What’s so great about the Pill?
Birth control pills (also called oral contraceptives or simply “the Pill”) are one of the most popular methods of birth control. About 34 percent of women in the United States use them. Taken properly, the most common form of the Pill is better than 99 percent effective in preventing pregnancy. You may have shorter, lighter, and more regular periods while on the Pill, and you’ll be less likely to suffer from menstrual cramps or premenstrual symptoms. It also lowers your risk of uterine and ovarian cancers, as well as pelvic inflammatory disease. Besides that, taking the Pill may help your bones stay strong and may prevent the hot flashes, night sweats, mood swings, and other symptoms that can occur as you approach menopause. Certain brands even seem to improve your complexion.
How does it work?
Birth control pills contain synthetic versions of the female hormones estrogen and progesterone. A steady low dose of estrogen prevents you from ovulating; progesterone inhibits the growth of the uterine lining, making it more difficult for a fertilized egg to become implanted there, and thickens the mucus around the cervix, keeping sperm from getting into the uterus. There’s also a progesterone-only version, known as the mini-Pill, which is slightly less effective (95 percent when taken correctly) and less commonly used, but which may be a better option for women who can’t take the combination pill because of side effects or health risks.
How can I get on the Pill?
You’ll need to see your doctor for an exam and a prescription. You can begin taking the Pill on any day during your cycle, but many doctors recommend that you start on the Sunday after your period to make sure you’re not pregnant. It’s a good idea to use another birth control method during your first month on the Pill, just to be safe. Expect to pay between $20 and $50 a month, depending on the brand.
How do I take the Pill?
The combination pills come in packs of 21 or 28. Some brands require you to take the pills in a particular order, because they give you varying amounts of the hormones at different times during your cycle. In any case, you take one hormone pill each day for 21 days, and then either nothing or a dummy pill (to keep you in the habit) for the next seven. During that week you’ll usually get your period.
The mini-Pills come in packs of 28. All the pills in a pack contain hormones, so it’s especially important not to miss one. These must be taken at the same time each day; if you’re off by even three hours, you’ll need to use a backup method for the next two days.
It’s also a good idea to use an additional method if you vomit or have diarrhea during a cycle, since your body may not be absorbing the hormones from the Pill. Some antibiotics and other drugs can also affect the way birth control pills work, so be sure to tell your doctor that you’re on oral contraceptives before you start taking any other medications.
What if I forget to take a pill?
If you miss a single pill, take it as soon as you remember. Then take the next one at your regular time. It’s okay to take two pills during the same day, but you may feel a bit nauseated. If you forget two or more pills in a row, take the last pill you missed right away and then start taking them again on schedule, throwing away any other pills you missed. Use a backup method of birth control for the next seven days. You may experience some spotting or light bleeding during this time. If you miss your period at the end of the cycle, see your doctor or healthcare provider for a pregnancy test. There’s no evidence that birth control pills can harm a fetus, but it’s a good idea to stop taking them (and to use another method instead) until you know you’re not pregnant.
What are the side effects?
Today’s pills contain much smaller amounts of hormones than the ones that first came on the market in the 1960s, and thus cause fewer side effects. You may have spotting or bleeding between periods, or no period at all. Some women get headaches and nausea (try taking your pills with meals or just before bedtime). Others report swollen breasts, increased appetite, weight gain or loss, an altered sex drive, or periods of depression. Most side effects go away within three months; sometimes switching to another brand of pill can help.
Can I take the Pill while I’m breastfeeding?
You can start taking the progesterone-only pill once you’ve established a good breastfeeding pattern, usually four to six weeks after your child’s birth.
Are there any health risks?
For many women, the Pill’s benefits outweigh its risks. While some reports have found a relationship between birth control pill use and increased risk of stroke, a recent review of available studies suggests otherwise. According to a report in the April 2004 Archives of Internal Medicine, researchers reviewed 36 different studies and found no real link between use of the newer low-dose pills and stroke. Though some studies reviewed by the research team showed an increase in strokes caused by blood clots, there was no increased risk of a hemorrhagic stroke (bleeding in the brain).
Any woman who’s had a blood clot should avoid the Pill, since it increases the likelihood of another one. In 2001 Dutch researchers conducted a review of studies involving blood clots in women who took birth control pills and found that the newer pills – those called third generation pills – presented a higher risk of blood clots than older or second generation pills.
If you’re a smoker, you shouldn’t take the Pill. According to Planned Parenthood, smokers over age 35 who take the Pill are 10 times more likely to have a heart attack than women who do neither.
According to the American Cancer Society, women who take birth control pills are at a slightly greater risk of breast cancer than those who don’t — though that increased risk disappears once a woman has been off the pill for ten years. A Scandinavian study of 100,000 women reported in the journal Cancer Epidemiology Biomarkers & Prevention found that women using birth control pills increased their risk of breast cancer by 60 percent, though a year after stopping the pill, their risk was only 20 percent higher than women who didn’t use it.
Some studies have shown a very small increase in the risk of cervical cancer. On the other hand, taking the Pill for even a short time cuts your chances of getting uterine or ovarian cancer by at least 40 percent, and the risk drops more the longer you’re on it. The American Congress of Obstetricians and Gynecologists reports that the combination pill may reduce the risk of ovarian cysts, pelvic infection, polycystic ovary syndrome, bone loss, ectopic pregnancies, endometriosis, and fibroids. Your doctor can help you weigh the benefits and risks of the Pill so you can make the decision that’s best for you.
What symptoms may indicate a medical problem?
Sharp pain in the chest, severe abdominal pain, a bout of coughing up blood, sudden shortness of breath, serious pain or swelling in one leg, severe headaches, blurred or double vision, slurred speech, and tingling or weakness on one side of the body are all potential indicators of a serious pill-related problem. Call your doctor right away if you notice any of these symptoms.
References
American College of Obstetricians and Gynecologists. Birth Control Pills.
Birth Control: Birth Control Pill. Kidshealth.org. Nemours Foundation.
US Department of Health and Human Services. Women’s Health USA
Beral V et al. Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46,000 women from Royal College of General Practitioners; oral contraception study. BMJ 9;318(7176):96-100.
Weiderpass E et al. Use of oral contraceptives and endometrial cancer risk (Sweden). Cancer Causes Control;10(4):277-84.
Contraception Health Risks. The Self-Care Advisor:217-18.
Barbara Bailey Kelley. Learning to Love the Pill – Again. Health :46-48.
Jensen JT et al. Health benefits of oral contraceptives. Obstet Gynecol Clin North Am(4):705-21.
Kemmeren JM, et al. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ 2001 Jul 21;323(7305):119-20.
Tanis BC, et al. Oral contraceptives and the risk of myocardial infarction. N Engl J Med 2001;345(25):1787-93.
Jon Knowles. Smoking or the Pill. Planned Parenthood Federation of America, Inc.
Kumle M, et al. Use of Oral Contraceptives and Breast Cancer Risk. Cancer Epidemiology Biomarkers & Prevention. Vol. 11, 1375-1381.
What Are the Risk Factors for Breast Cancer? American Cancer Society. Cancer reference Information.
Chan WS, et al. Risk of stroke in women exposed to low-dose oral contraceptives: a critical evaluation of the evidence. Arch Intern Med. 2;164(7):741-7.
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