The Birth Control Pill

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Birth control pills are a medication women take every day to prevent pregnancy. They are sometimes called “the pill” or oral contraception.  Most women using the pill take “combination pills.” These contain two hormones - estrogen and progestin.

Some birth control pills contain only one hormone - progestin. These are sometimes called “mini-pills”. Progestin-only pills are good for women who cannot use estrogen. The information below includes information about the combined pill only and will be referred to as “the pill” throughout.

The pill is a very reliable birth control method. If the pill is used correctly, less than 1 out of 100 women using the pill will become pregnant (.3 %). If the pill is not always used correctly, 9 of 100 will become pregnant (9%). To use the pill correctly, you must:

  • Take a pill every day (and the pill works best if you take it at the same time each day. You might find it helpful to take the pill when you do something else every day — like brushing your teeth or eating dinner).
  • When you first start the pill, it takes several days to begin working. Be sure to use backup birth control (like a condom) for the first 7 days on the pill.

There are many combined hormone pills available today, and while each one provides the same effectiveness against pregnancy when used correctly, there are variations between brand in the appearance, composition, and directions for use of each particular pill. Be sure to ask your healthcare provider or pharmacist if there are different considerations or directions for your pill, such as with Natazia® and others, than those that are outlined in this brochure.

BIRTH CONTROL PILLS DO NOT PREVENT SEXUALLY TRANSMITTED INFECTIONS. USE A CONDOM WITH EVERY ACT OF INTERCOURSE TO REDUCE YOUR RISK FOR ACQUIRING SEXUALLY TRANSMITTED INFECTIONS.

BEFORE STARTING THE PILL

Be sure that you have informed your health care provider if you:

  • Take any medications, herbal products or dietary supplements
  • Smoke or
  • Have any history of:
    • Migraine headaches
    • Hepatitis
    • Breast lumps or nodules
    • Diseases involving blood clots
    • Tumors of the ovaries
    • Diabetes
    • High blood pressure
    • Heart attacks
    • Cancer of the female organs
    • Active gallbladder disease
    • Inflammatory bowel disease
    • Lupus
    • Rheumatoid arthritis
    • Blood clots in your family or blood clotting factor mutations
    • Bariatric surgery or
    • A solid organ transplant.

Women with certain health conditions should not use combination pills. Others will need closer monitoring while on the pill to reduce the risk of negative health effects.

Smoking cigarettes with the pill, especially if you are over the age of 35, increases your risk for several serious conditions including blood clots, stroke, heart attack, and high blood pressure. Because of these risks, women who smoke and are over the age of 35 should not take the combined hormone birth control pill.

Your health care provider will help you weigh your particular risks relative to the pill.

HOW DOES THE PILL WORK?

The pill prevents pregnancy mainly by suppressing ovulation (the release of the egg from the ovary), by thickening cervical mucus, hampering the transport of sperm, and by other hormonal mechanisms which prevent fertilization and implantation of the egg.

WHAT ARE SOME BENEFITS OF THE PILL?  

  • The pill is safe, convenient, and very effective.
  • The pill allows for spontaneity.
  • Most women can get pregnant quickly when they stop using the pill.
  • Periods may become lighter and less painful if you take the pill.
  • The hormones in pills offer health benefits. The pill can offer some protection against non-cancerous breast growths, iron deficiency anemia, ovarian cysts, pelvic inflammatory disease, PMS symptoms, and menstrual-related migraine headache. Acne is often improved, and the pill offers protection from some cancers such as ovarian and endometrial (the endometrium is the lining of the uterus).
  • Birth control pills do not protect against sexually transmitted infections (STIs). Condoms do. Use a condom with every act of sexual intercourse to reduce your risk of acquiring sexually transmitted infections.
  • A prescription is needed to obtain birth control pills. This requires a visit to a health care provider.
  • Some side effects may occur while using birth control pills.
    • The most common side effects include bleeding between periods, breast tenderness, and nausea. These side effects typically only last for the first few months.
    • Less likely side effects include a loss of libido (sex drive), vaginal dryness, acne, freckling or darkening of the skin on your face, or depression.
    • Persistent minor side effects might be eliminated by changing the type of pill you are taking.
    • You may forget to take the pill every day. You may need to use backup birth control or take emergency contraception if you miss a pill or take it late. See “WHAT IF I MISS A PILL?”. Ask your health care provider or pharmacist if you have further questions.

WHAT ARE SOME DISADVANTAGES OF THE PILL?  

If you are experiencing problems, contact your health care provider BEFORE you stop taking the pill.

Serious side effects are rarely seen because of the lower dose of hormone in pills used today.  Serious side effects that are possible but not likely include:

  • Migraine headaches
  • Elevated blood pressure
  • Blood clots (in the rare case these occur they tend to happen in the leg, arm, or lung)
  • Nonmalignant liver tumors
  • Gall bladder disease
  • Heart attacks and
  • Strokes

Early Pill Warning Signs listed below may be an indication of the more serious problems listed above. Immediately contact a health care provider if you experience any of the Early Pill Warning Signs. An easy way to remember these Early Pill Warning Signs is to note that the first letter of each symptom spells out ACHES.

   Abdominal pain (severe), yellow skin or eyes

   Chest pain (severe)

   Headaches (severe)

   Eye problems (vision loss, vision disturbances)

   Severe leg or arm pain or swelling (in the calf or thigh or upper arm)

WHAT ARE THE DIFFERENCES BETWEEN THE DIFFERENT COLOR PILLS IN EACH PACK?

