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Hey everybody, here's Chuck this week on a Saturday with a pretty relevant topic these days.
Who knew that it would be relevant again?
And this is from June 19, 2018.
How the pill changed the world.
I think you know what pill we're talking about.
Welcome to Stuff You Should Know, a production of iHeartRadio.
Hey, and welcome to the podcast.
I'm Josh Clark. There's Charles W.
Chuck Bryant. And there is the ghost of Jerry Rowland.
The empty chair. Thanks again to this.
Thanks again to Ramsey.
Yeah. Thanks, Ramsey.
How do I feel about this?
I feel great. The pill is, it has everything.
This might be I just love this episode already.
I do too. But I kind of like when we did the female puberty episode.
I just feel nervous.
It's gonna be fine.
Dude explaining female reproduction.
I just don't know. Hey man.
We're just, we're just explaining stuff.
I know. I know. It's not like we're, we're, we're just, we're just explaining stuff.
Just be cool. Alright, so let's talk the pill.
Yeah, the opposite of having kids.
The pharmaceutical's so famous that it's called the pill.
It is. I read this New Yorker article about a book on the birth of the pill.
And now I'm talking about it.
So everything comes full circle.
Yeah. And they were saying like there's like you don't call anything else the pill.
Like Viagra is not the pill.
It's the little blue pill.
Antibiotics isn't the pill.
You don't call it the vacuum or the meat grinder, right?
Like there's, there's really nothing like that.
Yeah. Nothing compares to it.
And that's, it's for good reason.
I mean the pill is monumentally huge as far as pharmaceuticals and medicine goes.
I mean, on the scale of antibiotics, easily.
Yeah. And it's, it's the very first medication that was designed for a non -therapeutic purpose too.
Yes. Very interesting.
And so it's really difficult to over, to overstate how much of an impact the pill had when they released it in the 1960s when it first came out.
Are we going to do history first?
Yeah. Let's do that.
So let me set the stage for you.
Please. Oh, you're bringing a couch out.
Back in, back in the day, I'm going to do my Charles Nelson Riley one man show impression.
Back in the day, if you were a woman and you didn't want to get pregnant, you had to coordinate with your husband that he wear a condom.
Okay? Sure. Or boyfriend.
Well, that's like a whole other kettle of fish at this time.
Yeah. Supposedly in socially that went on all the time.
Yeah. There's plenty of premarital sex, but socially speaking, only single men were allowed to have premarital sex, which is like who are they having premarital sex with that?
Right? If they're the only ones allowed to have premarital sex.
Considering, considering everyone refused to officially recognize homosexuality even existed.
Yeah, I know where you're getting.
Okay. So there's a lot of double standards, a lot of repression going on, but if you were, if you were a woman and you wanted to have sex, so whether it was with the guy you were having sex with or your husband, you, you basically had to say, you gotta wear a condom.
And if he said no, well, you were SOL one way or another.
Either you weren't having sex or you're going to have sex without a condom.
And if that happened, there was a really good chance that you were going to end up getting pregnant just from having sex.
Yeah. The ball was entirely in the man's court and women did not have much say in the matter.
No, they didn't. There were a couple of things on the market.
So before the industrial revolution, there were like folk remedies where you could use herbs and stuff like that.
Basically, I think they're called herbal douches where you're just like squeezing stuff in there and hoping, hoping for the best, right?
And then by the depression, there's something, there's a whole line of stuff called gynecological AIDS or feminine hygiene, I think is what it's called.
And some of them worked.
Some of them kind of worked.
Some of them didn't work.
Some of them worked, but would kill you or give you chemical burns.
Right. There was a lot of problems.
So you didn't have a lot of options.
Right? And then along with the fact that you, you actually didn't have that many options socially in 1950, 30 States in the federal government said, you can't have anything that, that can be used as a contraceptive and you can't even learn about it from your doctor or from school, 30 States in the federal
government, this is 1950.
10 years later, the pill comes out and a couple of years after that, 5 million American women are using it as a contraception.
Yeah. And they, now it was in their hands.
They had the ability to decide for themselves whether sex led to pregnancy or not.
