At a glance......
- 1 Before taking Contraceptive Pill
- 2 Types of Contraceptive Pill
- 3 Benefits of Contraceptive Pill
- 4 Guiding pill prescription
- 5 Side Effects of Contraceptive Pill
- 6 Combined pill/Contraceptive Pill
- 7 THE PILL AND CANCER
- 8 Who can use the combined pill
- 9 References
Contraceptive Pill also is known as contraception and fertility control pill is a method or device used to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th-century Planning, making available, and using birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.
Oral contraceptive pills have been associated with increased risk for myocardial infarction, stroke, and venous thromboembolism. Studies have been published recently that suggest that these risks are minimal inappropriately chosen low-risk women. Stroke is a very uncommon event in childbearing women, occurring in approximately 11 per 100,000 women over 1 year. Thus, even a doubling of this risk with oral contraceptive pills would have minimal effect on attributable risk. The estimated risk of myocardial infarction associated with oral contraceptive pill use in nonsmokers is 3 per million women over 1 year. The estimated risk of venous thromboembolism attributable to oral contraceptive pills is less than 3 per 10,000 women per year. Additionally, the literature suggests that there may be an increased risk of breast cancer associated with long-term oral contraceptive pill use in women under the age of 35. However, because the incidence of breast cancer is so low in this population, the attributable risk of breast cancer from birth control pill use is small.
Before taking Contraceptive Pill
- The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), an implantable birth control. This is followed by a number of hormone-based methods including oral pills, patches, vaginal rings, and injections.
- Less effective methods include physical barriers such as condoms, diaphragms, and birth control sponges and fertility awareness methods. The least effective methods are spermicides and withdrawal by the male before ejaculation. Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them.
- Safe sex practices, such as with the use of male or female condoms, can also help prevent sexually transmitted infections. Other methods of birth control do not protect against sexually transmitted diseases. Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours after unprotected sex. Some argue not having sex as a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance
Contraceptive, pill Commonly called “the pill,” combined oral contraceptives are the most commonly used form of reversible birth control in the United States.
- This form of birth control suppresses ovulation (the monthly release of an egg from the ovaries) by the combined actions of the hormones estrogen and progestin.
- If a woman remembers to take the pill every day as directed, she has an extremely low chance of becoming pregnant in a year. But the pill’s effectiveness may be reduced if the woman is taking some medications, such as certain antibiotics.
- Besides preventing pregnancy, the pill can make periods more regular. It also has a protective effect against pelvic inflammatory disease (PID), an infection of the fallopian tubes or uterus that is a major cause of infertility in women, and against ovarian and endometrial cancers.
- Birth control pills (also called oral contraceptive pills and the “Pill”) are a type of female hormonal birth control method and are very effective at preventing pregnancy.
- The Pills are small tablets that you swallow each day. Most pills contain two types of synthetic (man-made) female hormones: estrogen and progestin. These are similar to the estrogen and progesterone normally made by the ovaries. These pills are called “combination oral contraceptives,” and there are many different kinds.
- The hormones in the pills prevent pregnancy by suppressing your pituitary gland, which stops the development and release of the egg in the ovary (ovulation) (see female reproductive anatomy image below). The progestin also helps to prevent the sperm from reaching the egg and changes the lining of the uterus.
Another type of pill contains only one hormone (progestin) and is called either the “progestin-only pill,” or the “mini-Pill.” It works by stopping ovulation and by helping to prevent the male’s sperm from reaching the egg.
Types of Contraceptive Pill
Combination Pills (COCs)
- Birth control pills with two hormones — estrogen and progestin — are called combination pills. They’re the most common type of birth control pill. Most combination pills come in 28-day or 21-day packs. You’re protected from pregnancy as long as you take 1 pill every day. You don’t have to take it at the exact same time every day, but doing so helps keep you in the habit of remembering your pill. You can also use alarms, reminders, or birth control apps to help remind you.
- Take 1 pill every day for 28 days (four weeks), and then start a new pack on day 29. The last pills in 28-day packs of combination pills do not have hormones in them. How many days you take hormone-free pills are different for different brands. Most commonly you’ll take hormone-free pills for 7 days, but sometimes less. These pills are called “reminder” or “placebo” pills — they help remind you to take your pill every day and start your next pack on time. Even if you don’t take them, you’ll be protected from getting pregnant if you have sex on those days. They may contain iron or other supplements that help you stay healthy. During the time you take these “reminder” pills is when you get your period.
