-Plough in 2007, which merged with Merck in 2009.

Noting in this article that Marker's (second) company (Botanica-Mex) failed is inappropriate and misleading, since its successor continued into the 21st century, and Marker's first company, Syntex, was the preeminent Mexican commercial producer of steroids for decades, played a significant role in the development of the oral contraceptive pill, and its U.S. successor continued for fifty years before being absorbed by Roche in 1994.

Lynn4 (talk) 17:30, 27 July 2012 (UTC)

Inaccurate sentences

On Placebo: "The presence of placebo pills is thought to be comforting, as menstruation is a physical confirmation of not being pregnant"

This sentence is confusing, as it induces the reader to expect an explanation to the use of placebo pills further to the reinforcement of the daily habbit, such as an anxiety relief effect.

It seems the statement refers not to the placebo pills but to the allowance of a monthly menstruation, which needs not "the presence of placebo pills" but only the cease to take active pills.

This could be rewritten as "The no-pill or placebo pill week" or "The 7 day cease of active pills" or any sintagm of similar meaning, followed by "is thought to be conforting...". Unless the original statement was due to have some other meaning I have not understood in which case I suggest it is more accurately explained.

On sexuality: "Many women taking the pill enjoy sex more because of reduced anxiety over pregnancy" This cannot be stated as a positive effect on sexuality caused by the pill, since it is exclusively psichologycal and is common to every contraceptive method with a low failure risk. I suggest it is removed or complemented with "as with any other contraceptive method", being the first preferrable since this information seems extremely obvious, common sensed and hence unnecessary.

--85.62.98.226 (talk) 12:04, 24 September 2008 (UTC)

I agree that the use of the term placebo pill is confusing. In addition, the statistics on VTEs contradict themselves. It is not possible for the overall risk to be 1 in 100,000 if the risks for all the subgroups is at least 5 in 100,000! The overall risk must be higher than the lowest subgroup risk. I will check the statistics from the most recent PubMed studies and fix those asap, or find other experts who can do so.

Some of the statements about research findings on benefits had no citations to back them up, despite being written months ago. I deleted some that seemed most questionable, but left the others and will look for medical journal citations to support them.

Universitydoc (talk) 18:00, 21 October 2012 (UTC)

Clarifications

The article stated that some COCPs are safer than others, which is certainly true, but didn't provide much information. I briefly summarized and inserted some of the info from the wikipedia article on drospirenone to clarify those statements.

Does anyone find the use of the acronym COCPs off-putting? I'd like to change it to OCs or birth control pills, but didn't want to make that change without asking.

Universitydoc (talk) 21:00, 11 November 2012 (UTC)

The acronym COCP is definitely not in common use/recognition. The problem with the terms OCs and birth control pills is that they are more general terms that include POPs. POPs have a different effectiveness, side effect profile, and mechanism of action than COCPs and so have their own article. So I'm torn on changing the current wording. Lyrl^Talk _C 04:05, 12 November 2012 (UTC)

COCP and antibiotic taking guidelines

This article has a section on drug interactions which includes broad spectrum antibiotics as a caution. In fact this caution has since been removed from the BNF and guidelines in the UK due to "a lack of evidence to support this interaction" (from BNF 63). Could this section please be updated with the newer information? FruitywS (talk) 18:33, 8 December 2012 (UTC)

Side Effects 2

I think that the side effects section should be rewritten. It's currently a bulleted list of things readers might think are side effects, but then the text goes on to debunk half of them. I feel it's misleading.151.200.77.56 (talk) 06:58, 6 January 2013 (UTC)

Randy Alcorn's Eternal Perspectives Ministry Does the birth control pill cause abortions? is not a WP:MEDRS

"Randy Alcorn (2011). Does the birth control pill cause abortions? 10th edition. Sandy, Oregon: Eternal Perspectives Ministry Press" is not a WP:MEDRS. BC07 (talk) 03:00, 31 August 2013 (UTC)

Cancer protective

I changed the heading from 'Cancer protective' to just 'Cancer'. COC have an overall protective effect against cancer, but there are some significant increased cancer risks too, so it seems a fairer headline. PhilMacD (talk) 09:55, 3 September 2013 (UTC)

Dubious, outdated, poorly sourced cut-and-pasted trivia by disruptive IP-hopping anonymous editor

I reverted this dubious, outdated, poorly sourced cut-and-pasted trivia added to the "History" section by longtime persistently disruptive IP-hopping anonymous editor 209.150.249.21 / 132.236.120.83 / 71.240.253.202
(aka 71.182.111.225 / 71.123.25.175 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75 / 71.182.100.111 / 71.240.244.35 / 71.123.31.25 / 71.240.247.110 / 70.16.49.248 / 71.182.108.43 / 71.182.98.194):

According to James A. Duke,

"The family of the yam Dioscoreaceae triggered North America's second revolution, the Sexual Revolution, by serving as the source for the steroid contraceptive."
Today, it is the (yambean) legume family Fabaceae that has replaced Dioscorea sp. as the starting material for steroids.
The days are over when Mexican barbasco fueled the steroid contraceptive industry.
All commercially available steroids start with soy sterols.