Well, and sort of even then.
Right. Because not all States allowed it.
And not all doctors would give it out.
Right. So it wasn't like, oh, the FDA said it's good to go.
So we can all get it.
Right. It was still a fight.
Yeah. For years and years and decades.
It really was. So I guess we should start with a woman named Margaret Sanger.
She is a very controversial figure, a founder of Planned Parenthood.
She's a nurse. And she wrote in 1912 about a magic pill that could prevent conception.
Yeah, just a theoretical, hypothetical pill.
Right. And she's controversial for many reasons.
Not the leases, which is her.
She was anti -abortion, kind of when she was most famous.
She was anti -abortion and kind of went all in on the pill and was like, this is the way to do it is to prevent the pregnancy.
Once you're pregnant, sorry.
Well, gotcha. And then, you know, there's the whole eugenics thing.
We should do a podcast on her probably at some point.
We should, because that's a, that's a rabbit hole right there.
Yeah. So, but she was the early champion of it.
She was, she coined the term birth control in I think 1912 as well.
Yeah. So in 1914, she started a newsletter called The Woman Rebel.
That's where birth control was first typed out and distributed the words, like you said.
And then in the 1920s, some breakthroughs happen in science where they were able to identify a progesterone and estrogen and realize kind of how it all worked.
Yeah. So at first they were looking at this stuff as fertility drugs.
And then they noticed that it actually could suppress fertility.
And as they were, I think this is in the forties when they were really starting in earnest, or is it the twenties?
Well, I mean, they were synthesizing it from animals and it was in early 1941.
I don't think they were even synthesizing.
I think they were extracting it.
And then that's what you got in your pill was animal hormones.
Well, it says synthesized from animals.
So maybe it was a process.
Gotcha. But eventually in 1941, Dr.
Marker, Dr. Russell Marker, just like James Bond for some reason, he discovered how to synthesize the synthetic form of progesterone, which is called progestin.
And that really, this is from wild yams, believe it or not.
Yeah. So he did that and that changed everything.
It did. It made it cheaper.
It made it easier to obtain.
You could research all of a sudden.
Right. Yeah. But you still couldn't really research, right?
Because there were laws on even doing research on birth control.
So the people who were doing this, it started out as Margaret Sanger.
She hooked up with a doctor named Pincus, and Gregory Pincus, who was a biologist, and he was interested in coming up with birth control as well.
Mary McCormick, was her first name Mary?
Katherine, Katherine McCormick of the McCormick, I guess the spices.
Okay. So she, she lent a tremendous amount of her wealth to this, to this research.
And then a guy named John Rock, who was a doctor who was also working on a birth control pill.
They all joined forces in the 1950s and started working on this really hard, but they had a lot of roadblocks up against them and they cut a lot of corners and getting this thing out into market.
Yeah, like going to Puerto Rico too, because they had to for trials.
Right. And so this is not like Puerto Rico was like, we don't want this, but you're forcing it on us anyway.
Puerto Rico had the exact opposite attitudes toward birth control that the United States did at the time.
So it was a good place to do it.
They just didn't inform anybody what was going on with this, that this was a clinical trial.
They just gave them some pills and said, here, take these, it'll keep you from getting pregnant.
Yeah, which they kind of came about by accident.
Some of the pills were contaminated with estrogen.
And they use that in scare quotes, I guess, just because what they really mean is mixed by accident.
And that reduced a lot of the side effects, because that was one of the big problems at first and continue to be for a while.
And eventually they landed on a drug company called Cyril.
There were two competing ones.
The other one was Syntex and Cyril, is that how you pronounce it?
Cyril. Cyril? That's what I'm going with.
S E A R L E. Cyril.
I want to hear you say it again.
Cyril. They finally came up with, thought was the right formulation.
And in 1962, Syntex came out with their version.
And then pretty soon it was being marketed and distributed after FDA approval in 1961.
So yeah, so Cyril was the one who hooked up with Sanger and Rock.
Yeah. And they were the ones who provided the pills for the clinical trial in Puerto Rico.
There was also a clinical trial at Women's Mental Asylum in Massachusetts.