- Take 1 pill every day for 21 days (three weeks) in a row. Then don’t take any pills for seven days (fourth week). You’ll get your period during the fourth week while you aren’t taking any pills. It’s important to take every pill in a 21-day pack because there are no reminder (hormone-free) pills. The hormone pills will prevent pregnancy even if you have sex during the week when you don’t take any pills. Start your next pack after not taking your pills for seven days — you may want to use an alarm or reminder to help you stay on track.
- Some combination pills have 12 weeks’ worth of hormone pills in a row, followed by up to 1 week of reminder pills. This is so you’ll only have your period once every three months. The hormones will prevent pregnancy even if you have sex during the reminder pill week. Other pill brands can also be used to skip your period by skipping the reminder pills.
There are two different ways to take the pill:
- The period option – Take the 21 hormone pills and then the 7 non-hormone pills. You will get your period while you are taking the 7 non-hormone pills. It may be lighter and less crampy than your regular period. You will not be protected from pregnancy if you forget more than one pill in a week
- The no-period option – Take the hormone pills continuously, every day. Take the 21 hormone pills and then start a new packet, missing the 7 non-hormone pills. This means you won’t get your period. With this option, you are protected from pregnancy unless you forget more than eight pills in a row. You can do this for as many packets of hormone pills as you like, and then you can take the non-hormone pills to have a period when you want to. You might notice bleeding and spotting at first, but this usually goes away with time or you can take the 7 non-hormone pills to have a period.
Benefits of Contraceptive Pill
Birth control pills have a number of benefits
- They protect you 24/7. You don’t have to worry about birth control during intimacy.
- They’re effective. They protect against pregnancy better than most other birth control options.
- They help regulate your menstrual cycle. This can be helpful for women with irregular or heavy periods.
- They’re fully reversible. This means when you stop taking them your cycle will return to normal and you can get pregnant later.
There are also benefits depending on the type of pill. Combination pills may also provide some protection against:
- ectopic pregnancy
- thinning bones
- non-cancerous breast growths
- endometrial and ovarian cancer
- heavy periods
- severe menstrual cramps
Progestin-only pills have other benefits as well, such as being safer for women who:
- can’t tolerate estrogen therapy
- are smokers
- are older than 35 years
- have a history of blood clots
- want to breastfeed
Birth control pills are used to treat many different conditions including
Polycystic Ovary Syndrome (PCOS)
- Is a hormonal imbalance which causes irregular menstrual periods, acne, and excess hair growth. For girls whose menstrual periods are irregular (too few or not at all), birth control pills work by lowering certain hormone levels to regulate menstrual periods. When hormones are at normal levels, acne and hair growth often improve.
- Most girls with endometriosis have cramps or pelvic pain during their menstrual cycle. Birth control pills are often prescribed continuously to treat endometriosis and work by temporarily preventing periods. Since periods can cause pain for young women with endometriosis, stopping periods will usually improve cramps and pelvic pain.
Lack of periods (“amenorrhea”) from low weight, stress, or excessive exercise
- Birth control pills may be prescribed to replace estrogen, which helps to regulate the menstrual cycle. Normal estrogen levels and healthy weight are important for healthy bones. If lack of periods is caused by low weight or an eating disorder, the best treatment is weight gain to a normal healthy weight.
- When over-the-counter medications don’t help with severe cramps, birth control pills may be the solution because they prevent ovulation and lighten periods.
Premenstrual Syndrome (PMS)
- Symptoms of PMS such as mood swings, breast soreness, weight gain and bloating, along with acne can occur up to 2 weeks before a young women’s period. Birth control pills may be prescribed to stop ovulation and keep hormone levels balanced. Symptoms may improve, particularly when oral contraceptive pills are prescribed continuously.
Primary Ovarian Insufficiency (POI)
- Birth control pills are often prescribed to girls who have ovaries that don’t make enough estrogen because of radiation and/or chemotherapy or a genetic condition such as Turner Syndrome or other conditions. The goal of this treatment is to regulate the menstrual cycle and keep bones healthy.
