The contraceptive pill. So much controversy, so many questions. How bad are the side effects really? Would the pill still be approved today? And what about the pill for men? That and much more - see: CONTENT 0:00 Intro 1:23 The menstrual cycle 3:20 How the contraceptive pill works 4:40 What exactly is “the” pill? 6:02 How effective is the pill at preventing pregnancy? 7:12 Side effects 12:45 The pill for men 16:26 Non-hormonal alternatives 17:36 Would the pill still be approved today? 18:56 Effectiveness, benefits and necessity maiLab is produced by Mai Thi Nguyen-Kim for funk (ARD & ZDF) ►funk web app: https://go.funk.net ►https://go.funk.net/impressum SOURCES & MORE INFORMATION Menstrual cycle and effect of estrogen-progestogen combination preparations (“the pill”): R Gätje, C Eberle, C Scholz, M Lübke, C Solbach (2015). Short textbook of gynecology and obstetrics (2nd ed.). Thieme guideline on hormonal contraception - Summary of side effects of the pill, vathromboembolism and the different levels of risk of preparations: https://www.awmf.org/leitlinien/detai... A possible complication of venous thromboembolism is pulmonary embolism. This is very dangerous with a mortality rate of 10% https://www.aerzteblatt.de/archiv/168... The pill report of the Techniker Krankenkasse from 2015 criticized the frequent prescriptions of combination pills with a particularly high or still unknown risk of thrombosis in the years 2011-2013: https://www.tk.de/resource/blob/20434... The popularity of the pill has been declining in Germany for several years: BZgA: https://bit.ly/3AFadZ5 Statista: https://bit.ly/3i1hL07 This study found that the risk of thrombosis returns to normal around 3 months after stopping the pill: https://pubmed.ncbi.nlm.nih.gov/7500748/ An EMA report in 2014 found that among the combination preparations, those with levonorgestrel, norethisterone and norgestimate had the lowest risk for venous thromboembolism: https://bit.ly/3AHHyD4 For this reason, the guideline on hormonal contraception recommends that these preparations be prescribed preferentially, especially for first-time users. A 2021 study funded by the BfArM confirms that combination preparations with levonorgestrel pose the lowest risk of venous thromboembolism. Prescriptions for combination preparations in the lowest risk class increased in the comparison of the periods 2005-2007 and 2015-2017, while those in the highest risk class decreased. For newer gestagens, whose thrombosis risk was previously unknown, a comparable increase in risk was found as for the highest risk class. https://www.bfarm.de/DE/Aktuelles/Pub... On the “mini pill” (monopreparation without estrogen): They do not control the cycle nearly as well as preparations with estrogen. Cycle irregularities such as missed periods or intermenstrual bleeding on other days are common. Depending on the severity, this can be a deal breaker for some women. The mini-pill, for example, is an alternative to the combined pill for contraception during breastfeeding, where you want to avoid estrogen. Mini-pills do not increase the risk of thrombosis, but in addition to cycle irregularities, they can have similar side effects to combined pills, e.g. mood swings, breast tenderness, changes in libido. Reviews of the current state of research on the pill for men: https://journals.sagepub.com/doi/pdf/... and https://www.sciencedirect.com/science... The large WHO study that was stopped prematurely after evaluating the side effects: https://academic.oup.com/jcem/article... Natural family planning (NFP) refers to various methods. With the symptothermal method, body temperature and changes in cervical mucus are specifically observed to determine the days on which one can have sex without contraception without becoming pregnant. When used correctly (but only then!), the method achieves a similar level of effectiveness to the pill: https://www.klinikum.uni-heidelberg.d... The Institute for Quality and Efficiency in Health Care (IQWiG) describes the hurdles for drug approval and a benefit assessment: https://bit.ly/3dPPA2z How much the health insurance companies are willing to pay for a newly approved drug depends on the benefit assessment (especially additional benefit compared to available alternatives). Further explanation of the terms “benefit” and “necessity” in connection with medical services (see slide 4): https://bit.ly/3wqo3vl Information on various contraceptive methods https://www.profamilia.de/themen/verh...