And the patients there didn't have any informed consent.
And when they released this formula, first it was for gynecological disorders, things like ovarian cysts.
They knew it could be used to treat that.
And Cyril at the time was like, they had no expectations for this whatsoever.
Yeah. And then within a year, there were half a million women in America who were suddenly using this for gynecological problems.
And Cyril figured out, well, no, they're actually using it for contraception.
Right. And so when they went and sought FDA approval and got it, that was when the floodgates opened.
Like there was now a pill on the market that could prevent contraception.
That was the woman's to take.
And all of a sudden, there was the first year there was 1 .2 million American women on the pill and Cyril at first thought, they're not going to want this.
Women aren't going to want to take a pill every day to keep from getting pregnant.
And they couldn't even finish the name pregnant before like the pills were being grabbed from their hands.
You know, it was a huge deal.
It was. And then these pills were not very safe.
That's the upshot of this.
The estrogen, there was way too much estrogen.
It was dangerous. It was causing cancer.
And in 1969, a very famous book came out called The Doctor's Case Against the Pill, written by a medical journalist named Barbara Seaman.
And she got together with a bunch of doctors and researchers and women and made a case against the pill that wasn't safe.
It was a senator named Gaylord Nelson, who read the book, took on birth control in Senate hearings.
And in January 1970, in the Senate chamber, there was this testimony about the pill going on, of course, run only by men, all the witnesses with only men testifying, providing witness testimony.
But there was a woman there named Alice Wolfson and her group, the DC Women's Liberation Group, they were sitting there just getting more and more steamed.
Yeah. In these hearings, at this time, these hearings were kind of under the radar.
Right. Until Alice Wolfson, like blew it up.
C -SPAN wasn't a thing yet.
Right. So they were just getting more and more steamed, watching all these men get up there and talking about women's reproductive health.
But not only that, they were also, these people were talking about how dangerous the side effects were with the pill.
Sure. Hypertension, blood clots, heart attacks, high blood pressure, stroke, all of these things.
And these, the women in the DC Women's Lib Movement, including Alice Wolfson were like, we've never heard this before in our lives.
How did our doctors not tell us this?
Well, that was the backstory is that none of the doctors were sharing this information because they were getting...
And I think there's always been a problem, not across the board, but with doctors in pharmaceutical companies, pushing certain drugs over others.
But at the time, it was way worse than it is now.
Oh, sure. So disclosure.
Yeah. There was a mentality among doctors, male doctors who believed that if you, a woman was better off not knowing, you didn't want to get her all upset by giving her all the information.
They didn't even have side effects listed.
Right. And if you did tell her you ran the risk since women were so suggestible, she might develop a stroke just by thinking about it so much.
So it was better off just not telling her about it.
Yeah, exactly. That was the entire medical establishment at the time.
Yeah. And so the pill went from this feminist icon in the sixties to by 1970 becoming an icon for white male patriarchy, medical patriarchy, and how patients informed consent was a paramount issue now.
And informed consent was literally born that day at that hearing.
They finally heard an expert say, estrogen is to cancer, what fertilizer is to wheat?
And Alice Wolfson stood up and started screaming.
She was screaming, why are you using women as guinea pigs?
Why are you letting drug companies murder us for profit and convenience?
And it got a lot of media attention.
And really, the aftermath of those hearings is when this consumer health movement started and they started informed consent, they started having to list side effects on bottles.
And, you know, it wasn't an overnight thing, but it really changed the pharmaceutical industry forever.
Right. So the pill managed to accept this, I guess iconography.
Yeah. It became a symbol for this other thing.
Yeah. But still managed to keep on keeping on like it, like I think 18, 87 % of women between 18 and 49 in the US followed those hearings once Alice Wolfson and the DC women's lib movement like made it a national thing.
And I think 18 % of them stopped taking the pill as a result, but the pill really didn't fall out of popularity.
It stood in as the as the icon for informed consent.
And then just as after that was established, it just went back to being the pill.
I think that's amazing.
It is because it was this huge thing in 1960 for one thing, huge thing in 1970 for another thing.
