The Birth Control Pill

Contents: Information about the Birth Control Pill About Oral Contraceptives Choose a Back-up Method Instructions for Use Answers to Common Questions Temporary Minor Discomforts Danger Signs Major Pill Complications The Pill and Other Drugs The Pill and STIs Additional Online Information Related Services at the Tang Center

About Oral Contraceptives
Oral contraceptives or birth control pills ("the Pill") are used by women to prevent pregnancy, to regulate the menstrual cycle, and to provide hormone replacement therapy. Combined birth control pills (containing estrogen and progesterone) work mainly by stopping ovulation -- if there is no egg to meet with sperm, pregnancy cannot occur. Reversible effects on the cervical mucus and uterine lining also discourage pregnancy. Under ideal conditions, oral contraceptives have an effectiveness rate of over 99.5%.

Recent data have shown a lower incidence of uterine and ovarian cancer in women who have taken the Pill. More research needs to be done regarding the Pill's relationship to breast and cervical cancer. There is no conclusive evidence that the Pill causes cancer. Possible benefits of taking the Pill include a decreased incidence of: ovarian cysts, benign breast changes, iron deficiency anemia, pelvic infections, ectopic pregnancy, acne, menstrual cramps and long, heavy menstrual flow. Women who use hormonal contraception are strongly advised not to smoke.

Choose a Back-up Method
To obtain continuous, effective contraception, plan to overlap the Pill with another method. It is important to have a back-up method of birth control (such as a combination of vaginal spermicide and condoms) to use while you take your first pack of pills. The Pill may not fully protect you against pregnancy during the first seven days. The back-up method also should be used any time you discontinue and then resume taking the Pill. The back-up method you choose will also be effective if you run out of pills, forget pills, experience Pill danger signs and stop using the Pill, or want protection from sexually transmitted infections.

Instructions for Use
Monophasic Pill: Contains the same combination of estrogen and progesterone in each 21 days of active pills.

• Unless otherwise instructed, start your first pill on the first Sunday after your period begins or the first day of your next period.
• Take one pill per day, until you complete the pack, at the same time each day. Begin your new pack after the 7 hormone free pills (even if you are still bleeding). You may start a new pack in less than 7 days to resume a Sunday-start schedule.
• You probably will have your withdrawal bleeding (menstrual period) sometime during the last seven days of each pack. The last seven tablets, in your 28-day pack, do not contain hormones. If you do not take the last seven tablets, begin your new pill pack on the 8TH day following your last hormone tablet.

Triphasic Pill: If you are using triphasic birth control pills (each 7 days of active pills contain a different combination of estrogen and/or progesterone), please read the package insert so that you are clear about the significance of the different pill colors and the need to take these pills in a specific order.

Continuous Cycling: Refers to continuous use of the Pill for 2 or more cycles (2 or more pill packs). For example, a 21 day cycle of hormone pills is taken, followed by another 21 day cycle of hormone pills. The 7 days of inactive pills are omitted. Continuous Cycling has been used for many years in clients with various medical problems, such as endometriosis. Safety with general use has not been established. Side effects may include irregular bleeding. The method is not approved for clients using triphasic pills. Prior to initiating this method, speak with your clinician.

Birth control pills work best when taken the same time each day. Try to associate taking your pill with another activity that you do approximately the same time each day, like going to bed or brushing your teeth. This will maintain a steady level of hormones in your system to protect you against break-through bleeding and possible pregnancy.

If you forget a pill, continue to take your pills as directed below and use a back-up method for at least 7 days. Missing pills puts you at significant risk for pregnancy if no back-up method is used.

If you miss ONE pill:

• Take the pill as soon as you remember.
• Take the next pill at the regular time (it's okay to take 2 pills on the same day or 2 pills at the same time).

If you miss 2 pills in a row (in 1st or 2nd week):

• Take two pills daily for 2 days
• Use back-up method for at least next 7 days

If you miss 2 pills in a row (in 3rd week) or if you miss 3 or more pills in a row in any week:

• If you are a Day 1 Starter
  • Discard the rest of the pack
  • Start a new pack the same day
  • Use back-up method for at least next 7 days
• If you are a Sunday Starter
  • Keep taking 1 pill every day until Sunday
  • On Sunday, discard the rest of the pack and start a new pack of pills that same day.
  • Use back-up method for at least next 7 days

If you have had unprotected intercourse:

• Call a clinic Advice Nurse and request information about the Morning After Pill treatment.

If you miss any of the last 7 inactive pills:

• You do not need a back-up method if these are the only pills that you didn't take this cycle, but be sure to start the next pack on time.

Answers to the Most Common Questions about the Pill

Temporary Minor Discomforts
Some women experience a variety of minor discomforts when starting the Pill. Some of these symptoms may be nausea, breakthrough bleeding, breast enlargement or tenderness, slight weight gain, mood changes, and changes in libido. Most of these symptoms will disappear within the first 3 cycles of the Pill. Acne, though often improved in the long run, may worsen for a couple of months when you first start the Pill. If any of your symptoms are severe or persist, call a Clinic Advice Nurse at (510) 643-7197.

The Pill Danger Signs

• Abdominal pain (severe)
• Chest pain (severe)/shortness of breath/coughing up blood
• Headaches (severe)/dizziness/weakness/numbness
• Eye problems (vision loss or blurring)/speech problems
• Severe leg pain of calf or thigh
  

If you develop any of these symptoms:

• Call or immediately come to Urgent Care, (510) 642-3188, or other emergency medical facility
• Call 911 for an ambulance in extreme emergency
  

Major Pill Complications
The most serious risk of combined contraceptives, including the Pill, is the potential for cardiovascular complications: blood clots, stroke, hypertension, or heart attack. These side effects are extremely rare and occur most often in women who smoke, who are over age 35, who have other health problems like hypertension, diabetes, heart disease, vascular disease, or blood clots; and those who have a family history of diabetes or heart attack under the age of 50. If you smoke, you may have an increased risk for developing major complications. Young, healthy, non-smoking women can use the Pill with very little risk of developing serious complications. Learn the Pill Danger Signs listed above.

The Pill and Other Drugs
The Pill may have adverse interactions with some other medications. In some cases contraceptive effectiveness is lowered. In a few cases, another drug may reach a toxic level in combination with the Pill. Be sure to inform your clinician and pharmacist at each visit of any medications, including non-prescription drugs, which you are taking. Always advise any clinician that you see for any medical problem, especially if admitted to a hospital or before surgery, that you are taking birth control pills.

The Pill doesn't protect against sexually transmitted infections
Even though you are using the Pill, seriously consider using condoms as well in order to protect you and your partner from sexually transmitted infections (STIs) e.g. chlamydia, gonorrhea, syphilis, HIV, etc.

 

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