The soybean is now the prime source of steroidal drugs, including contraceptives and steroidal anti-inflammatory drugs.

from:

Shurtleff, William; Aoyagi, Akiko (2009). History of soybeans and soyfoods in Mexico and Central America (1877-2009): extensively annotated bibliography and sourcebook. Lafayette, Calif.: SoyInfo Center, ISBN 9781928914211, p. 261:

955. Duke, James A. 1990. Introduction to food legumes.
In S.R. Singh, ed. 1990. Insect Pests of Tropical Food
Legumes. New York, NY. John Wiley & Sons. xvi + 451 p.
See p. 1–42 [20+ Ref]
• Summary: ...
"The family of the yambean (Dioscoreacae) triggered North America's second revolution, the Sexual Revolution, by serving as the source for the steroid contraceptive.
Today it is the yambean family (Fabaceae) that continues what Dioscorea sp. began.
'The days are over regarding production of steroids from Mexican barbasaco...all commercial available steroids start with soya sterols'
(E.W. McCloskey, Berlichem, personal communication, 31 March 1989).
The soybean is now the prime source of steroidal drugs, including contraceptives and steroidal anti-inflammatory drugs.

Other genera of legumes are also sources for drugs."
from:
Duke, James A. (1990). "Introduction to food legumes". in Singh, S.R. (ed.) (1990). Insect pests of tropical food. New York: John Wiley & Sons, ISBN 9780471923909, p. 4.

Using outdated (a 22-year-old source citing a 23-year-old personal communication) parochial (U.S. only) sources to produce undue emphasis on soya sterols as THE replacement to Mexican diosgenin in the commercial production of steroids is misleading and inappropriate.
Current and better sources (like Soto Laveaga's 2009 Jungle Laboratories and Evans' 2009 Pharmacognosy, 16th ed.) list soya sterols as merely one of many replacements for Mexican diosgenin in the commercial production of steroids (with others including Chinese diosgenin, hecogenin, total synthesis, etc.).
All of the bulk steroids distributed by the U.S. company Berlichem in the 1980s may have been produced from soya sterols, but other reliable sources do not support the contention that the soybean was, or is currently, the prime source of steroidal drugs worldwide.
Lynn4 (talk) 00:44, 2 August 2012 (UTC)

I reverted the reintroduction of dubious, outdated, poorly sourced cut-and-pasted trivia added to the "History" section by longtime persistently disruptive IP-hopping anonymous editor 96.238.155.96 / 209.150.249.21 / 132.236.120.83 / 71.240.253.202
(aka 71.182.111.225 / 71.123.25.175 141.149.208.54 / 71.123.29.191 / 71.182.123.65 / 71.123.17.215 / 71.182.107.102 / 70.16.52.193 / 70.16.61.75 / 71.182.100.111 / 71.240.244.35 / 71.123.31.25 / 71.240.247.110 / 70.16.49.248 / 71.182.108.43 / 71.182.98.194). Lynn4 (talk) 20:30, 2 December 2013 (UTC)

Failure rate

Such a key stat and it is not even discussed in the text, but only sits uncited in the infobox? --_{Piotr Konieczny aka Prokonsul Piotrus| reply here} 02:35, 4 March 2014 (UTC)

Needs reordering.

Wiiki is not a user manual. No need to remind women to take their pill daily as the first line.
Also the basic mechanism of how the pill works should be much earlier in the article, certainly before side effects. etc. 87.115.168.0 (talk) 11:16, 30 March 2014 (UTC)

"An overview of the History of creation of the pill in America" paragraph

I removed the following redundant, inaccurate, U.S.-centric paragraph that was added to the beginning the "History" section by Nobabiesforbabies (talk | contribs):

An overview of the History of creation of the pill in America:
The creation of the birth control pill in America began as early as 1915 when Margaret Sanger, one of the "mothers" of the pill, coined the term "birth control".
Margaret Sanger and Katherine McCormick, the other "mother" were both steadfast supporters of the women's rights movement and believed that women would not and could not achieve equality among men until they were in full control of their reproductive lives.
Sanger and McCormick joined forces in the early 1950's to develop a "magic pill" that women could take that would inhibit ovulation and prevent pregnancy, giving women reproductive control over their bodies.
After careful consideration Sanger and McCormick asked Dr. Gregory Pincus, an assistant science professor at Harvard with a tarnished reputation, and John Rock, a Harvard-trained obstetrician and gynecologist to conduct the research behind the pill.
Due to laws and regulations regarding birth control in America, researchers decided to conduct their clinical trials in Puerto Rico, which had a large population of poor women desperate for birth control and no laws prohibiting contraception.
There were serious problems with the trials at first; most notably the side effects of nausea and dizziness were unbearable for most women.
Despite setbacks such as this, researchers eventually created a pill with few side effects that was 99% effective in preventing pregnancy.
The pill was cleared for use by the FDA in 1960, though the pill did not immediately become available to women due to societal norms, ideas, and expectations about women's sexuality and intercourse outside marriage.
The 1960's were a very conservative time period and society generally believed that women should not have sexual intercourse until they were married, and even then sex was a means of producing children and not of physical pleasure for women.
The pill challenged these social norms by making it possible for women to have sex outside of marriage and derive physical pleasure from that sex without the threat of pregnancy, and such freedom for women threatening to age-old American patriarchal society.
However, by 1965 over 6.5 million women were on the pill, making it the most popular form of birth control in America.
In the purest sense the pill was created to prevent pregnancy, though in reality the pill liberated women in a way and magnitude that was unprecedented at the time and was instrumental in both the women's rights movement and the sexual revolution.
The effects of the pill and its liberation of women are very much visible in today's society, as women are able to date, have sexual intercourse solely for physical pleasure, and above all control the course of their lives by deciding when, and if they want to have children.