And now it's, it's, it's part of the cultural zeitgeist forever.
Should we take a break?
Yes. All right, we're gonna take a break.
We're all excited about history.
And now we're gonna get into science.
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Hey, let's talk menstrual cycles.
All right, let's, man.
Because that's all that's going on here is the pill manipulates the menstrual cycle by tricking the body with synthetic hormones.
Yes, it tricks the body into thinking it's already released an egg.
It's pretty brilliant.
It is, it is, but it's also kind of lo -fi if you think about it.
It is very lo -fi. It's neat.
So we should kind of give you an idea of what the menstrual cycle is, right?
It's 28 days. Generally.
Yes, that's the rule of thumb, but yes, it's certainly different for everyone.
Right. And I think it's also down to like hours and stuff like that too.
It's not just days.
It's a human construct, you know?
But have you stopped and ever thought about like how interesting it is that the cycle of the moon is like 28 days as well?
No, I think it's fascinating.
No, I didn't say it wouldn't pass.
I never stopped it.
I just think just in researching this, I was like, that's the cycle of the moon as well.
That's interesting.
So anyway, over the, say, roughly 28 day period, the whole thing starts with the pituitary gland getting a little froggy and saying, hey, I'm going to release some follicles stimulating hormone.
FSH. And that stuff floods the body and it makes its way down to the ovaries and it stimulates follicles, hence the name.
That's right. It makes these follicles and the ovaries grow and it just sets off a big series of events, basically.
Estrogen triggers that pituitary gland again.
Yeah, because the follicles then, in turn, release estrogen, right?
Yeah. And so the pituitary gland is busy because then it secretes what's called gonadotropin releasing hormone, G little n, big R, big H.
One of the better abbreviations ever.
Yeah, because it looks sort of like Guns N' Roses.
A little bit, yeah.
Oh, that is why I like that.
G and R, H. And that triggers a rise in luteinizing hormone, LH.
Right. And so luteinizing hormone goes back down to the ovarian follicles and it gets one of the follicles.
So if you have a bunch of ovarian follicles growing, one of them is going to clearly, it's the lead horse, right?
Yeah. It's going to develop into an egg.
And as the luteinizing hormone stimulates it to develop into an egg, the egg pops off, the rest of the other follicles wither and die, and then the egg travels down the fallopian tube.
Yeah. Where it may or may not be fertilized.
Yeah, this is called ovulation.
And while this is going on in the background, the uterine lining, the endometrium is thickening up.
Right. It's getting ready for business.
And the reason that is, is because the estrogen and the luteinizing hormone are causing that to happen.
Yeah, they're just rising and rising.
So the mucus in the vagina, I'm saying, oh, like even more than usual right now.
But the mucus in the vagina also, does it thicken?
Yeah. So it thickens.
Is that after the egg has been fertilized?
Because I think it would make it, it would become, okay, so it de -thickens, the uterine lining thickens.
I think the vaginal mucus makes it easier for sperm to make its way.
Yeah, yeah, correct.
Okay, sorry about that.
So if all that goes according to the genetic plan, then those sperm are going to make their way to an egg, the egg is going to become fertilized, it's going to come down the fallopian tube, attach to the uterus, and it's going to start to grow into a child.
Correct. It might also not happen either.
The woman involved might not have sex, so there might be no sperm.
The sperm might not make it, there might be some sort of barrier method being made.
Yeah, or the dude may have bad sperm.
Sure. Regardless of how this happens, if the egg is not fertilized, the egg eventually withers up itself and dissolves.
And that thickened endometrium is shed, basically.
Yeah, the uterine lining is shed.
Yes. So when that happens, like kind of iron -rich blood tissue.
Right. Okay. That is menstruation.
That's menstruation.
So when you think of, but that's your period.
Yeah. The whole thing's menstruation.
Well, yeah. Okay. It's like a 28 day cycle is menstruation.
Okay. Because I always think of like, yeah, the period's menstruation.
Right. No, that's actually the end of menstruation.
Right. And then the whole cycle begins again.
Right after that time, the pituitary glands like, oh, all right, I'll release some follicle stimulating hormone.
