Routine control of oral contraceptive users: a new ‘standard’ in The Netherlands

Abstract

Oral contraceptives ('the pill') have since the slXtIes assured themselves of a durable place in society. The general practitioner has from the start played a central role in maintaining proper control of women using this method of contraception [1]. It is doubtful whether users of any other form of medication have been investigated to systematically and on so large a scale. In the United Kingdom general practice has since the introduction of the 'pill' also been a source of study of adverse reactions [2]. The historical development of the health checks of users of the 'pill' is a fascinating one. Not surprisingly, a form of 'protocol' for this work emerged early, though not under that name: it was simply known as 'pill control'. As generally practised it comprised the taking of the woman's history and the performance of an extensive physical examination, to detect any possible contraindications before starting use of oral contraception. This was followed by half-yearly follow-up to trace adverse reactions, but also to record blood pressure and inspection of the portio uteri and for vaginal palpation and to test urine for glycosuria. At a later period regular examination of a cervical smear was added to the routine. It would go beyond the scope of the present paper to try and determine why, with the acquisition of this new role in providing health checks for users of the 'pill', general practice succeeded so well not only in achieving but also in applying a consensus as to its duties, something which has hardly proved possible in other areas of general practice. In fact, it soon became clear that adverse reactions to oral contraception were relatively limited. The preoccupation of the control routines with the genital system also proved to be inappropriate [4,5], since the major side effects turned out to be cardiovascular in nature [2,6]. The arrival of the 'sub-50' pill (i.e. with a much reduced dose of oestrogen) and the development of other methods of fertility control, such as sterilization, has probably further reduced the significance of this