• May, Elaine Tyler (2010). America and the Pill: A History of Promise, Peril, and Liberation. New York: Basic Books. ISBN 978-0-465-01152-0.
• Kruvand, Marjorie (Fall 2012). "The Pill at Fifty: How the New York Times Covered the Birth Control Pill, 1960–2010". American Journalism 29 (4): 34–67.

already discussed in the article:
• Margaret Sanger
• Katharine McCormick
• Gregory Pincus
• John Rock
• the first clinical contraceptive trial of Enovid in 1956 led by Edris Rice-Wray in the Río Piedras district of San Juan, Puerto Rico that contained the University of Puerto Rico School of Medicine
• the reduction of estrogen in Enovid to reduce side effects
• the 1957 FDA approval of Enovid
• the 1960 FDA approval of Enovid for contraceptive use

inaccuracies:
• Pincus was not "an assistant science professor at Harvard with a tarnished reputation"
• Rock was not merely "Harvard-trained", but was an eminent professor of gynecology at Harvard
• there were not "serious problems" with "the trials" at first
• side effects of nausea and dizziness were not "unbearable for most women"
• "The pill did not immediately become available to women due to social norms" is dubious
• "The 1960's were a very conservative time period" is dubious
Lynn4 (talk) 14:59, 19 May 2014 (UTC)

Re:

May, Elaine Tyler (2010). America and the Pill: A History of Promise, Peril, and Liberation. New York: Basic Books. ISBN 978-0-465-01152-0.
- p. 23:
  They set their sights on Gregory Pincus, a scientist with a somewhat tarnished reputation.
  This is an inaccurate, derogatory characterization of Pincus by Elaine Tyler May, for which she does not cite any source whatsoever.
- p. 23:
  In the 1930s, … he was an assistant professor at Harvard.
  Pincus was an assistant professor of biology at Harvard from 1930 to 1937; not two decades later when he led the development of the first oral contraceptive pill.
- p. 25:
  For this, the collaborators turned to Harvard-trained obstetrician and gynecologist John Rock, who was the director of Brookline's Reproductive Study Center.
  John Rock was a Harvard Medical School clinical professor of gynecology, who for three decades had been the director of the nation's leading fertility clinic at the Free Hospital for Women in Brookline, Massachusetts (where he was chief of gynecology) when he began working with Pincus on studies of progesterone to prevent ovulation in early 1953 (half a year before McCormick began funding Pincus and Rock).
  Rock opened his Reproductive Study Center on the grounds of the Free Hospital for Women in Brookline in 1955 after mandatory retirement at age 65 from Harvard and the Free Hospital for Women.
- p. 31:
  But there were serious problems with the trials.
  The high doses of hormones caused side effects such as nausea, headaches, and dizziness.
  In 1956, Rice-Wray reported that 17 percent of the participants complained of these symptoms.
  Elaine Tyler May does not say "the side effects of nausea and dizziness were unbearable for most women."
  May does misleadingly say "trials" when she only cites the percentage of side effects in the first 1956 trial (after which the estrogen dose was reduced by one-third).
  Norethynodrel 10 mg was chosen because in Rock's Brookline trials, use of norethynodrel 5 mg had resulted in breakthrough bleeding.
  In Rock's Brookline trials, the norethynodrel was found to contain 4 to 7 percent of the prodrug mestranol;
  purifying the norethynodrel to contain less than 1 percent mestranol resulted in breakthrough bleeding,
  so 2 percent (220 mcg mestranol—bioequivalent to 154 mcg of ethinyl estradiol) was chosen for the initial Puerto Rican contraceptive trial in 1956.
  As part of their extensive efforts to address the higher than expected (much higher than previously seen in Massachusetts) incidence of side effects reported in the 1956 first Puerto Rican trial,
  Pincus and Rock tried lower amounts of mestranol (180 mcg, 150 mcg, 80 mcg).
  The lower amounts of mestranol showed the same incidence of side effects, except for a higher incidence of breakthrough bleeding with 80 mcg of mestranol,
  so the amount of mestranol in Enovid 10 mg was lowered to 150 mcg (bioequivalent to 105 mcg of ethinyl estradiol) in the 1957 FDA-approved version.
  In 1958, contraceptive trials began using Enovid 5 mg (with 75 mcg of mestranol—bioequivalent to 52.5 mcg of ethinyl estradiol) which was approved by the FDA in 1961.
- Elaine Tyler May's book is not a good source for this article, which already directly cites (with fewer distortions) the sources she cites:
  • Marks, Lara V. (2001). Sexual Chemistry: A History of the Contraceptive Pill. New Haven: Yale University Press. ISBN 0-300-08943-0
  • Tone, Andrea (2001). Devices & Desires: A History of Contraceptives in America. New York: Hill and Wang. ISBN 0-8090-3817-X
  • Asbell, Bernard (1995). The Pill: A Biography of the Drug that Changed the World. New York: Random House. ISBN 0-679-43555-7
  • Watkins, Elizabeth Siegel (1998). On the Pill: A Social History of Oral Contraceptives, 1950-1970. Baltimore: Johns Hopkins University Press. ISBN 0-8018-5876-3
  • Segal, Sheldon J. (2003). Under the Banyan Tree: A Population Scientist's Odyssey. New York: Oxford University Press. ISBN 0-19-515456-8
  • Djerassi, Carl (2001). This Man's Pill: Reflections on the 50th Birthday of the Pill. New York: Oxford University Press. ISBN 0-19-850872-7
  • Marsh, Margaret; Ronner, Wanda (2008). The Fertility Doctor: John Rock and the Reproductive Revolution. Baltimore: John Hopkins University Press. ISBN 978-0-8018-9001-7
  • McLaughlin, Loretta (1982). The Pill, John Rock, and the Church: A Biography of a Revolution. Boston: Little, Brown and Co. ISBN 0-316-56095-2
  • Junod, Suzanne White; Marks, Lara (April 2002). "Women's Trials: The Approval of the First Oral Contraceptive Pill in the United States and Great Britain". Journal of the History of Medicine and Allied Sciences 57: 117–160
Kruvand, Marjorie (Fall 2012). "The Pill at Fifty: How the New York Times Covered the Birth Control Pill, 1960–2010". American Journalism 29 (4): 34–67.
- is a 38-page article "quantitative and qualitative content analysis of 50 years of coverage of the birth control pill in The New York Times" by a professor of journalism that has only one introductory paragraph about the development of the pill, which cites:
  • Asbell, Bernard (1995). The Pill: A Biography of the Drug that Changed the World. New York: Random House. ISBN 0-679-43555-7

