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What is the contraceptive pill?

Birth control pills

The Pill is the contraceptive that changed women’s lives and gave them control over their own fertility. Worldwide, hundreds of millions of people use it. In USA, approximately one in three of all sexually active women take it.

But let’s be very clear what we mean by ‘the Pill’. A lot of people (including even a few health professionals) get muddled up between the Pill and the mini-Pill. However, they’re totally different things.

The ‘ordinary’ Pill contains two hormones (that’s why it’s often called ‘the combined Pill’). The mini-Pill is quite different; it just contains ONE hormone.

The Pill is far, far more popular than the mini-Pill. For instance, in the United States there are 30 women taking the Pill for every one on the mini-Pill.

So, don’t get these two contraceptive methods confused. On NetDoctor, we offer you a totally separate article on the mini-Pill, but everything in this article is about the ‘ordinary’ Pill.

Important facts about birth control pills

The combined contraceptive pill is one of the most common contraceptive (birth control) choices in the UK. If the pills are taken properly, following the manufacturer’s instructions, the combined pill is 99% effective in preventing pregnancy.

The combined pill is made up of two hormones called progestogen and oestrogen. It can be taken either for 21 days in a row, followed by a seven-day break, or for 28 days (the everyday pill).

In some 21-day brands, each pill contains an equal dose of hormones. In others, called phasic pills, the pills contain varying amounts of oestrogen and progestogen and must be taken in the right order. Packets for this type of pill are often colour-coded to show the order the pills should be taken in.

The everyday pill is taken each day of the 28-day menstrual cycle with no break in between packets. The first pill of a new pack must be taken the day after the last pill in the old pack. Everyday pills must be taken in the right order as the packet contains seven inactive pills.

What does it contain?

The Pill contains two hormones that are very similar to those that your own body produces. They’re called:

  • estrogen (pronounced ee-stro-jen)
  • progestogen.

Quite a lot of different estrogens and progestogens are used in the many brands of Pill available on the market.

How does the birth control pill work?

Between them, the two hormones stop you from getting pregnant. The main way in which they do this is by stopping your ovaries from releasing an egg (ovulating) each month.

The combined pill contains two hormones that the body produces naturally (estrogen and progestogen). These prevent ovulation (the release of an egg from the ovary each month).

The mucus in the neck of the womb (cervix) becomes thicker, making it harder for sperm to reach the egg. The lining of the womb also becomes thinner meaning that there is less chance of a fertilized egg being accepted.

The hormones also protect you against pregnancy by:

  • thickening the mucus in your cervix – so that sperms can’t easily swim through it.
  • making the lining of your womb thinner – so that it’s less ‘receptive’ to an egg.

How well does a birth control pill work?

The combined pill can often mean shorter and lighter periods and can be especially helpful to women who suffer from premenstrual symptoms. It is also a very reliable form of contraception.

There is also evidence to suggest that the combined pill can protect women against cancer of the ovaries and womb, some pelvic infections, and lower the risk of non-cancerous growths called fibroids.

Very well indeed, which is why so many millions of women rely on it. Providing you don’t forget to take it (which is quite easily done!), it is most unlikely that you’ll get pregnant.

If 100 women took the Pill for a year (without forgetting to take any) then it would be surprising if even one of them got pregnant. In contrast, if 100 women don’t use any contraception for a year, up to 20 of them will get pregnant. That’s quite a difference!

What are the ‘good points’ about the oral contraceptives?

There are a lot of good points about the Pill:

  • it’s brilliantly effective
  • unlike condoms (which you have to put on before sex), it doesn’t interfere with the spontaneous enjoyment of a sexy, romantic evening
  • it usually takes away period pain
  • it makes your periods lighter
  • it makes them shorter
  • it helps protect you against certain illnesses – notably cancer of the ovary and cancer of the womb.

What are the ‘bad points’ about birth control pills?

It has side effects. Fortunately, for most women these are very trivial and short-lived. The common ones are:

  • headache
  • breast tenderness
  • nausea
  • slight (and we do mean ‘slight’) weight gain
  • ‘spotting’ of blood between periods.

As with any ‘non-barrier’ method of contraception, the main disadvantage of the combined pill is that it does not protect against sexually transmitted diseases.

Some women may also have short-term side effects such as mood changes, breast tenderness, sickness or vomiting, headaches, weight gain or weight loss, and irregular vaginal bleeding. These should all disappear within three months.

The combined pill may also increase blood pressure.

The combined pill can also make migraine worse. Migraine is more common in women than men, and this is linked to fluctuating levels of the hormone, estrogen. If you suffer from severe migraine that has neurological symptoms (‘classical’ migraine), you should not take the combined contraceptive pill.

Neurological symptoms include speech and vision difficulties, and numbness or tingling affecting a limb or one side of the body. Taking estrogen increases your risk of having a stroke if you suffer from severe migraines.

These side effects usually vanish after your first couple of packs of the Pill. If they don’t, then ask a doctor to change you to another brand.

But can oral contraception have serious side effects?

Yes, it can. And it’s important that you know the risks. Please do ask the doctor who prescribes your Pill to explain what the current situation is, especially if there have recently been any alarming headlines in the paper.

