Contraception - Oral Contraceptives

The “pill” refers to a monthly series of 21 or 28-day pills.  Different types contain differing amounts of one or both of two synthetic hormones similar to the body’s own estrogen. It is one of the most effective prescription methods when taken as directed.  About 2 women out of 100 will become pregnant during a year of actual use. 

How the pill works
Prevents ovulation from occurring.
Prevents the lining of the uterus from developing, so if an egg is fertilized it will not be able to implant.
Increases the thickness of the cervical mucous, blocking the cervix opening and discouraging the movement of sperm.

Effective use of this method
Swallow one pill everyday, at the same time, until you finish the pack. If you are using a 21-day pack, stop for one week and then restart your new pack. If you are using a 28-day pack, begin a new pack immediately.
Try to associate taking your Pill with some regularly scheduled activity, like going to bed, eating a meal or brushing your teeth. This may make it easier to remember. Pills work best if you take one about the same time every day in order to keep a steady level of hormones in your system. This is especially important if you have bleeding between periods.

If you miss a pill
Take it as soon as you remember or take two the next day.  Continue taking your pills as directed but use a back-up method of birth control (examples are foam or condoms) for the rest of the package.
If you miss two or more pills in a row, call your health care practitioner (Nurses Clinic, Hudson Health Center: 593-4730, 593-4731) and use foam and condoms any time you have sexual intercourse, or abstain from sexual intercourse altogether until you are protected by the pill. Review full instructions when pills are prescribed and call the health care practitioner if there are questions about when to take the pill. In order for the pill to be effective, one must be taken EVERYDAY at about the same time.

Advantages
It is highly effective.
Pill users are less likely to develop pelvic inflammatory disease (PID), an infection that occurs in the uterus, the fallopian tubes, or the ovaries.
The Pill protects against ovarian and endometrial cancer.
Regular menstruation, with less flow and cramping.
Increased sexual enjoyment due to the fact that the fear of pregnancy is removed and there is no interruption during intercourse.

Disadvantages*
There is a high discontinuation rate among pill users.  Many pregnancies occur when women discontinue using the pill, fail to begin another method and then have unprotected intercourse.  All pill users should have a second method of birth control available and ready to use.  The pill must be taken everyday about the same time.
The most serious side effects are cardiovascular in nature - blood clots, stroke, heart attack, and hypertension - but occur only in a small percent of women who use the pill.  They are most often in the group that is over 35 and/or smoke.
Minor side effects are nausea, weight gain, fluid retention, breast fullness, mild headaches, spotting or break through bleeding, missed periods, yeast infections, mood changes, decreased sex drive, and darkening skin on face (cholasma).  Most of these symptoms will go away or diminish after two or three months as the body adjusts to hormone changes.  Nausea may be associated with taking the pill on an empty stomach.
There is a possible delay before resuming normal periods of several months after stopping the pill.

Contraindications

Blood Clots (Phlebitis)               

Embolism

Stroke                           

Markedly Impaired Liver Function

Cancer of Breast or Reproductive System       

Pregnancy

Strong Relative Contraindications

Migraine Headaches                   

High Blood Pressure

Undiagnosed Abnormal Vaginal Bleeding       

Pre-diabetes or Diabetes

History of Gall Bladder Problems During Pregnancy

Gestation of 20 Weeks Terminated Within the Past 4 Weeks

Relative Contraindications

Varicose Veins                   

Asthma

Cardiac or Renal Disease               

Smoking

Chloasma (Darkening of the Skin)           

Family History of Diabetes

Fibroids in the Uterus                   

Epilepsy

Depression

Lactation (the Pill can be started during weaning)

Mental Retardation (related to the individual’s level of responsibility)

Patient with Profile Suspicious for Subsequent Infertility Problems (late onset of menses and very irregular menses)

*Recently, there has been a lot of information on the pill and its possible link to breast cancer.  To date, there is no conclusive evidence of a casual relationship between the two.  However, the pill has been found to provide a protective effect against the more insidious uterine and cervical cancers. 

Early pill danger signals - remember ACHES

Abdominal pain (severe)

Chest pain (severe)

Headaches (severe) and dizziness

Eye problems such as blurred vision

Severe leg pain (calf or thigh)