Birth Control Pills I Oral Contraceptive Pills

What are birth control pills?

Birth control pills are hormone-containing pills that prevent an unwanted pregnancy after sexual intercourse. They have to be taken orally (by mouth) like any other pill daily and are highly effective with an efficacy of more than 99%.

How do the birth control pills prevent pregnancy?

The birth control pills act in many ways to prevent pregnancy:

• They reduce ovulation from the ovaries so that the egg is not released.
• Secondly, they thicken the mucus around the cervix so that it does not let the sperm pass through, into the uterus and fertilize the egg.
• Thirdly, they alter the lining of the uterus (endometrium) in such a way that even if an egg gets fertilized, it is unable to attach itself to the wall of the uterus.

How effective are birth control pills in preventing pregnancy?

If you take your birth control pills daily without missing them and adhere to a fixed time every day, these pills have an efficacy of nearly 99% in preventing pregnancy. However, missing a dose or delaying a dose may reduce their efficacy. The efficacy may also be reduced by intake of certain drugs like antiepileptic medications or certain herbal supplements.

What is the best time to take birth control pills?

It’s a very frequently asked question, with a very simple answer!

It is very likely that someone can forget to take the pill at the scheduled time or forget to take it altogether. So the best time to take the pills is to combine them with an event that you are unlikely to forget. For example, you can combine them with your morning cup of tea, your morning breakfast, or with your other fixed medicines. Combining the pill with such daily events that are fixed and cannot be forgotten or postponed, eliminates the possibility of forgetting the pill.

In what dosing packs are the pills available?

Many types of dosing packs are available to suit everyone’s needs:

• 28-day conventional pack: The most common form of combined pill is a daily pill that you need to take every day for 28 days. The strip contains 28 tablets – the first 21 pills are hormonal tablets and the remaining 7 pills are nonmedicinal pills. Every month, you will have bleeding during the fourth week when you are taking the nonmedicinal pills. This bleeding is called Withdrawal Bleeding as it happens during to sudden absence of hormones.
• 21-day conventional pack: In some countries or in some brands of pills, the pack may have 21 hormonal pills only. So you have to take the pill for 21 days and then omit the pill for a week. After that, you start a new pack of 21 pills. The only difference from the 28-day conventional pack is that the nonmedicinal pills are not there; so you have to remember the pill-free days.
• 91-day or Extended cycle pack: This pack contains 84 hormonal pills and 7 nonmedicinal pills. You will take your hormonal pills daily for 84 days and then the nonmedicinal pills for the next 7 days. You will have withdrawal bleeding during these 7 days. So you will have bleeding only four times in an year. This is a good option for women who want contraception, along with a lesser frequency of cycles, for personal reasons or medical reasons like heavy periods, painful periods, endometriotic pain, premenstrual syndrome etc.
• 365-day or Continuous dosing pack: This pack has all 365 hormonal pills and no nonmedicinal pills. You have to take a hormonal pill every day. So technically, you stop having bleeding at all or you may have some episodes of intermittent bleeding. Again, a good option for women who want contraception but don’t want any periods, for personal reasons or medical reasons like heavy periods, painful periods, endometriotic pain, premenstrual syndrome etc.

Why are nonmedicinal pills added to the birth control pills?

As the name suggests, nonmedicinal pills do not have any active medical ingredient.

If you were to take only hormonal pills, you would have to take them for 21 days and then remember to omit them for the next 7 days and then again restart the pill for the next 21 days. This schedule is very tedious to follow, with a high likelihood of mistakes.

The nonmedicinal pills are only added to help you maintain your regularity of taking the pill daily at the scheduled time. Since you are taking the pill daily, you do not have to remember on which days not to take the pill. This reduces your likelihood of forgetting to take your pill and helps to form a daily habit.

What are the types of Birth control pills available?

There are two main types of birth control pills, based on their composition:

• Combined Pill or Combination Pill: Contains both Estrogen and Progesterone hormones. More commonly used.
• Progesterone-only Pill (POP) or Mini pill: Contains only one hormone Progesterone.

PROGESTERONE ONLY PILL (POP) or MINIPILL

• Contains only one hormone Progesterone.
• It is preferred in conditions where combined pill may be harmful or contraindicated due to undesirable side effects of estrogen. For example, if you have risk factors for heart disease, stroke, or deep vein thrombosis and if you are breastfeeding.
• In contrast to combined pill, the minipill has the advantages that it can be used immediately after your delivery and it can be used if you are breastfeeding.
• However, the minipill is linked to a slightly higher risk of having an ectopic pregnancy (pregnancy outside the uterus).

COMBINED PILL

The combined pill or the combination pill contains artificial variants of natural hormones estrogen and progesterone, in a fixed-dose combination. These pills have to be taken daily for 21 days and then left for 7 days, during which time the menstruation occurs. When taken correctly and diligently, they have more than 99% contraceptive efficacy. The hormone dose combination, packing, branding, and cost may vary between different brands, but the basic composition and mechanism remain the same.

