ORAL CONTRACEPTIVES

There are two types of oral contraceptives:

  • combined oral contraceptive pills; with both estrogen and progesterone

  • progesterone only pills; with only progesterone, for those who cannot tolerate estrogen

COMBINED ORAL CONTRACEPTIVE PILL

What is it?

The combined oral contraceptive pill, or the “birth control pill” contains both estrogen and progestin hormones. It is taken daily over 21-28 days to prevent pregnancy. Some pills have 21 or 24 pills containing hormones, and 4-7 pills that are inert, with no hormones. When you buy them, there will be 21 or 28 pills in each package. When you take in 4-7 inert pills, or stop after the 21 pill pack, you will have a period, or a “hormone withdrawal bleed”.

How does it work?

After you swallow a pill, the hormones are absorbed into the blood stream. This prevents ovulation so that no egg is released from the ovaries. It also helps to thicken the cervical mucus making it harder for sperm to travel into the uterus. It also helps thin the lining of the uterus to prevent a fertilized egg from implanting inside the uterus.

How do I start using it?

The pill can be started on the first day of your period, or the day after an abortion. This will mean that you are protected right away against pregnancy. You can also start in between your periods, but you must use condoms or abstain from sex for 7-10 days to let them work. You must take the pill at the SAME TIME EVERY DAY. Most women start with a package of 28 pills. This means you take one pill per day for 28 days, and on the last 4-7 days of the pack, you will likely have a period. You start the next package the next day- there are no days without pills- even if you have not bled. If you miss a day, you are at risk of pregnancy.

When does it start working?

If you start on the first day of your period, or on the day after an abortion, it will start working right away. If you start in between your periods, then it takes 7-10 days to be effective. Use condoms or abstain from sex until it is working.

What if I miss a pill?

You can get pregnant if you miss your pill by 12 hours or more. When you forget, take the missed pill as soon as possible, but it is wise to use condoms for the rest of the package or get a copper IUD right away. If you have unprotected sex after you miss a pill, you should also take the morning after pill which can be obtained from a pharmacy without a prescription. Ask for the emergency contraceptive pill.

Can anything make the pill less effective?

Yes. Many medications that are metabolized in the liver will interfere with your body being able to process the combined birth control pill. There include some antibiotics and some medications for seizures. Check with your doctor if you are on other medication when taking the pill. Also, if you have prolonged intestinal infections with diarrhoea, then the pill may not be absorbed well when you swallow it.

What are danger signs that something is wrong?

There is a small but serious risk of blood clotting with using the pill, though these risks are less than the health risks of pregnancy. If there is a clot forming, you may have severe pain in your calf or thigh, chest pain, severe headache or vision problems. Seek help at the emergency department right away.

PROGESTERONE ONLY CONTRACEPTION PILL (POP)

What is it?

The progesterone only oral contraceptive pill, or the “POP” contains ONLY progestin hormone, called norethindrone. It is taken daily to prevent pregnancy. When you buy them, there will be 28 pills in each package. You take them daily, every day, and start a new pack right away. There is no break.

How does it work?

It mainly works by slowing, thinning or stopping the growth of the inner lining of the uterus, called the endometrium, and by thickening the cervical mucus. Very few sperm can then travel into the uterus. In 60% of women who take the POP, ovulation is also inhibited, which means that no eggs are produced in the ovaries.

How do I start using it?

The POP is taken daily and at the same time of day (within three hours) to ensure a reliable effect. The pills should be started on the first or second day of the menstruation cycle, or the day after an abortion, and then daily (nonstop) thereafter. There is no pill free interval. All 28 pills in a package contain active medication. If you miss a day, you are at risk of pregnancy.

When does it start working?

If you start on the first day of your period, or on the day after an abortion, it will start working right away.  If you start in between your periods, then it takes 7-10 days to be effective.  Use condoms or abstain from sex until it is working. 

What if I miss a pill?

You can become pregnant if you miss your pill by 3 hours or more. When you forget, take the missed pill as soon as possible, but it is wise to use condoms for the rest of the package or get a copper IUD right away. The literature indicates that condom used for at least 48 hours is required, because it takes a few days to thicken the cervical mucus again once you restart the POP. If you have unprotected sex after you miss a pill, you should also take the morning after pill which can be obtained from a pharmacy without a prescription. Ask for the “emergency contraceptive pill”.

Can anything make the pill less effective?

Yes. Many medications that are metabolized in the liver will interfere with your body being able to process the POP. There include some antibiotics and some medications for seizures. Check with your doctor if you are on other medication when taking the pill. Also, if you have prolonged intestinal infections with diarrhoea, then the pill may not be absorbed well when you swallow it.

Many women like the POP for the following reasons;

  • It is safe for most women, for example, when you are breastfeeding, or cannot take estrogens for any reason, or you smoke and are over 35

  • It regulates your period, so you know when you expect it

  • It can reduce the amount of bleeding and/or cramps

  • It is 90-99% effective (depends on your perfect use)

  • It allows for more spontaneous sex as you are protected

  • No estrogen- related side effects

There are some health benefits to being on the POP

  • It may help reduce moodiness or other PMS symptoms that you have when you are not using any hormones

  • It is reversible- once you stop, you can get pregnant

  • It will help you avoid pregnancy till you are ready

Successfully switching from another method:

  • If you were on Depo-Provera, start at least a week before your next injection is due

  • Most side effects resolve in 2-3 months.

Many women like the POP for the following reasons:

  • It is safe for most women, for example, when you are breastfeeding, or cannot take estrogens for any reason, or you smoke and are over 35

  • It regulates your period, so you know when you expect it

  • It can reduce the amount of bleeding and/or cramps

  • It is 90-99% effective (depends on your perfect use)

  • It allows for more spontaneous sex as you are protected

  • No estrogen- related side effects

There are some health benefits to being on the POP

  • It may help reduce moodiness or other PMS symptoms that you have when you are not using any hormones

  • It is reversible- once you stop, you can get pregnant

  • It will help you avoid pregnancy till you are ready

Successfully switching from another method:

  • If you were on Depo-Provera, start at least a week before your next injection is due

  • Most side effects resolve in 2-3 months.

Some women don’t like the POP for the following reasons:

  • It may cause spotting, irregular, or no bleeding

  • It may cause hormonal side effects like bloating, headaches, or mood changes

  • It doesn’t protect against STIs

  • It must be taken at almost the same time every day so there may be more chance of it not working

  • Some women develop functional ovarian cysts which are not usually dangerous, but can cause pelvic pain

But it is a safe option for most women!

ORAL CONTRACEPTION PILL