The whole thing begins again.
The pill interrupts this by making the body think it's already released an egg.
Like when the egg comes off of the follicle and makes its way down to the fallopian tube, the ovum makes its way down the fallopian tube.
That's when the estrogen and the progesterone levels are high.
Okay. So the pill introduces progesterone and estrogen levels and keeps them high at all times.
And therefore the body stops releasing eggs because it thinks it's already released an egg.
Yeah. Just hijacks that whole process.
Right. Synthetically.
Yep. The woman's body is amazing.
It is. When you think about all that's going on.
Yeah. Our body's not doing anything even remotely like that.
It's making like farts.
That's what I thought.
When I was researching this, I was like, man, I've never felt less important.
Yeah. And like the insides of my body are just, I got some lungs doing some things.
I got a heart. And then like, I guess I'm still making sperm.
I don't even know. I've got like a wheezy old donkey running the show in there.
Kind of dirty. Oh goodness.
So the endometrium still builds up in the uterus and is released, but it's known as a withdrawal period.
So this is if you're on the pill.
But that's why your period while on the pill is going to be generally lighter and shorter.
Yeah. And so technically this, the pill mimics the structure called the corpus luteum.
Yes. Which is the thing that releases progesterone and estrogen once an egg is released.
So the body's like, oh, the corpus luteum's got it going on.
I don't need to release another egg.
I also am not going to have a period because during this time after the pill, those hormone levels start to become like a normal baseline in the woman's body.
There's no endometrium that builds up and therefore there's no endometrium to shed.
Right. And I don't think we mentioned this yet.
Progestin, which is the synthetic progesterone.
Right. It's going to make that vaginal mucus thicker.
So you were right earlier, it is thinner to make the sperm make it excess the eggs easier.
It will thicken it up that mucus to make it harder for the sperm.
So it's I think it's just sort of like a one, two punch to make it even harder to get pregnant.
Although you can still get pregnant usually due to misuse of the pill because what you do is you take the pill at the same time every day.
It's all very synchronous and depends on that timing.
And if you don't time it outright, your chances are getting pregnant or a little bit more.
But apparently if you're taking it exactly right at the same time, then your failure rate is going to be 0 .3%.
Right. So it's still technically possible.
Yes, it is 0 .3 % possible, which offers up the question like why, like when they were developing the pill, they had it completely in their control as to what they wanted to do with the menstrual cycle.
And they decided, and I never knew this, I didn't very interesting.
They decided to keep it on that 28 day cycle.
Because for a lot of reasons, they thought that the rock thought the Catholic Church because he was a Catholic, they might be more willing to approve it, if it seemed more natural, he was way off there.
They thought way off.
He thought that women would be more apt to take it if it didn't seem like it was disrupting things too much.
Yeah, I'm still in my regular cycle.
Right. Because you do have that withdrawal period.
It's not an actual real period, but it does come at the end of that, the pill cycle.
Yeah, but they could have gotten rid of the period altogether.
Right. And a lot of people are like, well, go do that.
And there are pills on the market that we'll talk about that do take away women's periods.
There's others that put them at different like spaces that amount like, like four times a year or something like that.
And people started looking into this and they're like, well, wait a minute, like, shouldn't women be having periods?
And the answer is not necessarily.
Right. Yeah. I mean, it's controversial.
Like if you're not ovulating, you technically don't have to have a period.
And this Molly Edmonds wrote this really interesting pill.
Old Molly article. Yeah.
Like is a period necessary, I think is what it's called.
And women today have many more periods than our ancestors.
Right. Something on the order of like 450 periods over the average woman's lifetime.
Yeah, about three times as many as our ancestors.
Yeah. So like back in like hunter gatherer pre pre pre agricultural women had about 160 or something.
Right. And that was because they had more kids.
They breastfed longer.
They didn't live as long.
Yeah. And so some people make the point like, well, women are having more more periods than ever before.
And the body wasn't meant for this.
It's actually kind of rough on the body to have a period.
Like when the the ovum pops off of the fallopian tube, it leaves a scar on the ovary.
Yeah. And that scar has to be repaired.
