Contraception: the pill does not dream anymore

Sign of the times: the pill , symbol of women's liberation in the seventies, is no longer dreaming. Banalized, scorned, even taken reluctantly, it now arouses an ambiguous feeling tinged with suspicion as much as covetousness . Including among its longtime users. Yet she continues to reign supreme in France. More than 91% of sexually active French women between the ages of 15 and 49 use contraception , according to the National Institute for Prevention and Health Education (InPes). and, of these, nearly 58% still opt for the pill, compared with only 24% for the IUD. A choice that is not insignificant considering the total number of tablets (more than 8,000) to be swallowed during the fertile life, between 17 years (average age of first sexual intercourse) and about 50 years (after menopause) ). Thus, each new announcement on their potential collateral damage sows an understandable panic. especially when the opprobrium is thrown on the new generation pills, supposed to represent a progress compared to the older ones.

Contraception: renewed fears

Since the arrival of the first oral contraceptives in 1956, their principle has hardly changed: to deliver a cocktail of female hormones to inhibit ovulation, thus preventing fertilization. Significant improvements have been made over the decades to reduce their undesirable side effects, such as acne , painful breasts, the occurrence of arterial disorders ... The doses of synthetic estrogen (ethinyl estradiol) have gradually decreased and new progestins have been introduced. However. While laboratories have been forced to impose their third- and fourth-generation pills (with desogestrel, gestodene or drospirenone) and many gynecologists have prescribed them while thinking of doing well, two recent studies are once again reviving fears about hormonal contraception.

The excitement spread as early as October 2011 following the publication in the British Medical Journal of the work of the University of Copenhagen on 1.3 million women. The verdict of the researchers is formal: the users of the Convuline, Jasmine, Belanette, Jasmine or Yaz type pills have a risk of venous thrombosis twice as high as those taking Minidril, Lovavulo, Leeloo, Ludeal or Zikiale. And six times higher than women without hormonal contraception. In other words, they are more prone to blood clots that can clog the leg veins (phlebitis) or lungs (pulmonary embolism). A few days later, the US Food and Drug Administration (FDA) corroborated these findings based on the analysis of the medical records of some 800,000 US women with different forms of contraception. The doubt that had been hanging over for several years is no longer allowed. " This venous risk exists in fact, says Dr. Christian Jamin, gynecologist and endocrinologist, and is relatively unpredictable. No reliable factor can predict more than half of the cases of phlebitis, the measurement of clotting factors, or the examination of family history. So much to know before swallowing hundreds of wafers with eyes closed.

Contraception: relativizing risks

Should we be alarmed? If this risk is extremely serious, it is rare. According to the National Agency for Drug Safety (ANSM), per 100,000 women taking a pill of third or fourth generation , the number of thromboses would be twenty to forty per year. Few in appearance. But, reduced to the 2 to 3 million French women who use these pills (out of 7 million taking oral contraceptives), this still affects every year 600 to 1 200 patients! " It's too much, of course, but less than the risk of phlebitis with a leg in the cast or during a long-haul flight ," says Dr Jamin. And, fortunately, the vast majority of these circulatory accidents are taken care of in time. Only about 1% of them turn out to be deadly.

" To minimize the danger, these pills should now be prescribed as second-line, when second-generation pills are not suitable," says Dr.Jamin, who adds immediately: the women who take them for several years should not especially give in to the panic. Changing the pill or taking a break of a few months under the pretext of resting your body is a miscalculation since the venous risks are higher during the first months of treatment. "

Contraception: natural formulas

The latest pills that arrived on the market (Qlaira then Zoely in early 2012) are not affected. They open a new era, that of natural hormones. Unlike other pills, the estrogen delivered is the exact replica of the hormones secreted by the ovaries, 17 beta-estradiol. Their biological impact is therefore much lower. " They do not seem to interfere with liver metabolism and clotting factors," says Dr. Jamin. Their tolerance is theoretically better and their risks lower. But we are still lacking in perspective. It takes five to ten years before it can be certified 100%, the time to garner the results of post-marketing studies involving hundreds of thousands of users, not the few thousand women recruited in the market. clinical trials.

In the meantime, other innovations may have emerged. Starting with a pill made from natural fetal estrogens. Called Estelle, it contains Estetrol, a hormone specifically produced during pregnancy by the human fetus. According to Professor Jean-Michel Foidart, co-founder of the Belgian laboratory Uteron Pharma, which develops it, it would present " a better profile of cardiovascular safety " in that estetrol is suspected of mitigating the risk of thrombosis, which is increased at pregnant women. The first clinical tests (in the Netherlands and Finland) showed that it also exerted an estrogenic action on the breast, suggesting a decrease in the risk of breast cancer . In animals, this molecule would even melt tumors. But do not rejoice too quickly. As long as the tests are not completed, no one can predict Estelle's destiny, and its launch on the market will not be possible before 2015.

