Birth Control – The Pill
The Pill (oral contraceptives)
Combined oral contraceptives are commonly known as “the pill”. They contain two man-made hormones called estrogen and progestin. The various brands of pills differ ONLY by the amount of estrogen in each pill and by the type and amounts of progestin. Some pills contain a constant dose of hormones while others are phasic in which the amount of hormones change to mimic your natural menstrual cycle. Each package contains 21 hormonally active pills followed by 7 placebo pills (28-day regimen) or 7 days of taking no pills (21-day regimen).
The pill prevents ovulation, which is the release of eggs from the ovaries. It also causes thickening of the cervical mucus to block sperm from entering the cervix and affects the lining of the uterus to prevent implantation of the pregnancy.
Among perfect users (women who miss no pills and follow instructions perfectly), only about 1 in 1000 women will become pregnant over the first year of use. Among typical users, about 3 to 5 in 100 women will become pregnant over one year of use. Pregnancy rates during typical use are based on the number of missed pills and delay in starting the next pill pack.
Most healthy women of reproductive years are good candidates for the pill regardless of prior pregnancy history if interested in birth control and are able to take a pill every day. This includes teens, overweight or underweight women, diabetics without underlying heart disease, women with family history of breast cancer, women over 35 who are non-smokers, and smokers under 35 (however, it is best NOT to take the pill and smoke!) The pill does NOT protect from sexually transmitted diseases particularly HIV. If this is a concern you should also use a condom.
A woman should not use the pill if she has history of:
- stroke or other diseases of the blood vessels
- blood clots in the lungs or legs
- heart attack
- active liver disease
- migraine headaches with changes in vision or tingling/numbness in the extremities
- age over 35 years and a smoker
- current or past history of breast cancer
There is no exact formula to determine which particular pill is best for you-every woman responds differently to different pills. Despite advertising, essentially all oral contraceptives work equivalently well. For you, the best pill is the one with the least amount of estrogen that does the job. In addition to protecting you from pregnancy, the pill should regulate your periods and some women do need more estrogen for this purpose. Price is another consideration. Most pills are $25-$35 or more per month. Many health insurance prescription plans do not cover birth control pills. The more popular, better-advertised pills can be more expensive. There are equally effective and appropriate pills for you that are less expensive. There are also programs available such as femScript which subsidize the cost of the pill. Ask about these alternatives.
Many of the side effects from the pill are due to the estrogen component and usually resolve within the first few months of starting the pill. Thus, new pill starters are encouraged to try the pill for at least 3 months.
- Caused by the estrogen component. Try taking the pill at night or with a snack. You may benefit from starting with the lowest estrogen dose (20 mcg) pill.
- Both the estrogen and progestin components of the pill may contribute to breast tenderness. Eliminating caffeine and chocolate from your diet may help.
- Breakthrough bleeding or any irregular bleeding may occur within the first 3 months of use, especially if you have missed pills or are not taking them at the same time each day. Breakthrough bleeding does not decrease the effectiveness of thepill provided you are taking them daily. If this persists after 3 months, often a change to a higher dose pill or simply a different brand will help. If intermenstrual bleeding persists, you may need to be checked for other causes of bleeding unrelated to pill use.
- If you develop headaches while on the pill, these need to be evaluated by your doctor. If you suffer from any neurological symptoms such as changes in vision or tingling/numbness in your extremities then you should immediately discontinue the pill estrogen will increase your risk of stroke. If headaches continue or worsen without neurological complaints, you may want to switch to the lowest dose estrogen pill or simply a different formulation. Women who suffer from menstrual migraines usually benefit from being on the pill.
- The pill may cause an increase in blood pressure in some women. New users should have their pressure checked 3 months after starting the pill and all women should have it checked at each doctor’s visit. Women with a known history of hypertension that is well-controlled on medications may be able to take the pill but should consult with their primary care doctor.
- The pill may stimulate the growth of gallstones in women with existing gallbladder disease.