And to repair the cells in the ovary have to divide.
And as long as they divide correctly, that that damage will be repaired.
If they divide incorrectly, that damage can turn into ovarian cancer.
So that's, that's a that's a problem with it.
There's also scarring with endo shedding of the endometrium, like actually having your period itself can leave scarring.
Same deal, right? Yeah.
And I think doesn't iron deficiency come into play.
So that's actually a benefit of having a period.
Oh, is it? You get rid of excess iron, which can lead to cardiovascular disease.
Well, and there are a couple of weeks during the menstrual cycle where women have a lot, a significant reduction in blood pressure.
So during the years, you know, their reproductive years, at least, they are at, I guess, a slightly lower risk of stroke and heart attack.
I think like 10 % lower.
Yeah. Well, that's not bad.
No, no. So there's pros and there's cons to having a period.
The thing is, this is what Molly ultimately points out is we actually don't know if a period is necessary.
Like the pill is still relatively new.
And I think there she quoted a doctor in there, Dr.
Susan Rothko, I think, or Roko.
And she called the, the pill that does away with periods entirely the greatest unregulated medical experiment of all time.
Yeah. And she, she makes a chilling point.
Like we don't really know what the side effects are yet because all of this is too new, especially the pill that, that does away with the period altogether.
Well, yeah. And they haven't done, there are no longterm studies of menstrual suppression from oral contraceptives, at least.
They don't know about what that means for a woman.
They don't know because most of this testing is done for women over 18.
So they don't know what it means for women under 18 at all because they're just not involved in the research.
Even though they do have research that shows about two thirds of women would get rid of their period if they could do so safely.
Because I mean, we haven't even mentioned PMS or PPMD, which is just, isn't that like a really, really severe form of PMS?
Yes. It's like much worse.
Yeah. Yeah. But whereas like PMS is not a picnic to begin with.
Sure. This is, this is like go to the hospital bad.
Right. Yeah. Can be at least.
Yeah. So yeah, that's really interesting to think about.
It also treats ovarian cysts.
There's other uses for, for birth control pills too.
Yeah. You want to take another break and get back to it?
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This is Tracy V. Wilson from stuff you missed in history class.
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Yeah, and that's why this story is so important.
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You get the picture and you know what?
I think that's fascinating.
It doesn't matter what you do for a living these days.
You need to be connected.
Yeah. And now the big part, this isn't just a Kentucky story.
AT &T is on track to cover more than 30 million locations with fiber by the end of 2025.
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Okay, Chuck, where are we?
Oh, we were talking about...
I'm over here hanging on this cliff by my fingernails.
I think you're doing great.
Isn't he doing great, everybody?
Yes. No. So remember, so there are side effects both positive and negative to taking the pill.
There's some very common negative side effects like nausea is a big one, weight gain, spotting, which is called breakthrough menstruation, which is where you have bleeding during the actual pill cycle, not the prescribed period cycle of the pill.
Yeah, and I don't think we mentioned yet either that in the pill prescription, in that monthly dose, there are seven, not always, but the way they designed it was there are seven placebo pills that are in there because you only take the pill for 21 days a month, but they put those extra seven pills
in there to keep women on that.
I guess the thinking was if they're used to taking this pill every day, they need to keep doing it.
They keep it as a habit.
Yeah, if they don't for seven days, they might forget on the eighth day, and that's bad news.
Yeah, so that's the most common way to do it, and that's a very easy type of pill to take, right?
Because all of them are the same level of hormone, and the seven inert ones are usually different color, and they come at the end of the month.
It's supposed to be easy.
There's actually a recall right now of Tetula.
Did you see that? No.
Tetula is made up by Allergan, I think, and they recalled a lot of their pills because they put the inert ones at the beginning of the cycle accidentally.
Just bad packaging?
Yes. Oh my gosh. And if you look, you can clearly see that the first, like, seven are different color, but where they're supposed to be at the end, they're at the beginning, and that is bad news if you're taking that pill.
So if you have Tetula, go check it right now and go get some more.
Yeah, but I think it interrupted you on the side effects.