Lynn4 (talk) 22:11, 22 May 2014 (UTC)

Possible mis-phrasing

From the sidebar: "User reminders Taken within same 24-hour window each day." I'm not sure that this sentence fragment means anything other than "Taken each day." This should be reworded so that the meaning is clearer. --73.190.104.68 (talk) 20:22, 15 April 2015 (UTC)

Different views in christian churches

The view on combined oral contraceptive pill is different in christian churches. On the one side is the view of Roman catholic church in Rome. On the other side are anglican and evangelical churches, such as Evangelical Church in Germany (EKD), which accepted combined oral contraceptive pill.

Focus.de: Pillenverbot bleibt Streitfrage zwischen den Konfessionen (German)

178.11.186.194 (talk) 00:46, 22 March 2016 (UTC)

External links modified

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Monophasic

The term is used but not defined or explained. ... I should not have to spell out how stupid and uninformative, un-useful that is. Here is a hint: Prior to using a term in your edit, make sure it is defined above or at the place it is used.72.16.96.109 (talk) 17:28, 30 September 2017 (UTC)

Popular Culture

Does anyone else think it would be a good idea to write how the introduction of birth control in the 1960s effected popular culture such as films and television shows being produced at that time? Tbenn2 (talk) 22:14, 29 November 2017 (UTC)

External links modified

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UCSF medical student to edit this page!

Hello Wiki! I am a 4th year medical student who is applying to OB/GYN residencies and I working with faculty at the University to edit this Wikipedia page for school credit over the next month!

I chose to edit this page because it is such an important topic and one that people often don't understand. It was also graded at a "c" level.

My current plan is to focus on the Medical Use section, Drug Interactions Section, Side Effects Section and ContraIndications sections. My goal is the help make the language clearer, update the sources (many are from the early 2000's, and add sources where there are none or where information is lacking. I want people who are using COC's to be able to look at this page and get the majority of their questions answered about use (both for contraception and other indications), effectiveness, side effects, and contraindications. My plan is to be done by 12/15. During this first week (11/27-12/4), I will mostly be gathering resources. Then for the following two weeks, I plan to make my edits, review them in my sandbox and then go live. Thanks!

DOtter (talk) 16:41, 27 November 2017 (UTC)

Great stuff! There's no need to announce yourself like this, but it's good news for the page and anyone interested in it :) ··gracefool 💬 10:35, 28 November 2017 (UTC)

PEER REVIEW TO ABOVE~

Overall, great job adding and improving substance to this super important topic for people around the world!

I think the "Contraceptive use" section under "Medical use" is well-done and highlights the main points about how COCPs are used as a contraceptive. I think that most people reading the section would understand the information conveyed. I do think that the readability could be improved with breaking up some the of the longer sentences and making more convoluted sentences simpler. Also, I think that it would be reasonable to consider a hyperlink for "contraception" or "contraceptive." I like the way that the "Effectiveness" section is developed and that it delves into non-perfect use efficacy, as well as making a distinction between "late" and "missed" pills.

Some other general suggestions for the sections you are primarily working on: 1). consider using more active voice instead of passive voice (this is hard to do, but I think could also state things more directly and simply!) 2). consider making the formatting within the sections consistent (for example, use bullet points instead of numbered points) to make the sections more visually compatible and concise. 3) perhaps expand the part on some reasons for non-perfect use (are there sources that cite more specific reasons?)

Thanks for all your work on this topic! Let me know if I can explain any of my feedback more

Wendi.gu (talk) 07:05, 12 December 2017 (UTC)

Minor edits

Hi all, we're a group of 4 medical students at University of Notre Dame Fremantle, and are hoping to make a few minor edits:

Add wiki link from “taken orally” to “oral administration”
Reference List 41 – change to match in-text citation
Adding Citation/Reference “Catalyst for the Sexual Revolution”
Giving updated reference for statistic – from 1 to 3% usage in Japan

Dan.kuilenburg (talk) 04:07, 23 January 2019 (UTC)

Lack of newly updated sources

There is a lack of studies that are up to date. One section that could also be mentioned is the effects of the pill on young adolescents versus adult women. Will the benefits/risks be the same if women started on the pill earlier? The section "Result on popular culture" is also lacking enough information, as it just seems out of place and random. Raachelc (talk) 02:16, 5 February 2019 (UTC)

UCSF Foundations 2 2019 Group 6C Goals

Hello Wiki!