These pills need about 7-10 days to start providing contraceptive protection against pregnancy. Till that time, it is very important to take some other form of contraception like condoms. However, if you start taking the pill right after your periods are over, then you do not need to opt for additional contraception as the contraceptive effect of pill will take over before your next ovulation.

Benefits of combined pills

Birth control pills are among the most widely used methods of contraception. The main benefits of opting birth control pills are:

• Effective Contraception – The most important use of combined pills is to protect against unwanted pregnancy. They have an efficacy of more than 99%, when taken correctly.
• Easy to use: Just take a pill daily and that’s all.
• Easily available: Available in most pharmacies and also over the counter in many countries.
• Does not require any special preparation before sexual intercourse, unlike the barrier methods.
• Easily reversible: If you want to plan your pregnancy, you just have to stop taking it and the effect wears off in a day. No prolonged waiting times.

In addition to these general benefits, the pills benefit many medical conditions as well, such as:

• Regulation of irregular periods: In women with irregular periods, the pills bring regularity by initiation of withdrawal bleeding at the end of the 21-day cycle of hormonal pills.
• Reduction of heavy bleeding: They help to reduce heavy bleeding in conditions like uterine fibroids, dysfunctional uterine bleeding (DUB) etc.
• Prevention of anemia: Pills help in anemia by regulating cycles and preventing heavy bleeding.
• Dysmenorrhea: They reduce the severity and frequency of menstrual cramps.
• Beneficial in PCOS, Acne, body hair and facial hair (hirsutism): Due to hormonal regulation and reduced androgen production, they reduce acne, hair growth on body or face and also reduce the symptoms of PCOS (polycystic ovarian syndrome).
• Reduce Premenstrual Syndrome (PMS) symptoms.
• Reduce hot flashes during menopause (see HOT FLASHES).
• Reduce risk of uterine, ovarian and colorectal cancers.
• Treatment of endometriosis

Who should not take combined pill?

It is generally believed that anyone can take oral contraceptive pills. However, the combined pill may be hazardous for you if you fall in certain categories like:

• Excess body weight: If you are overweight and have a body mass index of >35 kg/m² (see BODY MASS INDEX (BMI), combined pills may have more risks than benefits for you.
• Smokers > 35 years: If you are over 35 years and you smoke, you should avoid combined pills.
• If you have hypertension (high blood pressure) or diabetes (high blood sugar)
• If you are have risk factors for heart disease, stroke or deep vein thrombosis
• If you have liver disease
• If you have a history of breast cancer or have taken treatment for breast cancer: The use of birth control pills can slightly increase the risk of getting breast cancer.
• If you are likely to be bedridden for prolonged periods of time, then the risk of deep vein thrombosis increases with the use of combined pills. For example after an injury or orthopedic surgery.
• The pills can not be used immediately after childbirth. You have to wait for 3-6 weeks after your delivery to start taking combined pills.
• If you are breastfeeding, you can not use combined pills till your baby is 6 weeks old.

Side effects/Limitations of Birth control pills:

• Birth control pills have to be taken daily at the same time every day. This kind of schedule is very difficult to follow and women often forget to take their doses due to household or office work pressure. Due to this, the efficacy of the pills becomes questionable.
• To obtain birth control pills, you will need to visit your doctor and obtain a prescription, unlike other methods like barrier contraceptives that are available over the counter.
• Unlike condoms, pills do not provide any protection against sexually transmitted infections (STIs). For STI prevention, should practice safe sex and use barrier methods of contraception like condoms, along with the pill for STI prevention. (see Barrier methods of contraception).
• The pills take about 7-10 days to be effective. Till that time, you have to rely on other methods of contraception like the barrier methods, which are immediately effective.
• Other side effects of taking the pill may include headaches, worsening of migraines, nausea, vomiting, breast tenderness and mood changes.
• Sometimes, you may have slight bleeding or spotting, before the actual bleeding days. This is called breakthrough bleeding and is usually harmless.
• Increased or decreased libido (sex drive)
• Increase or decrease in vaginal discharge due to changes in hormone levels.

What should I do if I have missed my pill?

If you have missed your pill by mistake, do the following:

• Take your missed pill as soon as possible.
• Continue the next pill as per the regular schedule.
• If you have missed your pill by more than 12 hours, use additional contraception like a barrier method for 7-10 days.
• If you have missed your pill by a few days, discard the rest of the pack and start a new pack. Meanwhile, consider using alternative contraception like barrier methods for 7-10 days.
• Use emergency contraception if you had sexual intercourse on the day of missing your pill.
• Contact your healthcare provider, in case of any doubt.

Can I take two birth control pills in one day?

In routine circumstances, you should only take one pill in a day. There is no reason to take two pills.

However, if you have missed your pill, you should take it as soon as possible and take the next pill as per the regular schedule. This can mean that you may have to take two pills in a day.

What happens if I stop taking birth control pills for a week?

Birth control pills demand regularity and discipline for them to be effective.