Nausea, headaches, breast soreness, acne, depression, moodiness, weight gain, decreased libido, and sometimes these can be, like, if you start out on the pill, it can be worse.
A few cycles in, it might get better, and if it doesn't, there are different pills out there.
There are. So when those pills originally came out, that first formula, I think it was called, like, Enovid?
That was the first one on the market.
The first one by Searle.
Searle. And they had 10 milligrams of progesterone or progestin, and 0 .15 milligrams of estrogen, and that is, like, a nuclear bomb pill.
Women had the worst side effects from it, like, all these side effects, like, each of them a Mack truck, and they were still willing to go through it to, like, have control of their body as far as pregnancy went, but they very quickly figured out, through further research, you can do the same job, and the reason they
selected that is, like, they knew that there was not going to be any ovulation with 10 milligrams of progesterone, and so they figured out that you could formulate with a much lower amount of both progestin and estrogen and still get the job done, and they still do that today.
I think the estrogen gets down into the micrograms, and you can get, like, 2 .5 milligrams of progesterone in some forms of the pill, and then if, so if the pill is mistreating you, what you're saying is there options, right?
Well, yeah, there are three main types of oral, did I say kypes?
I think I did. You also said zero.
There are three main types of the oral contraceptive pills now.
Combination pills, progestin only, and extended release, which are the newest ones out there.
The combination pill is the most common pill that you will get.
The mini pill is the progestin only, and for some women that's better, like, if you're breastfeeding and you can't have the estrogen, like, this is going to affect your milk, you'll probably be on the mini pill, and the mini pill, peel, it works in a couple of different ways.
It makes the endometrium too thin to accept that egg, and it won't allow it to attach.
And again, with the vaginal mucus, it makes it too thick to allow the sperm to reach the egg, but it is a little less effective, but still effective, but a little less than the combination pill.
Because it's almost like a different, there are different mechanisms.
Yeah, like, it's 28 active pills for the mini pill.
Right, but rather than tricking the body into thinking it's released an egg, this is just making it hard to get pregnant.
Yes, exactly. It's almost like a different kind of pill.
And then there's, what's the other kind?
Well, the combination pill, the most common, there's a few subtypes of that pill as well.
Right, so there's monophasic, which is what I was talking about, where you've got 21 pills, and all of them are the same dose of progestin and estrogen, and then you've got the seven inert pills.
And some women say, I'm not going to have a period this month.
And then you just, rather than taking those seven inert pills, you just move on to the next month's 21 pills.
Yes, and I believe with the monophasic, if you miss a day, you can double up the next day.
Because it's the same amount of pills, or the same level of hormones, right?
So yeah, that's far and away the most common.
There's biphasic, which has two different levels of hormones, and then triphasic has three different levels.
And the point of biphasic and triphasic is they're designed to give you the absolute minimum amount of synthetic hormones that your body requires to keep from ovulating.
Because the point is, the lower the amount of hormones you have in there, probably the better off you are, whether it's cancer risk, moodiness, who knows?
You're just better off with the least amount that does the trick.
Yeah, and the kind of progestin in each of these is going to vary, but the type of synthetic estrogen is the same.
It's called ethanol estradiol.
Eric, estradiol. That's it.
Ethanol estradiol. Yeah, but the progestin is the thing that differs sometimes, right?
Correct. And depending if you're on a pill that uses one type of progestin, you can say, oh, I want to try a different type of progestin.
And then they'll say, here you go.
And then the extended cycle, which we talked about, this is the newest one on the market.
And I believe, isn't this the one that can reduce your period to, like, four times a year?
Yeah. So there's a couple of different, there's seasonale and seasonique, and they're called that because that four -time -a -year period, you'll just be like, oh, it's fall.
Oh, it's summer. Right.
Not in that order, but you know what I'm saying.
And then there's Librel, and I'm sure there's other ones on the market, too.
We don't mean to buzz market or anything like that.
So there's one that's like 365 days, and then there's others that are 84 days so that you have either no periods at all or four periods a year.
Right. So there you go.
So there's a couple of other things I want to hit on.
The pill is, it's so much larger than just birth control.