We are 2nd year pharmacy students from UCSF and are working with faculty to make edits to this Wikipedia page over the next few weeks. Our plan for improving the article include the following:

Try to update the article with newer statistics
Discuss pharmacy laws regarding furnishing birth control in some states in the US
Insert reference for drug interaction between birth control and St. John Wort's

Please let us know any comments/concerns/questions about our proposed changes! Thank you!

Cindytrac (talk) 21:51, 30 July 2019 (UTC)

UCSF Foundations 2 2019 Group 6b's Peer Review

Jennie's Peer Review (Group 6b):

Group 6c made improvements to the article. I appreciated the explanation about the drug interaction between birth control and St. John's Wort. Listing examples of some combined oral contraception that interact with St. John's Wort would improve that section.
Group 6c has achieved their goals for improvement. I feel like there is still room for improvement with updating the article with newer statistics.
Group 6c's submission reflects a neutral point of view. Jhum4993 (talk) 21:37, 5 August 2019 (UTC)

Gabi's Peer Review (Group 6b):

Group 6c helped to elaborate on some of the sections within this article. Specifically, members of this group added information about the prevalence of combined oral contraceptive pill use, the drug interaction with St John's Wort, and legislation which permits pharmacists to prescribe oral contraceptives in some states. I think the information added was very relevant to the topic and definitely improved the article. Similar to Jennie's review, I would like to see another sentence on the St John's Wort interaction that describes the effect of increased metabolism of ethinyl estradiol and progestin (e.g. lower efficacy of the pill when used with St John's Wort).
Group 6c did achieve their goals for improvement, specifically their three major edits matched their three described goals (seen above).
Group 6c's edits are formatted consistent with Wikipedia's manual of style. All new information was appropriately cited, and I appreciated the abundance of links to other wikipedia pages. Gabidriller (talk) 05:01, 6 August 2019 (UTC)

Ally's Peer Review (Group 6 b)

I think the new section describing legislation allowing pharmacists to prescribe birth control is very relevant and an important addition to this article. I think it would be great to add a little more detail on the St. Johns Wort interaction describing why the interaction is important and what problems arise from it.
The group successfully covered all three goals.
The tone of the article edits are neutral and free of plagarism. Allydiiorio (talk) 17:04, 6 August 2019 (UTC)

Thien's Peer Review ( Group 6b)

Overall I think the goals stated were sufficiently accomplished by the group. The group was able to elaborate on the pharmacy legislation regarding oral contraceptives. In addition to giving us more information on the Drug Drug intreaction of St John's Wort and oral contraceptive. The information added was relevant and contributes to the article as a whole in providing more information. Perhaps something that could be added to this article would be elaborating more on the potential side effects of increased metabolism of ethyl estradiol when it intreacts with St john's wort. Overall these edits fit the wikipedia guidelines and the information was appropriate cited.

8 cites on one claim

Normally I would just remove the extras, but since this is a medical topic I thought I would ask here first: do we really need eight refs on the statement "Syntex broke the monopoly of European pharmaceutical companies on steroid hormones, reducing the price of progesterone almost 200-fold over the next eight years"? See WP:OVERCITE for guidance, perhaps. ThatMontrealIP (talk) 03:01, 26 September 2019 (UTC)

I removed some redundant references I added a dozen years ago. Lynn4 (talk) 23:31, 27 September 2019 (UTC)

Oral contraceptives & pre-term birth

I recently came across this: Pregravid Oral Contraceptive Use and the Risk of Preterm Birth, Low Birth Weight, and Spontaneous Abortion: A Systematic Review and Meta-Analysis. It seems that pre-term birth should be mentioned as a separate side effect with a subcategory along with "Depression", "Hypertension" etc.--Epiphyllumlover (talk) 04:09, 11 January 2020 (UTC)

Weight gain

Dred05m and Avatar317, maybe you'd like to talk this over?

The last time I looked into it, which was some years ago, the state of the art was that COCs make some women hungry, so they eat more, so they slowly gain weight, and the various sides line up and say "Look, she gained weight when she started taking this, so they cause weight gain" and the other says "Nuh-uh, she only gained weight because she was overeating!"

Also, relatively few trials studied it, not all trials found a change, the amount of weight gained was small (~5 pounds/2 kg in the first year), and the mechanism was usually assumed to be due to progesterone (the same hormone that's blamed for weight gain at menopause) when the weight gain was due to increased food intake, and to temporary fluid retention otherwise. WhatamIdoing (talk) 17:18, 1 December 2020 (UTC)

@WhatamIdoing: Respectfully, what you think you know about this subject and what I think I know are irrelevant here: Are there any sources which support the weight gain claim? (Remember, No Original Research WP:OR) Until we have SOURCES saying otherwise, "Weight No proven effect" is appropriate.

If you can find the sources you say you remember reading and post those, we can then proceed on how/what to say about their conclusions. I'm not familiar with the Cochrane reviews but there might be some good info there; maybe @JenOttawa:, who I've seen post some well-referenced info, can help us here? Thanks! ---Avatar317 ^(talk) 22:10, 1 December 2020 (UTC)

The prescribing information on the packages say that weight gain is a possible side effect of unknown incidence.

