Written by :
Senior Consultant, Obstetrics & Gynaecology,
Indraprastha Apollo Hospital,
What are birth control pills?
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.
What are the types?
The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.
The dose of estrogen used in combined pill range from 15 mg to 50 mg low dose pills with estrogen content of 20 to 30 mg are safer because cardiovascular risk and risk of thrombosis are mainly from estrogen content of pill and are dose related. Therefore, the dose of estrogen is a critical issue in selecting an oral contraceptive. Progesterone used in currently available pills are divided into four groups:
- First generation progesterone- NORETHINDRONE group
- Second generation - NORGESTREL group
- Third generation- GESTODENE, DESOGESTREL, NORGESTIMATE
- Newest progesterone- DROSPRIRENONE
The main function of progesterone is to counteract the undesirable side effects of estrogen such as endometrial hyperplasia and heavy withdrawal bleeding.
New progesterone does not adversely affect the cholesterol lipoprotein profile and may be of greater value in acne and hiruitism. Oral contraceptives
have been divided into:
- Low dose oral contraceptives containing less than 50 mg of ethinyl estradiol (estrogen)
- First generation oral contraceptives containing more than 50 mg of ethinyl estradiol
- Second generation oral contraceptives containing levonorgesterol, norgestimate and 30 to 35 mg of estrogen
- Third generation oral contraceptive containing desogestrel,or gestodeme
How are the pills used?
The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.
If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.
If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.
Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.
What if one forgets to take a pill?
If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.
If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.
If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.
If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.
When to start taking the pills after having a baby?
If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.
If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.
What are the benefits?
The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.
Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.
What are the disadvantages?
One disadvantage of birth control pills is that one must remember to take a pill every day.
Problems one may have while taking birth control pills include:
- irregular bleeding for the first few months
- nausea and vomiting
- weight gain
- breast swelling and tenderness
- increased appetite
- scant or missed periods
- high blood pressure
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.
It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.
It is necessary to consult a doctor if one experiences:
- leg pain or swelling
- loss of vision or double vision
- bleeding irregularities
- more headaches than usual
- numbness of arms, legs, or any other part of your body.