So missing the pill, even for a day, can lead to reduced contraceptive efficacy.

If you miss the pill for a week, then you are no longer protected. You should discard the last pack and start a new pack. Consider using alternate contraceptive methods like condoms, for 7-10 days, to allow the pill to take complete effect. If you had unprotected intercourse during this week, you are at risk of getting pregnant and you should visit your doctor and take emergency contraception.

Can I use birth control pill while breastfeeding?

Yes, birth control pills can be used while breastfeeding.

The progesterone-only pills (POP) are safe to start immediately in breastfeeding whereas the combined pills should be avoided till six weeks of breastfeeding are over.

Can I get pregnant while on pill?

Yes, you can get pregnant while on pill. Birth control pills are one of the most effective methods of contraception but unwanted pregnancies can occur with any form of birth control and the pills are no exception. There can be many reasons for this:

• Forgetting to take your pill on some days
• Missing the pill because you ran out of stock
• Not taking the pill at a fixed time every day
• Taking certain medications which may reduce pill efficacy. For example, antiseizure medications, herbal supplements etc.
• No contraceptive method is 100% effective. Pills are more than 99% effective in preventing pregnancy when you follow the pill schedule perfectly with no mistakes. But 1 in 100 women can still get pregnant. More often, it’s difficult to adhere to the schedule due to personal, family or work obligations and most women tend to forget pills on some days or do not take them on time. So, the actual efficacy of the pill drops to about 91% – 9 of 100 women get pregnant every year while on pill.

A little discipline can avoid most of the reasons above, thereby preventing unwanted pregnancy. You should take your pill tagged to some daily schedule like morning tea, breakfast, lunch, or with other medications that you take daily. This reduces your chances of forgetting to take your pill. You should also keep a few extra packs with you, so you never run out of stock. While getting your prescription for birth control pill, you should always inform your doctor of any medications that you are currently taking. Your doctor will check if any of those drugs can interfere with your pill.

Can taking birth control pills while being pregnant cause miscarriage?

No, the birth control pills have not been shown to cause miscarriage or increase the incidence of birth defects in early pregnancy.

The birth control pills prevent you from getting pregnant by blocking the release of egg from your ovary and changing the cervical mucus so that sperm can not pass through, but do not affect a pregnancy that’s already there.

So, if you get pregnant while on pill, don’t worry. It happens to many women, as the pills are not 100% protective. However, you should immediately stop taking your pill, as soon as you know that you are pregnant.

Why are condoms a better option than birth control pill?

Both condoms and birth control pills are excellent methods of contraception, each with some benefits and limitations. However, condoms are considered slightly better than pills because of the following reasons:

• Condoms are easily available and available over the counter without any need of a prescription, as compared to pills where you need to visit a doctor, get a prescription and go to a pharmacy to buy.
• Condoms are much easier to use. They only need to be used just before sexual intercourse, as compared to pills that have to be taken regularly at a fixed time, irrespective of the frequency of sexual intercourse. Compliance becomes an issue with pills on long-term use.
• Condoms are much cheaper than pills.
• Condoms have the added advantage of preventing STIs, in addition to providing contraception.
• Pills, being hormonal in nature, have additional side effects, which are not there with condoms.

Do birth control pills cause cancer?

As compared to women who do not take the pill, taking a combined oral contraceptive pill:

• slightly increases the chances of breast and cervical cancers.
• slightly decreases the chances of ovarian and endometrial cancers

However, you should let your doctor evaluate your risk factors and decide whether to prescribe you the combined pill or not, based on your individual risk.

Can birth control pills affect my mental health?

All birth control pills contain analogues of estrogen and/or progesterone hormones, which are known to affect our mental health. Some common mental health issues that can happen with birth control pills are:

• New onset depression or increase in depressive symptoms
• Anxiety, usually mild but may be severe enough to discontinue therapy in some patients.
• Anger bursts and more negative emotional or psychological responses, especially in stressful situations.
• Persistently low mood.

However, the above information should not deter you from opting birth control pills. There are many reasons for this. First, the symptoms are highly variable and not present in everyone. The occurrence and severity of symptoms depend a lot on the baseline personality, previously existing mood disorders, and the presence of a family history of mood disorders. Such women have a greater likelihood of having new mental health symptoms or exaggeration of previous ones. Always inform your doctor of any such existing symptoms or a positive family history, while getting a prescription for birth control pills.

Carry home message

Birth control pills are an excellent contraceptive method, with an efficacy of over 99%, when used correctly. However, they contain hormones that affect your whole body, in addition to providing contraception. They may protect you against certain medical conditions and cancers, but also predispose you to certain other medical conditions and cancers.

So you should inform your doctor of any pre-existing medical conditions, personal history of mood disorders or cancers, family history of mood disorders or cancers and any medical treatment or herbal supplements that you are currently taking. You doctor will consider all of these and advise you about the best contraceptive option for you. Stay healthy!

For more such interesting information on women's health, kindly visit our website Expert Gynae Care and our YouTube channel @drnidhigarg

To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care