Heavy Menstrual Periods
- Birth control pills can reduce the amount and length of menstrual bleeding.
- For moderate to severe acne, which over-the-counter and prescription medications haven’t cured, birth control pills may be prescribed. The hormones in the Pill can help stop acne from forming. Be patient though, since it takes several months for birth control pills to work.
Guiding pill prescription
The guiding principles when considering which pill to prescribe for an individual woman are to choose a formulation that:
- has the lowest dose of oestrogen and progestogen to provide good cycle control and effective contraception
- is well tolerated
- has the best safety profile
- is affordable
- offers additional non-contraceptive benefits if desired.
- The first available formulation of the combined oral contraceptive pill contained 50 microgram of ethinyloestradiol for cycle control. However, an association between the pill and venous thromboembolism soon emerged. This was due to the effect of oestrogen on the synthesis of clotting factors.[Rx] To mitigate this risk, and reduce oestrogenic adverse effects, the dose of ethinyloestradiol was reduced to 35 and 30 microgram and more recently 20 microgram without an apparent loss of contraceptive efficacy.[Rx]
- The pills available in Australia are mostly in 28-day packs with 21 active and 7 inactive pills, to mimic the menstrual cycle. Some formulations contain 24 active and 4 inactive pills (24/4 regimes) which may reduce the chance of contraceptive failure and breakthrough ovulation.[rx] Extended pill-taking regimens are used by many women to delay or avoid a withdrawal bleed. This is most easily achieved with monophasic regimens in which each active pill contains the same amount of oestrogenand progestogen and the inactive pills are skipped. Typically this is done for three months at a time. Indeed evidence is available to support the safety of continuous use of the contraceptive pill for up to 12 months.[Rx] Another approach is called a ‘menstrually signalled’ regimen. Women take the pill continuously until they experience four days of vaginal spotting or bleeding after which they have a four-day pill break.
- Triphasic pills are commonly prescribed in Australia, but have no evidence-based advantage over monophasic pills in relation to their adverse effect profile or cycle control. A quadriphasic combined oral contraceptive pill that contains oestradiol valerate and desogestrel is formulated with an oestrogen step-down and progestogen step-up sequence.[Rx]The pill is a user-dependent method. Its failure rate therefore differs between ‘perfect use’ (0.3% annually) by women who take it consistently and correctly and ‘typical use’ (9% annually) when the pill is used inconsistently or incorrectly.[Rx]
Safety and tolerability
- Long-term cohort studies show that, compared to non-users of the combined oral contraceptive pill, users have lower rates of death from any cause. They also have significantly lower rates of death from cancer, cardiovascular disease and other diseases.[Rx]
- There is not a great deal of evidence for the benefit of one pill type over another. Although the newer combined oral contraceptives have been marketed on their non-contraceptive benefits, it is important to understand which claims are well substantiated.
Acne and hirsutism
- Most women with acne and hirsutism find that their skin improves when they take the combined oral contraceptive pill. This is in part because of a rise in sex hormone binding globulin. Pills containing cyproterone acetate, drospirenone, gestodene or desogestrel are often recommended, but the evidence for a benefit over levonorgestrel-containing pills is limited.
- The pills containing cyproterone acetate and ethinyloestradiol appear to improve acne (judged by inflammatory lesions and global assessments) better than those containing levonorgestrel.[Rx] Studies comparing pills containing cyproterone acetate with pills containing drospirenone, gestodene or desogestrel have had conflicting results.[Rx] Women with hirsutism may benefit from pills containing one of the anti-androgenic progestogens, including cyproterone acetate or drospirenone, which have been found to result in improvements in clinical hirsutism scores.[Rx]
Heavy menstrual bleeding
- All combined contraceptive pills can reduce the duration and heaviness of menstrual blood loss. Extending the days women take active pills while reducing or eliminating inactive pills can be useful for heavy menstrual bleeding.
