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Hormonal Contraception

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The oral contraceptive, used by more than 100 million women worldwide, is the ultimate endocrine disruptor. The Combined Oral Contraceptive Pill (COCP), often referred to as the birth-control pill, or simply "the Pill", is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal female fertility. Combined oral contraceptive pills were developed to prevent ovulation by suppressing the release of gonadotropins. Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as their primary mechanism of action.

They were first approved for contraceptive use in the United States in 1960. On May 9, 1960, the FDA announced it would approve Enovid 10 mg for contraceptive use. When it was approved on June 23, 1960, Enovid 10 mg had been in general use for three years during which time, by at least half a million women (a conservative estimate). The first published case report of a blood clot and pulmonary embolism in a woman in the US using Enovid at a dose of 20 mg/day did not appear until November 1961, four years after its approval. By this time, Enovid had been used by over one million women. It would take almost a decade of epidemiological studies to conclusively establish an increased risk of venous thrombosis (blood clots in veins) in oral contraceptive users, as well as an increased risk of stroke and myocardial infarction in oral contraceptive users who smoke or have high blood pressure or other cardiovascular or cerebrovascular risk factors.

Environmental impact
Human excretion in urine and feces of the natural estrogens estrone and estradiol and the synthetic estrogen ethinylestradiol by women using COCPs are likely to play a role in causing endocrine disruption in wild fish populations in some segments of streams contaminated by treated sewage effluents.

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