Birth control pills (also known as oral contraceptive pills), are one of the most popular medications used by women. Not only are they effective methods of contraception, but many women use the pill for regulation of their menstrual cycle, relief from severe menstrual cramps, or for reduction of heavy menstrual flow. Recent advances in the pill afford women with options regarding type and amount of hormones used, as well as some birth control pills that are not even in pill form.

Types of contraception:

Birth control pills fall under the category of hormonal contraception (as opposed to barrier methods such as condoms, or permanent methods such as a tubal ligation or a vasectomy). Combination pills contain both estrogen and progesterone, and are designed to act more like a woman’s natural cycle. (Depo Provera is another type of hormonal contraception, but, unlike combination methods, Depo contains progesterone only and most women will not have cycles after a few injections.) There are three basic forms of combination hormonal contraception: the pill, the patch, and the ring.

The Pill: By far, the most common form of hormonal birth control is the pill. Taken daily, the pill will afford women with effective contraception, less menstrual cramps, regular cycles, decreased menstrual flow, and often, improvement in acne. Almost all pills contain estrogen and progesterone for the first three weeks, followed by one week of placebo pills (often called “blanks”).

There are two main types of pills: monophasic and triphasic. Monophasic pills contain the same dosage of medicine every day, while triphasic pills vary the amount of hormone in each pill by the week. Monophasic pills are usually better for women with PMS, mood swings, or endometriosis. Triphasic pills are designed to follow your natural hormone fluxes and are sometimes better for women who have difficulty with low libido or irregular cycles. Both are equally effective at preventing pregnancy and the decision to choose one pill over the other may depend simply upon your or your doctor’s preference.

The pill also can vary in the amount of estrogen and the type of progesterone. The estrogen in the pill comes in 50 micrograms (high-dose), 35 (regular-dose), 30, 25, and 20 micrograms (low-dose). Higher dose pills can be better for women who have breakthrough bleeding (bleeding mid cycle) on low or normal dose pills. Lower dose pills are often better for women with endometriosis, or mild hypertension. In general, the lowest effective dose of estrogen that accomplishes your goals is the best for you. Your doctor will be happy to discuss the pros and cons of each pill with you at your appointment. The progesterone part of the pill often varies from product to product. Some progesterones are better at preventing acne, while others will provide more cycle control. Speak with your Kingsdale physician as to which option is best for you.

Who can take the pill?

In general, any woman of reproductive age (13-55) who needs the pill can consider taking it.

Reasons women take the pill:

• Contraception
• Control of irregular or heavy cycles
• Control of severe menstrual cramps (dysmenorrhea)
• Control of severe pre-menstrual syndrome (PMS)
• Treatment of severe acne (along with other methods)
• Treatment of endometriosis or pelvic pain
• Prevention of recurrent ovarian cysts

Who can’t take the pill?

The estrogen component of the pill, while affording most of the benefits, also can lead to some serious complications in women with certain medical conditions. Before starting the pill, every woman should discuss these risks with their Kingsdale physician. Estrogen tends to increase the ability of the blood to clot. Therefore, the most serious complication that can arise from taking the birth control pill is the risk of a blood clot in your legs (deep venous thrombosis). Anyone taking the pill who notices increases swelling, redness, or pain in her legs or who has sudden shortness of breath or chest pain should see a physician immediately.

Absolute contraindications to the pill:

• Any personal history of deep venous thrombosis
• Any personal history of heart attack or stroke
• Pregnancy
• Abnormal bleeding that has not been evaluated by your physician
• High triglycerides
• Women over the age of 35 who smoke (even socially)
• Active liver disease

How effective is the pill?
When taken correctly, the pill is up to 97% effective. In other words, women who take every pill in the pack at the correct time will have a less than 2-3% chance of pregnancy. The key phrase in that sentence is “when taken correctly”. Most women who become pregnant on the pill do so because they either miss a pill, or they forget to resume their pills after the pill-free week. For that reason, we recommend that you take your pill at the same time each day, and be sure to take all of the pills in the pack unless otherwise instructed by your doctor. If you miss one pill during the week, we recommend taking two pills the next day (one in the morning and one at night to prevent nausea), and be sure to use a backup method of birth control for that month if you do not do so already.

