The Two Sides of the Pill in Brazil

​Women use contraceptives in order to gain a crucial kind of control over their own bodies: the power to decide when and how many children they'll have.

Despite this advantage, the first pill I took hit me real bad. This happens to a lot of women—some develop a few hellish pimples on their faces or just lose libido; others end up in the ICU due to the daily ingestion of hormones for all those years.

So, we know all about the benefits. But what are the issues that could arise from taking the pill?

The birth control pill was born in the 1950s in America and started being sold during the 1960s. It was one of the major causes of the drop in birth rates in many countries, and also for the sexual revolution of a generation.

The Mexican chemist Luís Mira​montes found out in 1951 how to extract synthetic progesterone from plants so the drug could be made in the lab. The first pills sold combined estrogen and progesterone.

Ana Luiza Antunes Faria, a gynecologist at Pérola Byington Hospital in São Paulo, told me progesterone is the hormone responsible for the contraceptive effect of the pill, whereas estrogen controls the menstrual flow pattern and boosts progesterone's effect.

The pill mechanics aren't that simple. Progesterone tricks our brains into thinking we're ovulating every month, blocking the release of the FSH hormone (responsible for egg cell growth), which actually prevents ovulation itself.

Not ovulating allowed women to control the number of kids they wanted to have. Consequently, they began to occupy other spaces outside their homes, went to​ college, and entered the labor market for good.

In Brazil, the first pill that popped up in the market was ENOVID, in 1962. Joana Maria Pedro, historian and professor of the Universidade Federal de Santa Catarina, or Santa Catarina Federal University, and author of the study "The cont​raceptive experience in Brazil: A matter of generation," told Motherboard that the pill first emerged for means of birth control under a military dictatorship context. "The pills weren't meant for female emancipation, but women turned them… into an instrument of emancipation," she said.

The first pills had a high dosage of hormones, which led to severe side effects. These side effects were the end result of the 150 micrograms of ethinyl estradiol, a type of synthetic estrogen. That was a lot of hormones. By comparison, the high dosage pills of today have 50 micrograms of the same substance.

Even so, women gulped down the bad medicine to avoid ending up like their mothers, who had given birth to at least four, five, or even more kids.

Nowadays, most contraceptives available on the market are considered low dosage, with 15 to 35 micrograms of ethinyl estradiol. Besides the oral pill, women can also opt for injections (in quarterly or monthly intervals), vaginal rings, contraceptive patches, IUD (either chemical or copper), and implants.

However, none of them are failsafe. The Pe​arl Index exists to point out the failure rate of the contraceptive. It ranges from 0.3 percent to 1.25 percent. That means a single woman who uses some form of contraceptive can still get pregnant, even under ideal conditions. That doesn't account for mistakes, either: One of the pill's biggest flaws is its dependence on human memory.

When I was 17, I started on the pill for the very first time. During the first few weeks, I took it religiously every day at the same hour. After a while, I noticed my inability to remember to take it every day.

But even accounting for memory failure, the effectiveness of any contraceptive method stays above 97 percent if you do it right.

The pill also has side effects, however, which arise mainly due to the estrogenic component of the medicine. Since the dawn of contraceptive history, there have been side effects. The lighter ones I could feel myself, going through at least three different pills that led to the same problems: acne, weight gain, libido loss, nausea, and PMS, among other things that turn daily life into a nightmare. That can be solved by changing the method: a nausea-inducing pill could be traded for a vaginal ring or an injection.

The real major issue lies upon the effects that can lead up to serious health complications, such as pulmonary embolism and thrombosis. From the ;60s onwards, the thrombosis rates in women rose a lot due to the use of contraceptives. "Since the pill's dosage fell to under 50 micrograms of ethinyl estradiol, the rates [for thrombosis] diminished drastically," said Dr. Ana. That's why, today, doctors consider these cases to be rare, but it's not possible to measure just how rare they are, since they're not being documented, at least not in Brazil.

According to ANVISA, the regulator that acts as Brazil's Food and Drug Administration, there is no legislation that forces the doctors to notify such cases. "Unfortunately, according to data from the Pan American Health Organization, PAHO, just 5 percent of the doctors notify such cases, and regarding the adverse events' universe, just 10 percent of adverse reactions are recorded," the agency said in a study on contraceptives shared with Motherboard.

This same document points out that only three reports of thromboembolic events stemming from the use of the Yasmi​n pill were made on the Notivis​a system, which can be used by patients and physicians.

B​ayer, the group responsible for Yasmin, said in a statement by email that the medication "is effective and has a favorable safety profile (benefit-risk), when used in accordance with the package insert approved by health agencies on each country," besides being approved by regulatory organs worldwide, including ANVISA.

Last year, professor Carla Simone Castro fell victim to a cerebral venous thrombosis due to the use of Yasmin. "I took it for six months to treat a myoma. I had never taken any contraceptives my whole life, my doctor prescribed it to me, because I wanted to go through surgery and she thought it wasn't necessary. Six months later, I found myself in the ICU," she said.

To alert other girls to the risks of Yasmin, she made a v​ideo that went viral on Facebook. After posting the video, she began to receive messages from other women who also had thrombosis-related issues due to the use of contraceptives. Carla and another woman founded a Faceboo​k page to denounce such cases and to show women they weren't alone.

During the making of this report, I've came across other stories, even from 20-and-something girls, with pulmonary embolism and erythema on their legs related to the use of contraceptives, especially of the oral kind, but also due to the use of the vaginal ring, Nuvaring.

Dr. Ana reminds us that to know the patient's history is crucial to prescribe a contraceptive. "Without any drugs we already have the risk of thrombosis at each 5, 6, 10 thousand patients. Hypertensive patients older than 35 have a much larger risk of developing thrombosis under oral contraceptives. Patients with a genetic mutation of some clotting factors can also have that increase, which is already eight times the usual by default, and the pill raises it from 15 to 30, and sometimes that person doesn't even know she carries that factor," said the doctor.

To know if you have that genetic factor, you have to go under a genetic mapping of mutations.Unfortunately, Dr. Ana says, the government concluded the mutation affected so few people that a large-scale study was not feasible. "That just doesn't make sense when it comes to costs for public healthcare," she said.

Furthermore, in spite of everything, the pill is an invention no short of brilliant. "How many unwanted pregnancies, unwanted abortions and mothers' deaths related to an abortion haven't you avoided? We have to think about the benefits of the general population, of the birth rate control in general, of the mortality control in abortion. Then that's a great advantage for the pill," the doctor said. "Don't go raising any flags—there is no right or wrong."

This story has been translated from ​Motherboard Brazil by Thiago "Índio" Silva.