What do we mean by combined oral contraceptive pill?
How does the combined contraceptive pill work? (See Transdermal Patch)
1. Prevents the release of the egg from the ovary, a process called ovulation.
2. Thickens the cervical mucus or secretion preventing the entry of the sperm into the cervix.
3. Changes the lining of the uterus making it unfavorable for fertilization.
Does it work for everyone?
No, it does not work for everyone. You have to consult your doctor to see if you would be eligible to take the pill. Below is a general guideline. If you have any of the following factors mentioned below you may not be eligible to take the combined oral contraceptive pill. More so, you will be more prone for side effects from the pill.
1. Age> 35 years
2. History of smoking
3. Have a history of blood clots deep vein thrombosis (clot in one of the big veins in your legs, thighs or arms) or Pulmonary embolism (clot in your lungs).
4. History of stroke
5. History of breast, liver or endometrial (the lining of the uterus) cancer
6. Have a history of heart disease
7. Have kidney, liver problems
8. Have migraines with aura (complicated migraine or severe migraine)
9. Have diabetes-related complications, such as a damaged retina (retinopathy), in other words uncontrolled long standing diabetes mellitus.
10. Are about to be immobilized for a prolonged period due to major surgery
11. Have unexplained uterine bleeding
12. Are taking medications like antibiotics, over the counter medicine e.g. St. John's wort or anticonvulsants.
What are the different forms of pills available in the market?
1. Traditional pill form where the pill mimics the regular menstrual cycle.
a) The pack contains 28 pills. For 3 weeks the pill contains hormones and for the last week it is called a placebo where there are no hormones and that week you will have your monthly menses.
b) There is a different form where the pack contains only 21 pills. All 21 pills contain hormones. The last week you don’t take any pill and you will have you monthly menses. E.g. brand name: Loestrin.
The disadvantage is there is a higher chance of missing the pill as you have to remember to start the pill after a week. If you miss > than 2 days then you have to plan a backup method.
c) Another version is there are 24 active pills and only 4 pill free days.
E.g. Yaz 28, Beyaz and Loestrin 24.
2. Continuous pill form:
This form as the name says you take the pill without any break anywhere from 3 months to a year. What? You did hear that right!
What it means is you don’t have your periods every month. It is FDA approved and found to be safe. In fact there are some experts who suggest that the mood fluctuations, cramping and intermittent bleeding are found to be less with the use of continuous pill.
The first extended-cycle pill regimens introduced was (Seasonale), where you take the pill every day for three months, then one week of placebo pills. The others in the same category are (Seasonique, LoSeasonique). The difference between Seasonale and Seasonique is in the amount of estrogen. The latter has low estrogen which is responsible for most of the side effects like heart disease, stroke and blood clots.
A newer extended-cycle regimen is designed to be taken continuously for one year (Lybrel).
What are the advantages in using the combined pill?
1. Does not interfere with sex life
2. Highly effective
3. Reversible, does not affect fertility
4. May decrease premenstrual symptoms like mood changes or cramping.
5. Protection from ovarian cysts, ovarian cancer and uterine cancer
6. Usually lighter menstrual bleeding and less cramping
7. Predictable regular menstrual cycles with conventional pill
8. Can be taken continuously to decrease the number of periods with the continuous pill
It seems like it has got more benefits. Are there any side effects which you have to watch out?
The following are some of the common side effects.
1. Having to remember to take pill daily
2. unscheduled bleeding (usually resolves in 2-3 months)
3. High risk for medical complications in smokers as 4 and 5
4. Blood clots in the legs, lungs, heart or brain
5. Heart attack and stroke
6. Benign liver tumors
7. Increases risk of cervical, breast and liver cancer.
8. Offers no protection against sexually transmitted infections
9. Rarely, pigmentation of facial skin
When to start the Pill?
The pill should be started on the first day of the menstrual cycle to have the most benefit.
If for some reason you cannot start within 5 days, it is ok to start taking the pill anytime you want to. But remember to use a back-up contraceptive method for 1 week.
How early can you plan for a baby after stopping the pill?
Ovulation is usually delayed by 2 weeks once you stop taking the pill. So your next period would be at about 4-6 weeks.
You can become pregnant any time after your ovulation returns. What that means is if you get pregnant as soon as ovulation returns then you may not have your periods after stopping the pill.
It is advisable to wait for return of at least one normal menstrual before planning for a baby as it will be helpful to estimate your due date accurately.
Is it true that for some, the periods may not return to normalcy for prolonged periods after you stop the pill?
“Post pill amenorrhea” is term which your doctor might use. Amenorrhea is the absence of menstrual bleeding.
What happens to your body when you take hormones?
As we have discussed earlier Estrogen and Progesterone are 2 important female hormones secreted by our body. Since you have been taking these hormones from an external source your body stops producing them or decreases it dramatically to maintain the balance.
What happens when you stop taking the pill?
For most people the body returns back to normal state in 2 weeks. But for some the native hormone production can be delayed by about 3 months. If it is longer than that you may need a pregnancy test and other blood work to evaluate further. So please consult your doctor.
Can I get pregnant by chance when I am taking the pill?
Yes. You may get pregnant due to failure of contraception or because you missed your pills or some other drugs you are taking which may interfere with the birth control pill and make it less efficacious.
The failure rate of combined birth control pill in reality is about 2-3%. In an ideal pill user i.e. in someone who would take the pill at the same time of the day and every single day, the failure rate is only 0.1%.
Any time you miss the pill for more than 2 days you would have to use a backup contraception for a week. If you had unprotected intercourse at any time you missed the pill, you can use emergency contraception.
Is it harmful for the baby if you get pregnant by mistake when you are on the pill?
No. There has been research on this topic out of concern. Till date there has been no known documented birth defect for the baby from birth control pill.
However it is strongly recommended that you stop the pill as soon as you find out that you are pregnant.
Does the pill cause weight gain?
The estrogen in the pill can cause fat cells to increase in size. But this does not attribute to an overall weight gain. Many women on the pill may report weight gain. This is due to fluid retention due to hormones.
Do you have to start the pill in consultation with a doctor?
You may think you know so much information and you can get it over the counter. There are something’s which you have to watch when you are on the pill.
Your blood pressure, cholesterol levels, liver function tests, potassium level in blood and annual GYN exam and PAP smear exam. You may get the pill from anywhere but it is important to follow up with your doctor.
There are so many different pills in the market. Is there any difference between them or are they all the same?
The amount of estrogen and progesterone may vary among the different pills.
Over the years we have learnt that the amount of estrogen is responsible for side effects like blood clots, heart disease and stroke. Typically in the past each pill contained about 50mcg of estrogen. The newer combined oral contraceptive pill typically contains about 20-35 mcg.
There have also been changes in the amount and type of progesterone over the years. Typically the newer pills contain long acting progesterone where the effect lasts longer.
Is there any difference in the failure rate between branded ones and the generic pill form?
There have been only few studies done to compare the generic pill and the branded ones. To date there is no difference that we know of.