Women's Health and Fertility The Pill

Birth control pills contain substances similar to estrogen and progesterone, hormones that occur naturally in a woman's body. The pills prevent ovulation, the monthly release of an egg from an ovary. Without an egg to become fertilized, a pregnancy cannot take place.

How effective is the pill?

If taken very conscientiously, less than 1 woman out of 100 will become pregnant each year of use. However, in actual use as many as 3 to 5 women out of 100 women will become pregnant each year of use. The following medications may make birth control pills less effective:

anti-seizure medications
medications to treat tuberculosis

This does not mean you should stop either medicine. Let your clinician know if you are taking these or other medications so they can recommend backup contraception if necessary. In addition, conditions such as diarrhea and/ or vomiting that decrease absorption of the pills from the gastrointestinal tract also require use of an additional birth control method during that cycle.

How are pills packaged?

Each packet contains at least 21 hormone tablets. Some packets contain 7 additional tablets of a different color which contain no hormone. They are included to keep you in the habit of taking your pills so you don't forget when it is time to resume the hormone tablets. Other 28 pill packets are called "triphasic" pills in which the hormone tablets have changing levels of progestin and/or estrogen. The hormone tablets are color coded to reflect the different levels of progestin and/or estrogen.

How to start the pill?

Sunday Start

Take your first pill on the first Sunday after your menstrual period begins. If your period begins on a Sunday take your first pill on the same Sunday. Use an additional birth control method for the first 2 weeks of the first pill packet. Foam and condoms are good back-up methods, especially when used together. Continued use of condoms for protection from sexually transmitted diseases is encouraged.

How to take the pill?

21 Day Packet

Take one pill daily (once every 24 hours is ideal) for 21 days. Go off the pill for 7 days. Start a new packet on the 8th day. Remember to use a backup method the first two weeks of the initial pill packet.

28 Day Packet

Take one pill daily for 28 days. The last 7 pills are a different color without hormones. Start with a new packet the day after completing a packet. Remember to use an additional birth control method for the first two weeks of the initial pill packet.

Triphasic 28 Day Packet

Take one pill each day for 28 days. The first 21 days are hormone pills with three different colors. The last 7 pills are without hormones and will be represented by a 4th color. Start with a new packet the day after completing a packet. Use an additional method of birth control such as foam and condoms for the first 2 weeks of the initial pill packet.

What if I forget a pill?

Forgetting pills increases risk of getting pregnant. If you forget to take a pill, take the forgotten pill as soon as you remember it. If an entire day has gone by, take two pills. Use an additional birth control method (such as condoms) while taking the remainder of that pill packet. If you miss one pill or more, you are not protected against pregnancy. Take 2 pills a day until you have caught up. Do not take more than 2 pills on any one day. If you forget one or more pills, use an additional birth control method while taking the remainder of that pill packet.

If you miss pills, you may notice some breakthrough bleeding or spotting. If the bleeding is not heavy and you can tolerate it, take the pills you missed as directed and use a back-up method until you finish the packet. If the bleeding is heavy or you have a question, call the GYN & Sexual Health Clinic at 737-3769 for additional instructions.

If remembering to take the pill everyday is a problem, you may want to consider a different method such as DepoProvera injection (the shot) or Norplant implants.

What if I skip a period on the pill?

If you have missed pills, there is a chance that you could be pregnant. Come to the Student Health Center for a pregnancy test and make an appointment to find out the results. Remember to use foam and/or condoms as your back-up method. If you are sure you have not missed any pills, continue the pills as though you had a period. If a second period is missed come in for a pregnancy test and make an appointment for the results. It is not unusual to have shorter and lighter periods while on the pill.

Who should not take the pill?

Women who have ever had any of the following problems should not use the pill:

Blood clots in the legs, lungs or other places in the body
Stroke (blood clots or bleeding in the brain)
Heart attack
Tumors of the liver

If you now have any of the following, you also should not use the pill:

Cancer of the breast, uterus, cervix or vagina
A liver disease or disorder
If you are pregnant

What about the danger of smoking and taking the pills?

Smoking cigarettes while on the pill raises the risk of very serious problems such as heart attack and stroke. The risk increases with age and heavy smoking (15 or more cigarettes per day). The problem is greatest in women over 35. Women who take the pill should not smoke!

What are some minor problems or side effects of the pill?

Many women notice side effects that are a bother, but are not dangerous to their health. Such common problems include slight swelling and tenderness of the breasts, weight gain of about 2-5 pounds, nausea, spotting or a slight bloody mucous discharge in the middle of a menstrual cycle. Many of these problems go away after the first few months of use.