- The oestradiol valerate with dienogest pill has a quadriphasic regimen which reduces menstrual blood loss through its effect on the endometrium. It has an indication for the management of heavy menstrual bleeding. This pill appears to be more effective at reducing the number of days of bleeding and the amount of blood loss when compared to combinations of ethinyloestradiol and levonorgestrel.[Rx]
Premenstrual syndrome and premenstrual dysphoric disorder
- Menstrual-related symptoms are commonly reported, but a proportion of women will experience more severe cyclic symptoms, known as premenstrual syndrome. A further subset of women will experience severe dysphoric symptoms, which have been labelled as a premenstrual dysphoric disorder.
Side Effects of Contraceptive Pill
Birth control pill side effects that should be investigated are:
- A: Abdominal/stomach pain
- C: Chest pain (as well as shortness of breath)
- H: Headaches that are severe
- E: Eye problems such as blurred vision or loss of vision
- S: Swelling or aching in the legs and thighs (also redness, swelling or pain in the calf or thighs).
Most women have no side effects when taking birth control pills, but some women do experience irregular periods, nausea, headaches, or bloating. Each type of oral contraceptive pill can affect each woman differently.
Spotting or Irregular Periods
- Very light bleeding (you just need a panty liner or light day pad) may occur during the first 3 weeks of taking the Pill and may continue for several cycles, but this is not serious. Irregular bleeding is common if you are late taking your pills or you miss a pill. If the bleeding is new and you are sexually active, get checked for Chlamydia infection. If the bleeding becomes heavier.
- Sometimes a young woman can feel nauseated (sick to her stomach), but the feeling usually goes away if the pill is taken with food or with a bedtime snack. Sometimes a pill with less estrogen is prescribed if the nausea doesn’t go away.
- Sometimes, young women may complain of headaches when they start taking birth control pills. Most often headaches happen because of stress or other reasons such as skipping meals, not enough sleep, sinus infections, or migraines. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe a different pill with a lower amount of estrogen or may take you off of it completely and watch to see if headaches improve.
- Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercise and a healthy diet may help, but if they don’t, you should talk with your health care provider and try a different kind of oral contraceptive pill.
- Usually, the pill helps cure acne, but a few women feel they get acne from a certain kind of birth control pill.
Sore or enlarged breasts
- Your breasts may become tender or may get larger.
- Some teens gain weight and some teens lose weight while taking birth control pills, but most teens stay exactly the same weight. Many times a young woman thinks she has gained 5-10 pounds, but when her weight is actually checked, there is no change. If you think you may have gained weight while taking the Pill talk to your health care provider. Try to remember to watch your portion sizes and eat 5-7 servings of fruits and veggies each day and don’t forget to exercise. Your appetite may increase or stay the same.
What are the possible side effects of birth control pills?
Most women have no side effects when taking the oral contraceptive pill. However, it’s possible to have irregular periods, nausea, headaches, or weight change especially during the first few months. Each type of oral contraceptive pill can affect a young woman differently.
- Irregular periods: Spotting (you don’t need to use a regular pad, just a panty shield) or very light bleeding may occur during the first 1-3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, keep taking the pill and talk with your health care provider.
- Nausea: Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
- Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercise and a healthy diet may help, along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
- Sore or enlarged breasts: Very occasionally, your breasts may become tender and/or get larger, but usually your breasts will stay the same. Breast tenderness usually goes away after a few months.
- Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. Try to remember to watch your portion sizes, avoid fast food, and eat 5-13 servings of fruits and vegetables each day. Drink lots of water and don’t forget to exercise! Just in case you were wondering, there are no calories in the Pill.
If you do have side effects, you should talk to your health care provider. If the side effects are very uncomfortable or if they don’t go away after three cycles, your health care provider may switch you to a different pill.
What about serious side-effects?
There’s no doubt at all that the Pill can occasionally cause serious problems like:
- deep vein thrombosis. This is now known to be more common in women who are taking high oestrogen Pills and also third-generation Pills containing the progestogens desogestrel and gestodene
- heart attacks
Fortunately, these events are rare. But they are much more likely to happen if you have certain ‘risk factors’, which include:
- being a smoker
- having a family history of thrombosis or some similar illness (say, if your mother had a heart attack or a deep vein thrombosis at 40)
- being severely overweight
- being diabetic (though quite a few non-smoking diabetics do use the Pill, under careful supervision)
- high blood pressure
- high cholesterol level (hypercholesterolaemia)
- past history of phlebitis (vein inflammation) or thrombophlebitis
- being immobile for a while (especially when having a surgical operation).
