Family Planning Post #9: Hormonal Technologies

In this post, I will describe and discuss the various hormonal technologies that are employed as methods of birth control.

Birth Control Pill

There are several forms of the birth control pill. The two main categories are the combination pill, which uses a combination of estrogen and progestin (a man-made form of progesterone) to prevent successful pregnancy, and the progestin-only pill, which simply uses progestin to prevent successful pregnancy.

According to the American Pregnancy Association:

"Oral contraceptives are designed to prevent pregnancy in one of three ways:

• Prevent ovulation each month.
• The cervix produces less and thicker mucus so that sperm cannot easily enter the uterus.
• The lining of the uterus becomes thinner, making it more difficult for a fertilized egg to attach to the uterus should ovulation occur and fertilization take place. Ethical Consideration."

The link to the "Ethical Consideration" is exactly the same link that they include in the information on IUDs, and it reads as follows:

"It is possible that you may not have been aware that any ethical questions existed concerning contraception. The contraceptive methods that involve the changing of the lining of the uterus to prevent implantation from occurring create an ethical or moral consideration for some people.

Some people believe that life begins at conception whereas others believe it begins at implantation. The ethical consideration develops for individuals who believe that life begins at conception.

When contraceptive methods fail to prevent ovulation or fertilization, the changing of the uterine lining is used to prevent the fertilized egg or “life” from implanting in the uterine wall. It is this action that leaves people believing they have crossed an ethical boundary."

KidsHealth provides further information on the progestin-only pill (aka "mini-pill"):

"Another kind of pill that may change the number of monthly periods is the low-dose progesterone pill, sometimes called the mini-pill. This type of birth control pill differs from the other pills in that it only contains one type of hormone — progesterone — rather than a combination of estrogen and progesterone. It works by changing the cervical mucus and the lining of the uterus, and sometimes by affecting ovulation as well. The mini-pill can be slightly less effective at preventing pregnancy." [emphasis mine]

Other links to check out to determine the function of "the pill":

The Center for Young Women's Health at Children's Hospital Boston

KidsHealth by Nemours Foundation

Depo-Provera, Birth Control Patch, and Vaginal Ring

Depo-Provera is administered by a health care professional once every three months. It contains a chemical called depo-medroxyprogesterone acetate (DMPA), which is designed to mimic the natural function of progesterone.

The Birth Control Patch (aka Ortho-Evra) is a small sticky patch that is applied to the skin. Hormones contained in the patch are absorbed through the skin into the system of the woman. The patch is replaced once a week for three weeks and is left off the skin for one week to allow for menstruation.

The Vaginal Ring (aka NuvaRing) is a small piece of flexible plastic that is inserted into the vagina for three weeks at a time. Estrogen and progestin in the ring are absorbed into the system to affect the way the body works. The ring is removed for one week to allow for menstruation, and then a new ring is inserted.

According to the American Pregnancy Association:

Depo-Provera (the shot), OrthoEvra Patch (birth control patch), and NuvaRing (the vaginal ring) all operate with the same three mechanisms:

• "First, it prevents the ovaries from releasing an egg, which is also known as ovulation.
• Second, it thickens the cervical mucus which acts as a barrier preventing the sperm from reaching the egg.
• Third, it changes the lining of the uterus preventing implantation. Ethical Consideration."

As you can see, they all also come with the same "Ethical Consideration" warning associated with the birth control pill (of both types) as well as the IUD.

There are a host of side-effects associated with all of the hormonal technologies listed above, which remind us that there are issues we need to consider related to stewardship of our bodies. However, for the sake of space, I will let you read about the physical side effects of these hormonal technologies on your own.

I will focus now on providing you with resources to help you determine how to evaluate the morality of using these methods of birth control...

Conclusions

All of the hormonal technologies described above operate with the same three basic mechanisms. If you were to read the Physician's Desk Reference at your neighborhood library--or if you were to check out the insert in the packaging of your prescription if you are currently taking any of these medications or using these devices--you would notice that all three of these mechanisms are listed for each brand/medication/device. If the manufacturers are listing these as the mechanisms, then it's safe to say that they probably really are the mechanisms/functions of these technologies.

As Amber mentioned in her first post, there are varying opinions, even among Christian obstetricians, regarding whether or not hormonal technologies are acceptable methods of birth control. After all our reading and research, it comes down to two basic systems of thought:

• One the one hand, there are some doctors who would say that there is not enough proof that there is a high enough risk that the uterus would be altered in such a way as to make implantation of a fertilized egg impossible. These doctors feel comfortable prescribing the combination pill and some other hormonal technologies to their patients because there is not enough proof to them that there is a significant rate of the third mechanism working.
• On the other side, there are doctors who would say that there is significant evidence that this third mechanism of hormonal technologies exists for a reason--it is there because the first two mechanisms may fail, and this third function is there to help prevent successful pregnancy. Their conclusion is that the mechanism exists for a purpose, and even if the first two mechanisms USUALLY work, these doctors do not feel comfortable prescribing these hormonal forms of birth control because there is even the slightest chance (if not a really good chance) that they would be causing the abortion of a fertilized egg (aka newly-formed human life, a baby).

I previously quoted Dr. Albert Mohler, president of The Southern Baptist Theological Seminary, when he wrote, "Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." (Can Christians Use Birth Control?) [emphasis mine]

It is this very same conclusion that has shaped my conscience regarding the issue of hormonal birth control methods--long before I even heard of Dr. Mohler. I cannot shake it off and pretend like it's not there. (I also tend to see all the various physical side effects of these technologies as a common grace to those who may not be motivated by things of the Lord, as these side effects could be a way to steer us away from the use of abortifacient technologies even if we don't know about or are not motivated by their moral implications.)

Randy Alcorn has written a very thorough booklet called Does the Birth Control Pill Cause Abortions? outlining the evidence that supports his conclusions. You can find it at http://www.epm.org/pdf/bcpill.pdf.

Also, you may refer to Amber's first post for additional articles discussing the various positions taken on this issue.

Next up... sterilization. In the meantime, please let us know what your experiences have been with hormonal technologies. Do you have any additional questions/comments/resources?