A survey conducted by Consumers Association of Penang on oral contraceptive pills showed that they were easily and freely available at pharmacies. These drugs are controlled by the Poisons Act 1952, which requires the seller to record their sales in a register called Poisons Book kept by the pharmacy. The easy availability of these drugs over the counter without the registration of the buyer's details makes a mockery of the Poisons Act. The law is openly flouted by pharmacies in Penang and a grocery shop in Kulim, Kedah. An earlier survey also found such pills being sold in the Chow Kit area in KL and in grocery shops in other rural areas.
It is frightening that the health authorities are unaware of this situation as the easy availability of these pills shows their very inept enforcement. As a result, thousands of Malaysian women may be suffering in silence from adverse health effects due to ignorance of the dangers that these drugs pose and the ineffective laws.
In a survey of 15 outlets, oral contraceptives were sold over the counter (without registration of the buyer's details in the Poisons Book) in 14 pharmacies. Only in 1 pharmacy, the buyer was asked to register herself but the authenticity of the buyer's details was not verified. This means that fake details can be entered into the Poisons Book. Of the 14 outlets, only 5 of the pharmacies asked some questions, but ultimately sold the pills. A male buyer was also able to get the pills from some pharmacies. He could buy it for the use of others.
The pharmacies surveyed were located in Penang. They were near schools, near a university, in shopping complexes and in residential areas.
A number of contraceptives were sold in loose strips with no drug information on the use, contraindications or side-effects given to the buyer.
The prices of the pills were marked up in some cases. For a same brand of pills, the price ranged from RM4.80-RM6.50. We also purchased an emergency contraceptive (2 pills) for RM3.50. Across the different brands, the prices of the contraceptive pills surveyed ranged from RM4.80-RM23.00. Some pharmacies allowed the pills to be sold cheaper when the buyer bargained for a better price.
The easy availability of these pills allows the dangerous abuse and misuse of the pills by Malaysian women. These drugs need to be dispensed under a doctor's supervision due to its dangers and long-term effects.
The pills, besides being used a contraceptive, is used for other off-label uses like for postponing periods. According to the survey reports, Malaysian girls seek online consultation for postponing their periods to prepare for university exams, or to visit their hometowns during religious, social and family functions as they do not want to be left out. The pills are often used by women during Ramadhan and when they go to perform the Haj.
According to a drug insert, the pills should not be used in the presence of any of the following conditions, including pregnancy, cardiovascular disorders, cerebrovascular disorders, hypertension, diabetes, obesity, anaemia, cancer and many more.
Taking synthetic hormones as in contraceptive pills to control the ovulation process, is suppressing the natural process of ovulation. This can disrupt the natural process of reproduction in women, causing pain, discomfort, change in moods and depression, and further creating reproductive problems for the woman who may later want to bear children.
The adverse effects of these pills are many and they include depression, breast lumps, heavy vaginal bleeding between periods, hypertension, high cholesterol, blood clot in the leg, chest pains, signs of liver damage, signs of stroke and others. Many of these serious adverse effects can be attributed to the estrogen content of birth control pills.
The effects of these oral contraceptive pills on a woman's reproductive cycle is like binding a child who is naturally active and full of enthusiasm, which will lead to a dramatic counterproductive reaction. Similarly the normal ovulating egg which is inhibited, will in the process, change the normal bodily and reproductive functions, and alter the woman's moods and psychological state.
In a typical female monthly reproductive cycle of 27-29 days, there are 7 days of menstruation, 8-10 days of ovulation, and 10-11 days of premenstrual syndrome. With all these, she is left with only 5 good days without any stress of pain from her cycle. The pain and distress in the reproductive cycle is common among all women but are aggravated by the pills which are trying to control the ovulation process. The use and misuse of these pills can totally disturb a woman's reproductive cycle and leave her body altered.
The hazards associated with contraceptive pills and the reproductive cycle:
• PMS(PMT) – Premenstrual Syndrome also known as Premenstrual Tension
• Ovulatory pain – Pain during the ovulation period
• Dysmenorrhea – pain during menstruation
• Menorrhagia – Disturbed menstrual bleeding
PMS (PMT) – Premenstrual Syndrome/ remenstrual Tension
Premenstrual syndrome (PMS), also known as Premenstrual Tension, relates to the changes of physical or emotional symptoms like serious crimpy pain, associated with engorged vein of the lower limbs, congestion of breasts, vomiting, nausea, depression and the increased sensitivity to sound and smell. These symptoms occur before a woman starts her monthly menstrual cycle, which could be about 5-11 days prior to the release of menses. The symptoms usually stop when menstruation begins, or shortly thereafter.
Ovulatory pain – Pain during ovulation
This pain occurs between the 11th and 17th day of the menstrual cycle and is associated with white discharge and pain radiating towards the thighs and also towards the lower base of the pelvic region. This is caused by the suppression of ovulation by the drug LEVONORGESTREL along with ETHINYLESTRADIOL for contraception.
Dysmenorrhea – pain during menstruation
Pain during menstruation is often accompanied with vomiting, nausea and irritation. The pain radiates from the lower abdomen towards the back and moves down the thigh and causes stiff legs.
Menorrhagia – Disturbed menstrual bleeding
Increased menstrual bleeding, often bleeding with clots and also with severe pain.
NOTE: These conditions may occur in about 80% of women but taking contraceptive pills or misuse of these pills for off-label uses will make the conditions worse.
– The existing law, the Poisons Act 1952, in relation to contraceptives is totally meaningless as it has failed to protect women's health, and in the process, puts their reproductive health in jeopardy. Over-the-counter sale of contraceptive pills has to be stopped and the use of these pills needs to put under a doctor's prescription and supervision. New laws are needed to replace the existing ones.
– A campaign should be launched to educate women on the dangers and misuse of contraceptive pills and how they affect women's health and their reproductive system. Young women should be educated on how their reproductive cycles wok in relation to their health.
– Women should be educated on other safer contraception methods which pose fewer dangers to their health.
– Men should play their part in contraception and the protection of women's health. Condoms, coitus interruptus and vasectomies should be used. In Thailand, vasectomies are encouraged by both the Government and private sector. In 1984, 164,511 vasectomies were carried out there. The onus of contraception should not be placed on women alone. The concern should be shared to ensure the good quality of life of women and to ensure healthy mothers and offsprings.
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