- more regular and predictable menses
- decrease in the number of days of bleeding and amount of blood loss each month
- decrease in menstrual cramps
- decreases acne (all brands decrease testosterone which decreases acne)
- improves hirsutism (excessive hair growth)
- decreases benign breast disease (fibroadenoma and cystic changes)
- lifetime decrease risk of ovarian cancer by 40% continuing at least 15 years after use
- lifetime decrease risk of endometrial cancer by 50%
- decreased risk of colorectal cancer in current users and within 10 years of use
- desirable effect on cholesterol; increases the good cholesterol while decreasing the bad cholesterol
- preserves bone density and possible reduction in osteoporosis
You must wait for your next period to ensure that you are NOT pregnant when you start the pill. You can start EITHER:
Day-1 start: on the first day of bleeding
Sunday start: on the Sunday following the first day of bleeding
If you start the pill on a Sunday you will NOT get your period on the weekend. If you start the pill within the first five days of your period you will be protected from pregnancy that first month and not need a back-up method. You can use the following regimen to benefit from a Sunday Start and still have immediate protection from pregnancy. If your period starts on a Monday or Tuesday, this regimen will shorten your cycle by one or two days, which is not harmful to you. Then start your next and all subsequent pill packs on the Sunday following completion of the prior pack.
|If your period starts on Sunday||Start pill today|
|If your period starts on Monday||Throw out Sunday’s pill, start today with Monday’s pill|
|If your period starts on Tuesday||Throw out Sunday and Monday’s pills, start today with Tuesday’s pill|
|If your period starts on Wednesday||Start pill the following Sunday|
|If your period starts on Thursday||Start pill the following Sunday|
|If your period starts on Friday||Start pill the following Sunday|
|If your period starts on Saturday||Start pill the following Sunday|
|If your period starts on Sunday||Start today|
The pill may be started after the end of a pregnancy. You may start the pill the Sunday after a termination of pregnancy. It will then be effective two weeks later when it is generally safe to return to sexual activity. You may experience irregular bleeding the first month due to both healing from the procedure itself as well as your body getting use to the hormones.
You may also start the pill after a full-term pregnancy. If you do NOT plan to breast feed the pill may be started on the Sunday three weeks after delivery and will be effective by the sixth postpartum week when it is generally safe to return to sexual activity. In women who choose to breastfeed, the estrogen component of the pill may decrease the milk supply, thus progestin-only pills are recommended and are initiated after 6 weeks when the milk supply is well-established.
You must take one (active) pill everyday. Most packs contain 3 weeks of hormonally active pills followed by one week of inactive pills (or 7 days of taking no pills) during which time you will get your period. The placebo pills serve as a reminder to get you into the habit of taking a pill every day and not forgetting to start your next pack. Try linking it to something you do the same time every day (i.e. brushing your teeth before going to bed).
If you miss any of the inactive pills throw out all pills missed. If you miss any of the hormonally active pills:
Missed 1 pill in any week. Take the missed pill NOW and the next pill at the usual time (this may entail taking 2 pills now). You will be protected from pregnancy but may have some breakthrough bleeding or spotting for the remainder of the pill pack. This should resolve when you start your next pack.
Missed 2 pills in week 1 or 2. Take 2 pills NOW and 2 pills tomorrow. Then take 1 pill a day until you finish the pack. Use a backup method of contraception (i.e. condom) for the next 7 days. Again you may have some bleeding or spotting for the remainder of the pill pack.
Missed 2 pills in week 3 or missed 3 or more pills. For Day-1 Start: Throw out pack. Start new pack the same day. Use a backup method for 7 days. For Sunday Start: Take 1 pill each day until Sunday. On Sunday, throw out the old pack and start a new pack. Use a backup method for 7 days.
If you do miss 2 or more pills and are concerned you may be pregnant, emergency contraception or the “morning-after pill” is available. This must be taken within 72 hours (or 3 days) of unprotected intercourse. You may call the office to receive this form of contraception. Of note, this is only intended for occasional use and not as a regular method of birth control.
Call your doctor if you have any of the following problems: severe abdominal pain; severe chest pain (shortness of breath or sharp pain on breathing); severe headache, dizziness, weakness or numbness, especially if one sided; eye problems (vision loss or blurring), speech problems; or severe calf or thigh pain.