Sure. I mean, just the fact that it's birth control is an enormous thing.
Like you said, John Rock thought he was going to be able to convince the Catholic Church that this is an okay thing.
Yeah. That was not the case.
In the late 60s, the black power movement really zeroed in on the pill, especially the men of the black power movement, and said, this is tantamount to black genocide.
And they definitely had a case.
There were plenty of cases of black women who went into hospitals and gave birth and then came out unknowingly sterilized.
Like the doctor had just taken it upon himself to sterilize her after delivering her baby.
Yeah. So they had this evidence to back this up, and it was never shown like, yes, there was a conspiracy to wipe out black power in America through the pill.
But there were plenty of black women at the time who said like, yeah, I can get birth control pills easier than anything down at the corner clinic or something like that.
And even with the early trials, from John Rock and Gregory Pincus, like one of the things that they zeroed in on Puerto Rico for was because they thought that if they could show that backwards Puerto Ricans of color could learn how to take the pill regularly, it would demonstrate that women in the inner
cities could, or women in developing countries could.
So there was definitely like a mentality toward the white establishment being on board with the idea of at least providing the tools for minorities to control their rate of birth.
It's just pure and simple.
That was a thought of it.
It was, and it's had tremendous amount of benefits too, but there was some darkness in the place that it originally came from as well.
Well, yeah, and of course, anti -abortion groups think that the pill still to this day is an abortion -causing agent, what they call in, do you know how to pronounce that?
Abortifashion? Abortifashion?
I think so. Yeah, I think that's right.
Which, you know, that's that's long been their argument.
Well, their argument is that it makes the uterus hostile to a fertilized egg, like prolonged use would prevent a fertilized egg that would otherwise attach from attaching.
And so that's for all intents and purposes, abortion in their position.
Right. And yeah, that is, I don't think that one settled by any stretch of the imagination.
So you got anything else?
I got nothing else.
As I predicted, this is a good one.
I think it was good.
I think it was great.
I hope he did all right.
Yeah, because we're not like patronizing.
We've never been patronizing.
We might be like white dudes, but we're very much aware that we're white dudes.
And let me leave you with this white dude.
If you're a white dude, whether it's in America or the West or anywhere, your one job is to have some perspective.
That's your first and foremost job.
Take yourself out of your own shoes once in a while, look around, put yourself in other people's shoes.
Your eyes will open widely in a GOG.
Some say walk a mile.
Sure. Why not get a little weight off, right?
At least go check the mail.
If you want to know more about the pill, just type in the pill.
It'll bring up some cool stuff on howstuffworks .com.
And there's also a really great American experience site on PBS that had a bell.
Oh, man, that was good.
Yeah. So good. And since I said American experience, and Chuck said, so good, it's time for listener mail.
Oh, no, it's not, no listener mail today, because we've had some milestones here lately.
And as we sit here today in real time, we as a company are celebrating the 10 year anniversary of stuff you should know again, again.
But we're actually having the party today.
And on the same day, Apple announced at their WDCC, yeah, their developers conference, got up on stage and this one kind of hit me.
Like we had the thousand episodes, that was good.
The 10 years kind of hit me in a big way.
But they got up on stage today and they said that stuff you should know is now the first podcast in history, first and only to reach 500 million downloads and streams on their platform.
Yeah, which is I didn't know.
No, it hit me too. Somehow.
Adam Caroll is in the Guinness Book of World Records.
Right. But here we are.
Yeah, as the only one.
And that's because of you all out there.
Yes. A gazillion times.
But without you, there is no us.
We would have been long gone, if not for your support.
So we continue to give thanks.
Thank you again. Yeah.
We will continue to give thanks.
And we will continue to podcast.
Yes, we will, Chuck.
Yes, we will. And that's all I got.
If you want to get in touch with us, you can send us all an email to stuff podcast at howstuffworks .com and as always to us that are extraordinarily grateful home on the web, stuff you should know.
Stuff you should know is a production of I heart radio for more podcasts, my heart radio, visit the heart radio app apple podcasts or wherever you listen to your favorite shows.
This is Tracy V. Wilson from stuff you missed in history class.
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