"For fifteen years, women are turning away from the pill more and more, tired of suffering the side effects of this powerful drug (...) Faced with this disaffection, some are shouting back, but it is becoming difficult to ignore the effects of hormonal contraception: a first-class carcinogen, endocrine disruptor and true chemical castration, its effects on women, their children and the environment are extremely worrying ".

These claims are taken from the book by independent journalist Sabrina Debusquat, "J'arrête la pule", published on September 13, 2017.

A work and remarks shock challenged by many health professionals. At the editorial desk, we tried to unravel the true and the false about what has long been considered a symbol of women's emancipation and sexual freedom.

To do this, Geneviève Plu-Bureau, Gynecologist at the Cochin-Port-Royal Hospital in Paris, Professor of Medical Gynecology at Paris V University and Isabelle Derrendinger, Councilor at the National Council of the College of Midwives and Director of the school of midwives of Nantes, have agreed to decrypt with us the big accusations that weigh on the pill today.

MC: In 2010, 40.8% of French women took the pill, today they are only 33.2%. Do you think that the case of 3rd and 4th generation pills has changed women's view of this mode of contraception?

Geneviève Plu-Bureau: "I think it's more of an awareness of contraceptive diversity, and women are turning more to LARCs (IUDs and implants) because they are very effective."

The problem with the pill is that it can be forgotten while other methods do not require a daily dose.

Isabelle Derrendinger : " Without doubt the 'scandal' of pills has made other forms of contraception more popular and it has been the 'gateway' to this distrust, but behind it there is also a rejection of the device. But we can not say that there is a total 'disenchantment' of women for the pill because it is still popular. "

Mistrust of the pill could, therefore, partly be linked to the refusal to ingest hormones?

Isabelle Derrendinger : " Yes, certainly, there is a general expectation of women to be less exposed to hormones and many say they do not want it, both through an IUD and oral contraception.

Those who refuse have two main reasons: the fear of personal risks of exposure to hormones and an eco-citizen position of not wanting to disseminate hormones in nature via urine. "

We hear more and more about alternative methods of contraception called "natural" (observation of the cervical mucus coupled with the taking of temperature for example). Is this worrying?

Geneviève Plu-Bureau: "Even if we see a recrudescence of this choice on social networks and forums, in practice, no, and the figures of the Health Barometer 2016 * prove it because only 4.6% use it . "

The danger is that the craze for natural methods perceived on the Internet tends to increase and that eventually there will be more voluntary interruptions of pregnancy.

Isabelle Derrendinger : " The methods themselves are not dangerous because they bring nothing in terms of products in the body.They are more exposed to a pregnancy.What you need to know is that there are complexities For example, when one is sick and has a fever, it is difficult to have reliable figures when taking temperature and they are not suitable for all women.

Those who work at night for example or who make bearings will not always be in the same conditions every day. The observation of the cervical mucus imposes a certain rigor. But just like the pill, which also has to be taken at regular times. Apart from the IUDs and the implant, which, once put down, do not impose particular vigilance, any contraception, whatever it is, involves constraints. "

How could information and support on contraception be improved?

Isabelle Derrendinger : " As caregivers, we have a posture that needs to be changed, and we always talk about contraception as if it were an end in itself by asking questions like, 'What method do you want?' it seems to me that we are mistaken.

The ones we should ask are: 'Do you accept that we are talking about your sexuality? How is she today? How do you envision it? ' The answer will then be much more suitable than saying 'You take this pill, is it right for you? Would you like to continue with her? We must have a different approach. So I think that it is not a contraceptive consultation that needs to be done, but a consultation on education for sexual and educational life that would make it possible to assess the perimeter of women's sexuality and their real needs.

They do not all have the same concerns: some have just given birth, have a desire for pregnancy (or not), one at 20 and is homosexual, the other 40 and she is heterosexual ... He does not There is no standardized system. The only norm is the one defined by the woman.

If on the other hand we continue to address contraception through the contraceptive, I'm afraid that we are in a mapping type: 'You want hormonal contraception or not? Hormonal? IUD? Pill ?'. Certainly, we will have presented to the patient the entire contraceptive panel made available in France today, but not necessarily met his needs.

Infertility, mood disorders ... Does the pill have a real impact on these pathologies?

Geneviève Plu-Bureau: " It is impossible to make a global synthesis on mood disorders and the pill - there are so many studies going in one direction and others in the other. This is a reflection of what we see in the cabinets: there are patients who support well, others who will see their mood disorders improved, others who will To see them get worse, you have to talk to the patient to see if everything is fine. "

"And it's totally wrong to think that the longer you take the pill for many years, the more likely you are to become sterile."

In her book "I stop the pill", Sabrina Debusquat argues that the pill is an endocrine disruptor, is this the case?

Isabelle Derrendinger : " The pill is an alliance of hormones that must have the least impact on health while having an impact on fertilization, so it is not a totally natural mechanism.

I would not use the term 'endocrine disruptor', but in the sense that it will change the hormonal context of the woman, yes, it will disrupt her own hormonal cycle to allow her not to have a pregnancy if she does not. do not desire. "

"The role of hormones seems essential in the development of breast cancer": this quote from the book by Sabrina Debusquat is from one of your books Dr. Plu-Bureau. What else can you tell us about this?

Geneviève Plu-Bureau: "It is a hormone-dependent disease, so obviously, the hormones are involved, but taking this quote and transferring it to the pill is dishonesty.There are plenty of hormonal diseases For example, there is more lupus in women.This has absolutely nothing to do with contraception.Nothing at all.

And to say that the pill does not protect women against certain cancers is completely wrong. "

There are proven benefits to ovarian, endometrial and colon cancer.

"On the ovary for example, many studies show that it reduces the risk of 50%, it's huge.

In this book, we talk a lot about risks, but not about profits. When prescribing contraceptives or hormonal treatments one always evaluates the benefit-risk balance. Women must be aware that it is impossible to have only profits, there are always risks. "

" Today, we have more women who will die because of their pill each year, than domestic violence," said the author in a video produced by the media "Brut". What do you think of this statement?

Isabelle Derrendinger : " It's shocking and unsuitable".

How can violence between women who are killed, who is being abused, and a contraceptive be linked?

"With contraception, they decide not to have children, they are actresses, they are victims of violence, it is a causal relationship that I do not endorse.

By putting forward what she believes to be truths to destroy so-called false truths, she creates them herself. A woman who does not wish to have a pregnancy but who has read her writing and will reject a method of contraception, may become pregnant and lead an unwanted pregnancy or abortion.

With biased writing, I think it generates more risks than benefits for women. "

* https://inpes.santepubliquefrance.fr/CFESBases/catalogue/pdf/1806.pdf