The pill can’t do everything.

While there are many advantages to using the pill, it is important to remember that while affording reliable contraception and cycle control, the pill does not prevent sexually transmitted diseases such as gonorrhea, HIV, HPV, or herpes. Therefore, we strongly recommend following safe sex guidelines and use condoms when needed. Some studies have shown an increase in the incidence of sexually transmitted diseases, specifically HPV (the virus that can cause abnormal paps) in women on the pill; most likely due to the decreased use of condoms by women who use oral contraception.

What if I smoke?
If you smoke, the best decision you could ever make for yourself is to quit smoking. The physicians at Kingsdale are unanimously supportive of patients who want to quit smoking and your doctor has a variety of interventions that can help you to quit. If you are approaching 35 years old and smoke even one cigarette occasionally, you will need to decide to quit smoking, or find alternative methods of birth control or cycle control. (As doctor’s, of course we prefer that you choose to stop smoking). Speak with your Kingsdale physician as to which smoking-cessation method is best for you.

How do I start the pill?
Most doctors recommend starting the pill on the first Sunday after the start of your next period, even if you are still bleeding. You can technically begin the pill at any time after a cycle, but there are two main reasons for choosing a Sunday start. First, by convention, most women begin on Sunday and it is the default day for most pill packs (all packs have stickers that you can place over the Sunday guide if needed). The second reason is for convenience, as most women who start on Sunday will not have their period during the weekend (a definite bonus for vacations or the occasional weekend excursion). We also recommend using an additional method of birth control for the first month on the pill.

What about antibiotics if I’m on the pill?
Despite common belief, only a few antibiotics affect the reliability of the pill and require alternative contraception for the month you are on them. Rifampin (an antibiotic used to prevent bacterial meningitis), and Phenobarbital and phenytoin (anti-seizure medications) will definitely affect the pill, and you cannot rely on the pill alone for birth control if you are taking these medications. However, if you are on high doses of antibiotics, if you are taking antibiotics for a long period of time, or if you become anxious about pregnancy when given a prescription for antibiotics, we recommend using back up birth control for that month.

What do I do if I’m on the pill and I miss a period?
If you are on the pill and are late for your cycle, the first thing you should do is check a home pregnancy test or come into the office for a lab test to be sure that you are not pregnant. If your test is negative, then the missed cycle is likely a side effect of the pill. Over time, the lining of the uterus can become so thin on the pill that some women will notice that their periods become very light or they may miss one or two altogether. This can be more common with some varieties of the low-dose pills. If this becomes bothersome or if you would like to change pills, simply make an appointment to discuss this with your physician.

The patch:

The birth control patch is a relatively new method of combination hormonal birth control for women. It has the same hormones as the pill, but, instead of entering the body through the digestive tract, they are slowly absorbed through the skin. The patch is applied every week, and affords women the convenience of not having to remember to take a pill every day. The patch can be placed almost anywhere on your body and must be changed every week for three weeks each month. During the fourth week, it is removed, and a normal menstrual cycle should occur. The adhesive on the patch has been designed to endure daily activity, swimming, exercise, and most other physical endeavors. The patch may be a good option for women who are not the best at remembering to take a pill daily, who have a tendency to get migraines, or who have tried pills in the past but, for whatever reason, did not like them. The same contraindications and risks exist for the patch as they do for the pill, and you should consult with your physician before trying the patch.

The ring:

The vaginal contraceptive ring is another relatively new method of hormonal birth control. It consists of a synthetic ring filled with hormones that is placed vaginally, and remains in place for three weeks. After three weeks, it is removed, and your cycle should begin normally. It is no more difficult to insert than a tampon, and is designed so that you should not even notice it when it is in place. It offers women an option with less necessary attention than the patch or the pill as it needs to be replaced only every month. Also, because the hormones are absorbed through the lining of the vagina, some women notice increased lubrication and a lower incidence of yeast infections while using the ring. Again, as it contains estrogen and progesterone, the same risks apply as with the pill and the patch. Speak with your Kingsdale physician at your next appointment for more information.