Other side effects that may occur are: increase or decrease in acne; decreased lubrication during intercourse; darkening of skin on face; mood change; increase or decrease in sex drive.

Spotting (light bleeding - no tampon needed) or breakthrough bleeding (heavier bleedingÑtampon needed) occasionally occur between menstrual periods, especially during the first three months of pill use. If either occurs continue to take your pills as directed and be sure to keep an accurate record of when during your cycle this happened. These symptoms usually disappear within the first three months. If they persist please return to the Student Health Center for further evaluation.

What are the serious risks of the pill?

There is an increased risk of forming blood clots in the blood vessels. Clotting can cause a stroke (a clot in the brain) or a heart attack (a clot in the blood vessel of the heart). Clots also could form in the lung, arms or legs.

Any of these problems could lead to death. For pill users, the risk of death from a clotting problem is 4 times greater than for women who don't take the pill. The risk of serious clotting problems requiring hospital care, but not leading to death, is 10 times greater for pill users than non-users.

Some women also develop high blood pressure while on the pill. For this reason, it's important to have your blood pressure checked every 3-6 months when beginning the pill. Other problems reported less often are gall bladder disease and liver tumors.

Birth control pills are considered medication, and when seeing a health care provider they should be informed you are using the pill.

What are the danger signs on the pill?

Call the clinic if you notice any of the following problems:

A - Abdominal pain: Unrelated to anything else.
C - Shortness of breath, severe tightness in chest.
H - Headache: More frequent or more intense.
E - Eye problems: Blurred vision, flashing lights or whites of eyes turn yellow.
S - Severe leg pain: Veins that swell and feel warm to touch.

Remember the word "ACHES"

What are benefits of taking the pill?

Besides preventing pregnancy, the pill causes regular cycles (periods start predictably every 28 days); it usually decreases the amount and length of menstrual flow; and it often decreases menstrual cramps.

In women who use the pill, there is a decreased chance for ovarian cysts and ovarian and uterine cancer. There is no known increase or decrease in breast cancer occurrence.

Pills are not known to decrease fertility or chances of getting pregnant after going off the pill, although women who were irregular before using the pill may have irregular periods for a time after stopping pills.

