A hard pill to swallow

'Within a day, I had actually turned grey. I couldn't breathe'

Women who claim they nearly died from the side-effects of the Pill are suing doctors and manufacturers for negligence.

Last summer Jill Nolan (not her real name) was a fit young woman. A mother and a partner in a family business, she enjoyed good health and led an active life. In October, she nearly died of a heart attack. Jill is only now beginning to recover. She has panic attacks and will be on medication for the rest of her life. She is frightened to exercise. And she believes it is all because, last June, her doctor put her on the Pill.

Three million women in this country take the contraceptive pill. For most of them it is perfectly safe. But every year between 15 and 20 women die from side-effects, and the health of many more, like Jill Nolan, is ruined. More than 50 such women are now taking action against the manufacturers of the Pill and their doctors who prescribed it to them.

The Pill is no stranger to controversy. Feminists have credited it with engineering the great sexual revolution of modern times, while conservatives have cursed it for spawning a promiscuous and permissive society. In fact, the Pill was originally designed as an instrument of racist population control by a post-war white America increasingly alarmed by Third World population growth. When the first Pill was ready to be tested in 1954, it was on poor Puerto Rican women that experiments were conducted.

In 1960, the US government licensed the first Pill, Enovid, despite appalling side-effects: nausea, headaches, cervical disfigurement. Two years later, despite 132 recorded cases of thrombosis and three deaths, the British government followed suit. Unsurprisingly, a backlash emerged in the Seventies, as women suffered worse side-effects and grew distrustful of the supposed wonder drug. But dramatic improvements were made, and the public image of the Pill has been transformed. By 1991, some 200 million women worldwide had taken the Pill.

The women taking legal action today did not take crude early forms of the Pill back in the 1960s; they are young women on sophisticated, low- dosage pills in the 1990s. Most developed blood clots on the lungs or suffered heart attacks, while others developed liver cancer. Many are permanently disabled and most are on medication for the rest of their lives.

The legal campaign was prompted by the death last December of Beverley Marsh, 21, of a heart attack. Consultant Dr Gordon Jackson told the inquest: "I think she would still be here now if she had not been on the Pill." The coroner, Sir Montague Levine, made a formal plea to Pill manufacturers to put clear and bold warnings of possible side-effects on the packets, instead of in small print in accompanying leaflets. He recorded an open verdict.

It was Sir Montague's plea which attracted publicity and alerted Nina Roland, a Liverpool solicitor, to the problem. She appealed to women who had experienced difficulties on the Pill to come forward, and has been overwhelmed at the response. "Hundreds of women have approached us, and we're getting more inquiries every day," she says. "I was astonished." One of them was Jill Nolan, from Liverpool, who went on the Pill last June at the age of 36. She did not drink or smoke and was not overweight.

"I kept asking them if it would be suitable for me, and they said, 'It's a low dosage, it's fine'," she recalls. She was prescribed Noriday, but within weeks found herself getting breathless. For three months she suffered acute breathing problems, but her doctor gave her tablets for a chest infection and assured her it was just a cold.

"Then suddenly, out of the blue in October, I absolutely collapsed. I turned grey, I was sick and I passed out. I was in a terrible state. My husband couldn't find a pulse." She was rushed to a medical centre where they ran an ECG, but found no traces of a heart attack and sent her home.

"I felt like I had 'flu. I was walking around in a daze. Five days later, I got the violent pains again." Again, her doctor diagnosed a chest infection and prescribed more antibiotics.

"Within a day I had actually turned grey. I couldn't breathe. I was admitted to hospital, and by day three they told me I had had a heart attack, caused by a blood clot. I was devastated. None of the doctors had thought a woman of my age could possibly be having a heart attack. Well, why didn't they ask if I was on the Pill?"

Jill's case highlights one of the major complaints: doctors are failing properly to monitor women on the Pill or identify symptoms of Pill-related problems.

Ms Roland, co-ordinating their legal campaign, says: "We were initially targeting drug manufacturers for inadequate warnings, written in tiny print using medical jargon. But when we began to talk to the clients it became clear that these were also cases of medical negligence." She claims doctors are failing to diagnose the Pill's side-effects, and others are prescribing the Pill to women for whom it is clearly very dangerous.

"Some cases are just so obvious," she says. "There's simply no defence for putting women who smoke, drink, are overweight or have high blood pressure or a family history of thrombosis on the Pill. But it's happening."

Elaine Hegarty, 24, a typist from Liverpool, is another client taking action. In spite of high blood pressure, she was prescribed Marvelon, a low-dosage pill, in July 1993. "There were no warnings from my doctor," she says. "Nothing." Within months she had developed a severe cough but, like Jill, was treated for a chest infection. When she collapsed with a severe pain in her right lung, her doctor again dismissed it as nothing serious.

"I couldn't even speak without choking, and I could hardly move," she recalls. Eventually, she went to hospital, where blood tests found less than half the normal oxygen level in her blood stream. "That was when they asked if I was on the Pill. That was the first time anyone had ever mentioned it." Blood clots had formed all over her right lung, and she was placed on heavy medication for four months. Her consultant told her she was a medical mystery; the only explanation he could see was the Pill.

"They say the clots are gone now, but my whole life has been turned upside down. I couldn't look after my young baby, I was on sick pay for six months. And when I went back to work, they made me redundant. The doctors say there'd be a risk if I ever want to have more children. I thought the Pill was safe. No one ever said anything like this could happen. And the stuff on the leaflet was hardly a warning; it was tiny and vague. There was never any proper warning."

Manufacturers of the Pill will claim in their defence that their warning policy is perfectly adequate. A spokesperson for Syntex, makers of Noriday, declined to comment on any individual case but said: "We put everything we possibly can on our information leaflets. The information should speak for itself." Drug companies are also expected to claim that it is the responsibility of doctors to reiterate the warning to their patients, and to prescribe carefully, says Ms Roland.

Dr Patrick Hoye, a medico-legal adviser for the Medical Defence Union, which advises doctors on legal action, admits that incidents of negligence do occur. But he argues: "There must be an area where problems are just unfortunate rather than negligent. People have to be aware that there must always be untoward incidents over which no one can have any control, and no one can predict."

The first writs will be served by the end of the year. Should they succeed, six-figure pay-outs are anticipated. Litigation on behalf of women who have died is also under way. There has never been a successful product liability suit against a drug manufacturer in this country, but Ms Roland is confident. She believes people's attitudes are changing. "There's a breath of fresh air. People are saying, 'I've been injured so why shouldn't I be compensated?' "

Meanwhile, Jill Nolan is trying to come to terms with what happened to her. "I've only just started to feel myself again. They've told me to put it behind me, but I was a very active, happy woman before this happened. They don't even know where the blood clot went - it could still be there. It's been a terrible, terrible nightmare."