I believe that the latest Cochrane review says there is insufficient evidence. WhatamIdoing (talk) 23:53, 1 December 2020 (UTC)

Correct on the latest Cochrane review I can find saying the following: The four trials with a placebo or no intervention group did not find evidence supporting a causal association between combination contraceptives and weight change. and Available evidence is insufficient to determine the effect of combination contraceptives on weight, but no large effect is evident. I agree that barring some extremely high-quality evidence past this Cochrane review, there is no need to mention weight gain as a potential side effect, or if it is mentioned, it must be clarified as "potential" or "insufficient evidence to prove it doesn't happen" or something. To help prevent anyone from repeating searches, a search for both "combination contraceptive weight gain" and "contraceptive weight gain" filtered for meta-analysis, review, or systematic review and sorted by "most recent" doesn't find any newer articles of promise. -bɜ:ʳkənhɪmez (User/say hi!) 04:50, 2 December 2020 (UTC)

Queen's University Medical Student Editing Initiative

Hello,

We are a group of medical students from Queen's University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We looking forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you, Karabesa (talk) 20:19, 23 November 2020 (UTC)

1. Side effects: We propose on inserting the following content under Section:Side Effects and Subsection:Common, “Additionally, taking the pill can be helpful in preventing pelvic inflammatory disease ^[1]",and removing "pelvic inflammatory disease" from the statement "On the other hand, the pills can sometimes improve conditions such as pelvic inflammatory disease, dysmenorrhea......". Chickensaladsandwich (talk) 20:53, 2 December 2020 (UTC)Chickensaladsandwich

Under Section:Side Effects and Subsection:Common, we propose changing the final sentence of the second paragraph to include a reduced risk of endometrial cancer as well as ovarian cancer. The sentence would be "Use of oral contraceptives also reduces lifetime risk of ovarian and endometrial cancer." ^[2] --Sarahliuu (talk) 16:25, 3 December 2020 (UTC)Sarahliuu

Under Section:Side Effects and Subsection:Heart and blood vessels, we propose changing the first sentence of the second paragraph to reflect an update to the Cochrane review that was cited for this claim. The sentence would be "While lower doses of estrogen in COC pills may have a lower risk of stroke and myocardial infarction compared to higher dose estrogen, users of low estrogen dose COC pills still have an increased risk compared to non-users."^[3] Karabesa (talk) 02:11, 4 December 2020 (UTC)

References

^ Schindler, AE (2013). "Non-contraceptive benefits of oral hormonal contraceptives". International journal of endocrinology and metabolism. 11 (1): 41–7. doi:10.5812/ijem.4158. PMID 23853619.
^ Pragout, D; Laurence, V; Baffet, H; Raccah-Tebeka, B; Rousset-Jablonski, C (December 2018). "[Contraception and cancer: CNGOF Contraception Guidelines]". Gynecologie, obstetrique, fertilite & senologie. 46 (12): 834–844. doi:10.1016/j.gofs.2018.10.010. PMID 30385358.
^ Roach, RE; Helmerhorst, FM; Lijfering, WM; Stijnen, T; Algra, A; Dekkers, OM (27 August 2015). "Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke". The Cochrane database of systematic reviews (8): CD011054. doi:10.1002/14651858.CD011054.pub2. PMID 26310586.

2. Contraindications: Under Section:Contraindications we propose adding to the fourth sentence of the first paragraph so it reads "All COCP users have a small increase in the risk of venous thromboembolism compared with non-users; this risk is greatest within the first year of COCP use.^[1] Individuals with any pre-existing medical condition that also increases their risk for blood clots have a more significant increase in risk of thrombotic events with COCP use^[2]."13svdo (talk) 23:06, 3 December 2020 (UTC)(talk)

Under Section: Contraindications, we propose to add to the contraindication already stated for women who are breastfeeding due to risks of blood clots by elaborating on the concerns about the transient risk of COCPs on breast milk production as well as clarify when COPCs are generally safe to use again by postpartum women breastfeeding or not. The additions would be "While studies have demonstrated conflicting results about the effects of COPCs on lactation duration and milk volume, there exist concerns about the transient risk of COCPs on breast milk production when breastfeeding is being established early postpartum.^[3] Due to the stated risks and additional concerns on lactation, women who are breastfeeding are not advised to start COPCs until at least six weeks postpartum, while women who are not breastfeeding and have no other risks factors for blood clots may start COCPs after 21 days postpartum.^[4]^[5]" Smaho22 (talk) 08:39, 4 December 2020 (UTC)

References

^ Black, A; Guilbert, E; Costescu, D; Dunn, S; Fisher, W; Kives, S; Mirosh, M; Norman, WV; Pymar, H; Reid, R; Roy, G; Varto, H; Waddington, A; Wagner, MS; Whelan, AM (April 2017). "No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception". Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 39 (4): 229-268.e5. doi:10.1016/j.jogc.2016.10.005. PMID 28413042.
^ Black, A; Guilbert, E; Costescu, D; Dunn, S; Fisher, W; Kives, S; Mirosh, M; Norman, WV; Pymar, H; Reid, R; Roy, G; Varto, H; Waddington, A; Wagner, MS; Whelan, AM (April 2017). "No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception". Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 39 (4): 229-268.e5. doi:10.1016/j.jogc.2016.10.005. PMID 28413042.
^ Lopez, Laureen M; Grey, Thomas W; Stuebe, Alison M; Chen, Mario; Truitt, Sarah T; Gallo, Maria F (20 March 2015). "Combined hormonal versus nonhormonal versus progestin-only contraception in lactation". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003988.pub2.
^ Medical eligibility criteria for contraceptive use (Fifth ed.). Geneva, Switzerland: World Health Organization. ISBN 9789241549158.
^ "Classifications for Combined Hormonal Contraceptives | CDC". www.cdc.gov. Centers for Disease Control and Prevention. 9 April 2020.