Contraception: pills without hormones?

Researchers are also working on completely different paths: to develop pills that hinder fertilization without going through the hormonal route. The advantage is obvious. Without hormones , they would not interfere with any of the major physiological mechanisms that underlie the functioning of our body: menstrual cycle, coagulation, metabolism ... Their side effects should be minimal or non-existent. At the Karolinska Institute in Stockholm, for example, biologists have identified and determined the 3D structure of a protein (ZP3) present on the surface of eggs and essential for the attachment of spermatozoa. Without it, the fusion of the two sexual cells, thus the formation of the egg, is impossible. Blocking this protein would prevent the development of embryos. The approach is bold but still uncertain.

Another idea, on which the University of California and the Bonn Center for European Studies are working, is more promising. This is to neutralize the sperm in the vagina and uterus to prevent them from completing their "journey" to the egg. In the body of the woman, the male cells would become vigorous indeed thanks to the progesterone, which would open small channels in their flagellum in which rush calcium ions. By closing this door, the sperm are rendered less active and prevented from going to meet the egg. This is the goal pursued by Californian researchers, convinced that there is a revolution in contraception.

More advanced is the work of the University of Oregon, which involves letting the eggs mature but preventing their release by the ovary. Each egg develops in a small sac (the ovarian follicle) that is supposed to break during ovulation so that the reproductive cell can migrate into the tubes. This rupture can not be done without the intervention of specific enzymes (metalloproteinases) which degrade the wall of the bags. By injecting inhibitory molecules of these enzymes, ovulation is suspended. The trials conducted on eight female macaques were conclusive: none ovulated. Research must continue before it comes to marketing a hormone-free pill.

Contraception: and why not men?

In the meantime, it is the men who could soon be put to work ! Announced repeatedly, the male pill finally seems not far to succeed and start responding to a request. Two concepts are currently under study. The first is based on the application of ultrasound to the testicles. Tests conducted on rats, published last February by Reproductive Biology and Endocrinology , have shown that two fifteen-minute sessions divide the number of spermatozoa by one hundred, thus inducing temporary sterility . It remains to find the dose that could be used repeatedly without causing undesirable effects.

The second method is more traditional: administer hormones (a mixture of testosterone and progesterone injected intramuscularly) to prevent the production of spermatozoa . The first results of clinical trials conducted in Beijing on 855 men are encouraging. After thirty months of treatment, the efficacy seems good, the reversible method and the side effects absent. Only obstacle: how to deliver these hormones orally? Because the prospect of a monthly sting is likely to cool more than one ...

Contraception: no, the pill does not make you fat

The very first pills, highly dosed, caused frequent weight gain. This is no longer the case with today's. Formal evidence was provided last year by Swedish researchers at the University of Gothenburg, who have followed 1,400 women of childbearing age for 15 years. Those who took the pill during all this time recorded a weight gain of 0.5 kg per year on average. Is. But women who have not used any hormonal contraception have similarly coated with physical activity and number of identical pregnancies . " The pill has no impact on fat, " says Dr. Christian Jamin, a gynecologist. Some result in slight water retention, resulting in a few hundred grams more on the scale. Others are a little diuretic and induce the opposite effect.

Contraception: anti-forget app

77% of women on pill admit having already forgotten at least once to swallow their precious tablet. Result: unplanned pregnancies and abortions . 10% to 15% of French abortions would be the consequence of such a miseries. A free application , Pil 'by the hour, developed by Dr. David Elia, gynecologist in Paris, avoids this pitfall.

Usable with an iPhone , iPad or iPod Touch, it fits all pill brands. Just scan the barcode printed on the box to set the alerts and get appropriate advice, in case of digestive disorders or jet lag while traveling abroad. Convenient !

Contraception: IUD, the panacea?

The IUD, long rejected in the background, is more and more popular. Especially since " the new models do not have much in common with those of twenty years ago," says gynecologist Marianne Buhler. In women whose emotional life is stable, they do not have an increased risk of tubular sterility linked to infections . A study published in May 2012 by the University of Washington also proves their superiority in terms of efficiency. The rate of contraceptive failure (unwanted pregnancy) is only 0.27% for IUD users, compared to 4.5% for those who choose a "short-term" method (pill, patch or vaginal ring).