Oves@womenshealthandfertility.com


	The Pill The Pill Is it the best alternative What are birth control pills (BCPs) and how do they prevent pregnancy? Birth control pills contain substances similar to estrogen and progesterone, hormones that occur naturally in a woman's body. The pills prevent ovulation, the monthly release of an egg from an ovary. Without an egg to become fertilized, a pregnancy cannot take place. How effective is the pill? If taken very conscientiously, less than 1 woman out of 100 will become pregnant each year of use. However, in actual use as many as 3 to 5 women out of 100 women will become pregnant each year of use. The following medications may make birth control pills less effective: anti-seizure medications medications to treat tuberculosis This does not mean you should stop either medicine. Let your clinician know if you are taking these or other medications so they can recommend backup contraception if necessary. In addition, conditions such as diarrhea and/ or vomiting that decrease absorption of the pills from the gastrointestinal tract also require use of an additional birth control method during that cycle. How are pills packaged? Each packet contains at least 21 hormone tablets. Some packets contain 7 additional tablets of a different color which contain no hormone. They are included to keep you in the habit of taking your pills so you don't forget when it is time to resume the hormone tablets. Other 28 pill packets are called "triphasic" pills in which the hormone tablets have changing levels of progestin and/or estrogen. The hormone tablets are color coded to reflect the different levels of progestin and/or estrogen. How to start the pill? Sunday Start Take your first pill on the first Sunday after your menstrual period begins. If your period begins on a Sunday take your first pill on the same Sunday. Use an additional birth control method for the first 2 weeks of the first pill packet. Foam and condoms are good back-up methods, especially when used together. Continued use of condoms for protection from sexually transmitted diseases is encouraged. How to take the pill? 21 Day Packet Take one pill daily (once every 24 hours is ideal) for 21 days. Go off the pill for 7 days. Start a new packet on the 8th day. Remember to use a backup method the first two weeks of the initial pill packet. 28 Day Packet Take one pill daily for 28 days. The last 7 pills are a different color without hormones. Start with a new packet the day after completing a packet. Remember to use an additional birth control method for the first two weeks of the initial pill packet. Triphasic 28 Day Packet Take one pill each day for 28 days. The first 21 days are hormone pills with three different colors. The last 7 pills are without hormones and will be represented by a 4th color. Start with a new packet the day after completing a packet. Use an additional method of birth control such as foam and condoms for the first 2 weeks of the initial pill packet. What if I forget a pill? Forgetting pills increases risk of getting pregnant. If you forget to take a pill, take the forgotten pill as soon as you remember it. If an entire day has gone by, take two pills. Use an additional birth control method (such as condoms) while taking the remainder of that pill packet. If you miss one pill or more, you are not protected against pregnancy. Take 2 pills a day until you have caught up. Do not take more than 2 pills on any one day. If you forget one or more pills, use an additional birth control method while taking the remainder of that pill packet. If you miss pills, you may notice some breakthrough bleeding or spotting. If the bleeding is not heavy and you can tolerate it, take the pills you missed as directed and use a back-up method until you finish the packet. If the bleeding is heavy or you have a question, call the GYN & Sexual Health Clinic at 737-3769 for additional instructions. If remembering to take the pill everyday is a problem, you may want to consider a different method such as DepoProvera injection (the shot) or Norplant implants. What if I skip a period on the pill? If you have missed pills, there is a chance that you could be pregnant. Come to the Student Health Center for a pregnancy test and make an appointment to find out the results. Remember to use foam and/or condoms as your back-up method. If you are sure you have not missed any pills, continue the pills as though you had a period. If a second period is missed come in for a pregnancy test and make an appointment for the results. It is not unusual to have shorter and lighter periods while on the pill. Who should not take the pill? Women who have ever had any of the following problems should not use the pill: Blood clots in the legs, lungs or other places in the body Stroke (blood clots or bleeding in the brain) Heart attack Tumors of the liver If you now have any of the following, you also should not use the pill: Cancer of the breast, uterus, cervix or vagina A liver disease or disorder If you are pregnant What about the danger of smoking and taking the pills? Smoking cigarettes while on the pill raises the risk of very serious problems such as heart attack and stroke. The risk increases with age and heavy smoking (15 or more cigarettes per day). The problem is greatest in women over 35. Women who take the pill should not smoke! What are some minor problems or side effects of the pill? Many women notice side effects that are a bother, but are not dangerous to their health. Such common problems include slight swelling and tenderness of the breasts, weight gain of about 2-5 pounds, nausea, spotting or a slight bloody mucous discharge in the middle of a menstrual cycle. Many of these problems go away after the first few months of use. Other side effects that may occur are: increase or decrease in acne; decreased lubrication during intercourse; darkening of skin on face; mood change; increase or decrease in sex drive. Spotting (light bleeding - no tampon needed) or breakthrough bleeding (heavier bleedingÑtampon needed) occasionally occur between menstrual periods, especially during the first three months of pill use. If either occurs continue to take your pills as directed and be sure to keep an accurate record of when during your cycle this happened. These symptoms usually disappear within the first three months. If they persist please return to the Student Health Center for further evaluation. What are the serious risks of the pill? There is an increased risk of forming blood clots in the blood vessels. Clotting can cause a stroke (a clot in the brain) or a heart attack (a clot in the blood vessel of the heart). Clots also could form in the lung, arms or legs. Any of these problems could lead to death. For pill users, the risk of death from a clotting problem is 4 times greater than for women who don't take the pill. The risk of serious clotting problems requiring hospital care, but not leading to death, is 10 times greater for pill users than non-users. Some women also develop high blood pressure while on the pill. For this reason, it's important to have your blood pressure checked every 3-6 months when beginning the pill. Other problems reported less often are gall bladder disease and liver tumors. Birth control pills are considered medication, and when seeing a health care provider they should be informed you are using the pill. What are the danger signs on the pill? Call the clinic if you notice any of the following problems: A - Abdominal pain: Unrelated to anything else. C - Shortness of breath, severe tightness in chest. H - Headache: More frequent or more intense. E - Eye problems: Blurred vision, flashing lights or whites of eyes turn yellow. S - Severe leg pain: Veins that swell and feel warm to touch. Remember the word "ACHES" What are benefits of taking the pill? Besides preventing pregnancy, the pill causes regular cycles (periods start predictably every 28 days); it usually decreases the amount and length of menstrual flow; and it often decreases menstrual cramps. In women who use the pill, there is a decreased chance for ovarian cysts and ovarian and uterine cancer. There is no known increase or decrease in breast cancer occurrence. Pills are not known to decrease fertility or chances of getting pregnant after going off the pill, although women who were irregular before using the pill may have irregular periods for a time after stopping pills. Oves@womenshealthandfertility.com