3. Role of placebo pills: Under Section: Role of placebo pills, we propose to add two sentences briefly detailing the supplementation of COCPs with folic acid. The following sentences will be added to the end of the paragraph: “As well, birth control pills, such as COCPs, are often fortified with folic acid as it is recommended to take folic acid supplementation months prior to pregnancy to decrease the likelihood of neural tube defects in infants.^[1]^[2] With folic acid fortification, people who have been taking COCPs for months before pregnancy may already have sufficient amounts.^[3]^[4]” sbk1998 (talk) 19:10, 4 December 2020 (UTC)

References

^ Viswanathan, Meera; Treiman, Katherine; Kish Doto, Julia; Middleton, Jennifer C; Coker-Schwimmer, Emmanuel JL; Nicholson, Wanda K (Jan 2017). "Folic Acid Supplementation: An Evidence Review for the U.S. Preventive Services Task Force". U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.: 4-05214-EF-1. PMID 28151610.
^ Lassi, Zohra; Bhutta, Zulfiqar (April 2012). "Clinical utility of folate-containing oral contraceptives". International Journal of Women's Health (4): 185-190. doi:10.2147/IJWH.S18611. PMID 22570577.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Viswanathan, Meera; Treiman, Katherine; Kish Doto, Julia; Middleton, Jennifer C; Coker-Schwimmer, Emmanuel JL; Nicholson, Wanda K (Jan 2017). "Folic Acid Supplementation: An Evidence Review for the U.S. Preventive Services Task Force". U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.: 4-05214-EF-1. PMID 28151610.
^ Lassi, Zohra; Bhutta, Zulfiqar (April 2012). "Clinical utility of folate-containing oral contraceptives". International Journal of Women's Health (4): 185-190. doi:10.2147/IJWH.S18611. PMID 22570577.{{cite journal}}: CS1 maint: unflagged free DOI (link)

Thanks for sharing these improvements. Note @Smaho22 and Sbk1998: Multiple use of the same reference- tech tip. When you add your references while editing, you can see the options "automatic... Manual... Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live on Monday.JenOttawa (talk) 16:57, 7 December 2020 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): DOtter. Peer reviewers: Wendi.gu.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 18:06, 16 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2019 and 16 April 2019. Further details are available on the course page. Student editor(s): Raachelc. Peer reviewers: Raachelc.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:19, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Davdang, Cindytrac, Gabidriller, RwengUCSF, AMONGxicillin.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:19, 17 January 2022 (UTC)

Quality of the sources of the article

I just stumbled upon this article a few hours after having read Wikipedia:Identifying reliable sources (medicine). I have been surprised by the important number of primary sources and popular press while there is an important number of reviews and clinical guidelines that assessed all the available literature, including evaluating evidence quality.

Per the Wikipedia policies of neutral point of view, no original research, and verifiability, articles need to be based on reliable, independent, published secondary or tertiary sources. For biomedical content, the Wikipedia community relies on guidance contained in expert scientific reviews and textbooks, and in official statements published by major medical and scientific bodies. Note that health-related content in the general news media should not normally be used to source biomedical content in Wikipedia articles. (From Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources)

For the benefit of the reader, shouldn't this article avoid primary sources and popular press, except for fresh new studies satisfying quality of evidence criteria, but not included yet in reviews and clinical guidelines? Mathias Hoffnung (talk) 19:49, 8 July 2022 (UTC)

Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 August 2022 and 20 September 2022. Further details are available on the course page. Student editor(s): Rwile, Carlosr97, Rballena, Cindyf99 (article contribs). Peer reviewers: Pdh1997.

— Assignment last updated by Pdh1997 (talk) 00:53, 16 September 2022 (UTC)

pdh1997 review: The addition of the Menorrhea section was clear and appreciated the use of inclusive language. Additional sources work and are correct. One section of critique is that the use of inclusive language could be adjusted throughout the article. (Ex: people who menstruate or have ovaries instead of women) Overall great additions and edits to the article. — Preceding unsigned comment added by Pdh1997 (talk • contribs) 23:18, 16 September 2022 (UTC)

Wiki Education assignment: Technical and Scientific Communication

This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 August 2022 and 9 December 2022. Further details are available on the course page. Student editor(s): Amorton9 (article contribs).

— Assignment last updated by Amorton9 (talk) 18:46, 20 September 2022 (UTC)

contraindications

Isn't progesterone contraindicated for people with ehlers danlos syndrome? 2601:645:100:8380:0:0:0:CA87 (talk) 02:05, 7 November 2022 (UTC)

Has bioidentical progesterone ever been combined with estrogen in a trialed birth control study?

I did a little looking around and I can't tell.

Bioidentical (found in nature) progesterone as opposed to progestin (not found in nature). --Timeshifter (talk) 09:19, 8 December 2022 (UTC)

Misinterpreted primary source

The article quote this study: Effects of combined hormonal contraception on health and wellbeing: Women's knowledge in northern Italy,Nappi et al. (2014).

This study is about the knowledge of CHC effects on health among women. For example, 48% of the respondant believed CHC could cause low sex drive , but contrary to what's written in the article,

Another 47% of the women recorded vaginal dryness and 48% experienced low sex drive.[83]

they didn't report low sex drive for themselves.