Along with your pack of the Pill, there is a leaflet with a full list of known possible side effects. But some of the important ones that you really need to know about are:

  • heart attacks (coronary thrombosis)
  • strokes
  • thrombosis (clotting) in the leg veins – possibly leading to a clot in the lung.

The risk of any of these things happening to you is very small indeed. But that risk is increased by certain factors:

  • if you smoke – smoking and the Pill are a bad combination
  • if you are diabetic
  • if you have seriously high blood pressure
  • if you are obese
  • if you’ve already had a thrombosis
  • if you have bad varicose veins (possibly)
  • if you have a worrying family history of clots or thrombosis (say, if your mother had a coronary at an early age).

For a fit woman who doesn’t smoke and who doesn’t have a ‘bad’ family history of thrombosis, the risk to your life is generally reckoned to be less than that of pregnancy.

But, obviously, before you go on the Pill you should ask the doctor to tell you what the latest knowledge is regarding risks. New research is published every few weeks!

In recent years, there has been a lot of argument about whether one particular group of Pills is associated with a higher danger of thrombosis. Currently, it seems likely that brands which are described as ‘third generation’ Pills do carry a slightly higher risk than more long-established types.

Who can take combined contraceptive pills?

Not every woman can use the combined pill and there are a number of reasons why it may not be a suitable method of contraception. The combined pill should not be taken if:

  • the woman is pregnant, or thinks she might be pregnant
  • the woman is over 35 years old and a smoker.

The combined pill is also not a suitable method of contraception if the woman has ever had:

  • venous or arterial thrombosis (blood clots)
  • raised blood pressure, heart abnormalities or circulatory disease
  • liver or gall bladder disease
  • diabetes
  • unexplained vaginal bleeding.

Can birth control pills cause cancer?

As we’ve seen, the Pill seems to help protect you against two types of cancer. But it is probable that it slightly increases your risk of:

  • breast cancer
  • cancer of the cervix – though this can be completely prevented if you have regular smear checks.

Note: in April 2017, new research published in the Journal of the American Medical Association suggested the Pill may make women less likely to develop bowel cancer.

If this turns out to be true, it would be a considerable ‘plus’ for the Pill – since cancer of the bowel is extremely common. In the United States, it kills over 8,000 women a year.

There is also a very, very rare type of liver cancer that has been linked with Pill use.

Where can you get the Pill?

In most countries, the Pill is only available by doctor’s prescription. In the United States, doctors from whom you can get the pill include:

GPs – they do the majority of Pill-prescribing in Britain. It’s not widely known that if you don’t want to go to your own GP for the Pill, you can consult another one.

  • gynecologists.
  • some genitourinary medicine (GUM) clinics.

How do you take birth control pills?

Unfortunately, the packaging of pills varies a great deal – and it varies a lot from country to country. What follows describes the situation in the United States.

Nowadays, Pills generally come in packs of 21. You take one every night, and a pack lasts you for three weeks. At the end of the three weeks, you break for a week. During the week’s break, you’ll have a period. It’s stopping the Pill at the end of the pack that brings on the bleeding. (Your period should be shorter and lighter than it would be were you not on the Pill. And it should also be pretty free of pain.)

After the week’s break, you start the second pack of 21.

A fairly small proportion of women in the UK (but a lot in the USA) are on packs of Pills that contain seven dummy tablets to take during the week’s break. These packs are called ‘ED’ (meaning ‘every day’).

Unless your doctor advises you differently, or unless you get any worrying side effects, you should carry on taking the Pill – three weeks out of every four – throughout the year.

Are all contraceptive pills more or less of the same type?

No, they vary a lot in their ingredients. So if one doesn’t suit you, you can easily change to another.

Quite a few brands of Pill are of a type called phasic. This means that the dose of hormone varies at different times of the month. While this variation in dosage seemed a great idea when it was first introduced, in practice, it’s very easy to get confused about phasic Pills – especially if you miss any.

How do I start?

In the United States, it’s now standard procedure for women who are taking the Pill for the first time to begin the initial pack on the first day of their period.

If you do it this way, you will be protected against pregnancy immediately. (Practices in other parts of the world differ considerably.)

Am I protected during my seven-day break?

Yes. Provided you haven’t missed any pills, you should be okay.

Does anything make my birth control pills less efficient?

Yes. These things make it less likely to protect you:

  • forgetting pills
  • having diarrhea and/or vomiting (‘D and V’ or ‘traveler’s tummy’)
  • some types of antibiotics.

What do I do if I miss a pill?

This subject if very complicated, and the answer depends very much on which type of pill you are on.

In general, you’ll probably ‘get away with it’ if you miss only one pill, and take it as soon as you remember – though there’s a greater danger if you forget one at the end of a pack.

But being more than 12 hours late in taking a pill can be very risky. For detailed individual advice, ring your local Family Planning Clinic. If they’re shut, ring the Contraceptive Education Service Helpline on 0207 837 4044, or consult any doctor.

Remember: if you’ve missed pills and things look rather alarming, you can probably save the day by taking the post-coital pill (after-sex pill) – often mistakenly called ‘the morning-after Pill’. It can be used during the 72 hours after unprotected sex.

Remember that, unlike the condom, the Pill does not protect you against any sexually transmitted diseases.

If you have problems remembering to take your Pill on time, you may benefit from NetDoctor’s text message reminder service.

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