Combined pill/Contraceptive Pill
- The combined oral contraceptive pill is usually just called “the pill”. It contains artificial versions of female hormones oestrogen and progesterone, which women produce naturally in their ovaries.
- A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening usually by keeping the egg and sperm apart or by stopping the release of an egg (ovulation).
How effective is the Pill at preventing pregnancy?
- The Pill is very effective if you take it exactly as you are supposed to – one pill a day, taken at the same time each day. You should also use back-up contraception such as condoms if you have diarrhea or vomiting, or are taking a medication that could change the effectiveness of the birth control pill. Using condoms is always important to decrease your chances of getting a sexually transmitted infection (STI)
Although it’s obvious that the Pill is most effective against pregnancy when it’s taken at the same time every day, perfect use can be difficult for both teens and adults. That’s why it’s often considered 92% effective. This means that if 100 women use the Pill, but don’t take it perfectly, 8 or more women will become pregnant in a year.
Advantages of the combined pill
Advantages of taking the combined pill include:
- It usually makes periods shorter, lighter and more regular.
- It can improve symptoms that can come with periods such as pain, mood swings and headaches.
- It lessens the risk of cancer of the ovaries and uterus.
- It can be used to safely skip periods.
- It usually improves acne.
Disadvantages of the combined pill
Disadvantages of taking the combined pill include:
- You will need to remember to take a pill every day.
- Cost can be an issue.
- You will need to be able to visit your doctor regularly to renew your prescription.
- It can cause side effects such as nausea, breast tenderness, headaches and increased appetite.
- It can lead to serious complications such as deep vein thrombosis (blood clots), heart attacks and strokes, but these are not common.
- The combined pill does not suit women who have medical conditions such as certain types of migraines, high blood pressure, severe heart conditions or liver disease.
- It is not recommended for women who are very overweight, or who smoke and are aged over 35.
- Vomiting and severe diarrhoea can stop the combined pill from being absorbed by the body.
- Some medication, such as the type used to treat epilepsy, and the herbal remedy St John’s wort, may stop the combined pill from working.
- It does not give protection from sexually transmissible infections (STIs).
But can’t it give you a lot of side-effects when you start?
Yes. During the first few packs of the Pill, many women get minor, passing side-effects, such as:
These side-effects usually go away after the first few packs. If they don’t, it’s easy to get rid of them by simply switching to another brand. For a complete list of side-effects, please read the leaflet that comes with your Pills.
THE PILL AND CANCER
- Research shows that even if there is a risk of breast cancer, it is small. Before you start taking the pill, the nurse will ask you if you or anyone in your family has had breast cancer.
- If you’ve been on the pill for five or more years and you carry certain types of wart virus, you might be more at risk of cervical cancer. Whether you take the pill or not, you should get a cervical smear every three years.
- Your risk of ovarian cancer lowers by 50% if you take the pill. Even 30 years after stopping the pill you will still have a lower risk.
- This is cancer of the lining of the uterus. Your risk of endometrial cancer lowers by 50% if you take the pill. Even 15 years after stopping the pill you will still have a lower risk.
Who can use the combined pill
If there are no medical reasons why you cannot take the pill, and you don’t smoke, you can take the pill until your menopause. However, the pill is not suitable for all women. To find out whether the pill is right for you, talk to your GP, practice nurse or pharmacist.
You should not take the pill if you:
- are pregnant
- smoke and are 35 or older
- stopped smoking less than a year ago and are 35 or older
- are very overweight
- take certain medicines (ask your GP or a health professional at a contraception clinic about this)
You should also not take the pill if you have (or have had):
- thrombosis (a blood clot) in a vein, for example in your leg or lungs
- stroke or any other disease that narrows the arteries
- anyone in your close family having a blood clot under the age of 45
- a heart abnormality or heart disease, including high blood pressure
- severe migraines, especially with aura (warning symptoms)
- breast cancer
- disease of the gallbladder or liver
- diabetes with complications or diabetes for the past 20 years.