Better, secondary, more on point sources on the effects of CHC on health should be used. [Special:Contributions/129.199.26.18|129.199.26.18]] (talk) 13:34, 16 February 2023 (UTC)

[1] Schindler, AE (2013). "Non-contraceptive benefits of oral hormonal contraceptives". International journal of endocrinology and metabolism. 11 (1): 41–7. doi:10.5812/ijem.4158. PMID 23853619.

[2] Pragout, D; Laurence, V; Baffet, H; Raccah-Tebeka, B; Rousset-Jablonski, C (December 2018). "[Contraception and cancer: CNGOF Contraception Guidelines]". Gynecologie, obstetrique, fertilite & senologie. 46 (12): 834–844. doi:10.1016/j.gofs.2018.10.010. PMID 30385358.

[3] Roach, RE; Helmerhorst, FM; Lijfering, WM; Stijnen, T; Algra, A; Dekkers, OM (27 August 2015). "Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke". The Cochrane database of systematic reviews (8): CD011054. doi:10.1002/14651858.CD011054.pub2. PMID 26310586.

[4] Black, A; Guilbert, E; Costescu, D; Dunn, S; Fisher, W; Kives, S; Mirosh, M; Norman, WV; Pymar, H; Reid, R; Roy, G; Varto, H; Waddington, A; Wagner, MS; Whelan, AM (April 2017). "No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception". Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 39 (4): 229-268.e5. doi:10.1016/j.jogc.2016.10.005. PMID 28413042.

[5] Black, A; Guilbert, E; Costescu, D; Dunn, S; Fisher, W; Kives, S; Mirosh, M; Norman, WV; Pymar, H; Reid, R; Roy, G; Varto, H; Waddington, A; Wagner, MS; Whelan, AM (April 2017). "No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception". Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 39 (4): 229-268.e5. doi:10.1016/j.jogc.2016.10.005. PMID 28413042.

[6] Lopez, Laureen M; Grey, Thomas W; Stuebe, Alison M; Chen, Mario; Truitt, Sarah T; Gallo, Maria F (20 March 2015). "Combined hormonal versus nonhormonal versus progestin-only contraception in lactation". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003988.pub2.

[7] Medical eligibility criteria for contraceptive use (Fifth ed.). Geneva, Switzerland: World Health Organization. ISBN 9789241549158.

[8] "Classifications for Combined Hormonal Contraceptives | CDC". www.cdc.gov. Centers for Disease Control and Prevention. 9 April 2020.

[9] Viswanathan, Meera; Treiman, Katherine; Kish Doto, Julia; Middleton, Jennifer C; Coker-Schwimmer, Emmanuel JL; Nicholson, Wanda K (Jan 2017). "Folic Acid Supplementation: An Evidence Review for the U.S. Preventive Services Task Force". U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.: 4-05214-EF-1. PMID 28151610.

[10] Lassi, Zohra; Bhutta, Zulfiqar (April 2012). "Clinical utility of folate-containing oral contraceptives". International Journal of Women's Health (4): 185-190. doi:10.2147/IJWH.S18611. PMID 22570577.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[11] Viswanathan, Meera; Treiman, Katherine; Kish Doto, Julia; Middleton, Jennifer C; Coker-Schwimmer, Emmanuel JL; Nicholson, Wanda K (Jan 2017). "Folic Acid Supplementation: An Evidence Review for the U.S. Preventive Services Task Force". U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.: 4-05214-EF-1. PMID 28151610.

[12] Lassi, Zohra; Bhutta, Zulfiqar (April 2012). "Clinical utility of folate-containing oral contraceptives". International Journal of Women's Health (4): 185-190. doi:10.2147/IJWH.S18611. PMID 22570577.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[1]

[2]

[3]

[1]

[2]

[3]

[4]

[5]

[1]

[2]

[3]

[4]

Percy Julian again

See also Percy Julian

What affects Birth Control?

Carl Djerassi, Der Standard, The Guardian, and CathNews.com

Duplicate sections

Price?

24-July edits

Dubious sentence

Canada

interaction

Breast cancer risk review

scientific findings/iarc/ stroke journal/etc

NPOV problems

Cancer

Mechanism

Side Effects

Moved point of view of author to here

Percy Julian yet again

Clinical trials in Puerto Rico

Mechanisms of Action

Off-topic History section paragraph

Japan

More COPYVIOs and SYNTH by disruptive IP-hopping anonymous editor

Inaccurate sentences

Clarifications

COCP and antibiotic taking guidelines

Side Effects 2

Randy Alcorn's Eternal Perspectives Ministry Does the birth control pill cause abortions? is not a WP:MEDRS

Cancer protective

Dubious, outdated, poorly sourced cut-and-pasted trivia by disruptive IP-hopping anonymous editor

Failure rate

Needs reordering.

"An overview of the History of creation of the pill in America" paragraph

Possible mis-phrasing

Different views in christian churches

External links modified

Monophasic

Popular Culture

External links modified

UCSF medical student to edit this page!

Minor edits

Lack of newly updated sources

UCSF Foundations 2 2019 Group 6C Goals

UCSF Foundations 2 2019 Group 6b's Peer Review

8 cites on one claim

Oral contraceptives & pre-term birth

Weight gain

Queen's University Medical Student Editing Initiative

Wiki Education Foundation-supported course assignment

Wiki Education Foundation-supported course assignment

Wiki Education Foundation-supported course assignment

Quality of the sources of the article

Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022

Wiki Education assignment: Technical and Scientific Communication

contraindications

Has bioidentical progesterone ever been combined with estrogen in a trialed birth control study?

Misinterpreted primary source