In most packets, the first 21 days of pills contain the active hormone. These pills are often called the “active pills”. They may be all one color or three colors if you are using a triphasic pill. Each color indicates a different amount of either the estrogen or progestin or both depending on what brand of pills you take. The last 7 days of 28-day packs contain inactive “reminder” pills. You are protected from pregnancy while using the reminder pills.  If the last week’s pills are brown, they may be iron tablets.  The purpose of the “reminder” pills is to continue the habit of taking a pill each day. Some people choose not to take the “reminder” pills. Do not stop taking the pill during the hormone pill weeks, unless directed by your health care provider.

You should expect your menstrual bleeding to occur during the week when you are on the “reminder” pills. It can start on any one of those days and it may or may not end before you start your new pack. Start your new pack immediately after finishing your last packet of pills, even if you are still bleeding.

HOW DO I START TAKING THE PILLS? 

There are three ways you can start taking the pills.

  • Quick Start (recommended): Start your first packet any day of your menstrual cycle if you are reasonably sure you are not currently pregnant.
  • Sunday Start: Start your first packet of pills on the first Sunday after your menstrual flow begins.
  • Day 1 Start: Start your first packet of pills on the first day of your menstrual flow.

Regardless of which method you use, take one pill each day until you finish the packet. Upon completion of the packet, begin the next packet of pills immediately the next day.

HOW SOON WILL I BE PROTECTED AGAINST PREGNANCY? 

When you begin your first pack of pills, you should use a backup method of birth control, such as condoms, for the first 7 days of the pack if you use the Quick Start or Sunday Start method. If you begin taking your pills on the first day of your menstrual flow, you do not need to use a backup method for the first 7 days.

Remember, the pill, when used correctly, only protects against pregnancy. It does not protect against sexually transmitted infections. Use a condom with every act of sexual intercourse to reduce your risk of acquiring a sexually transmitted infection.

WHEN SHOULD I TAKE MY PILL? 

Take your pill at approximately the same time each day. Try to associate taking your pill with a regular daily activity, like eating a meal or going to bed. The effectiveness of the pill depends upon your consistency. If you do not take your pill at approximately the same time each day, your pill will be less and effective and you may be more likely to experience side effects such as irregular bleeding.

IF I DON’T WANT TO HAVE MY WITHDRAWAL BLEEDING (“PERIOD”) AT A PARTICULAR TIME, CAN I JUST SKIP THE “REMINDER” PILLS?   

One of the advantages of the pill is that you are potentially able to both predict and manipulate your cycle. Consult with your health care provider before taking the pill other than as directed. If you simply take two packs of hormone or active pills consecutively (and skip the “reminder” pills), you may still experience irregular bleeding. For information about how to avoid your withdrawal bleeding on a particular date, consult your health care provider with as much advance timing as possible.

The pill may be used safely in extended regimens (24, 42, 63, or 84 days of active pills or continuous active pills). Consult your health care provider if you have questions about extended regimens. See www.noperiod.com for more information.

WHAT IF I MISS A PILL? 

  • If you are less than 12 hours late taking your pill, take it now and take your next pill at the time you usually would.  No further action is needed.
  • If you are more than 12 hours late, take your missed pill now and any other pill you are supposed to take today.  Finish taking all other pills in your pack on time.  If you have had sex in the last 5 days without extra protection, use Emergency Contraception.  Use abstinence or condoms with every act of sex until you have taken 7 active pills in a row. 

WHAT IF I MISS A “REMINDER” PILL? 

If you are using a 28-day pack of pills and you forget any of the 7 “reminder” pills (without hormones) in week 4, discard the pills you missed and keep taking one pill each day until the pack is empty. You do not need a backup method of birth control.

WHEN ARE TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT PREGNANCY?

  • The first 7 days of your first packet if you use the Sunday or Quick start methods
  • If you miss active pills. Get more info about this situation by reading “WHAT IF I MISS A PILL?” above.
  • If you vomit within 1-2 hours after taking an active pill consider it a missed pill and refer to the previously provided instructions
  • If you have severe diarrhea (> 3 loose stools in 24 hours) consider it a missed pill and refer to the previously provided instructions
  • If you take other medications that may decrease the effectiveness of the pill (see “ARE THERE ANY DRUG INTERACTIONS WITH THE PILL?” below)

WHAT IS EMERGENCY CONTRACEPTION AND WHEN MAY IT BE NEEDED FOR A WOMAN ON THE PILL?  

Emergency contraception (also called “the morning-after pill”) is given as soon as possible within 120 hours of intercourse without effective contraception. Emergency contraception is meant for emergency use only and is not an effective method of birth control for routine use. Sometimes when you are on the pill you need to also use a backup method of birth control (see “WHEN ARE TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT PREGNANCY?” above). If you are in a situation where you need a backup method, have had intercourse and either your backup method failed or you didn’t use a backup method, you should consider emergency contraception. Some types of emergency contraception are available over-the-counter. Other types don’t require a prescription but are kept behind the pharmacy counter. Ulipristal (ella) is an emergency contraceptive pill that is available only by prescription. For more information, you may call (919) 966-2281 or consult our Emergency Contraception information. To be prepared, you may request emergency contraception to keep on hand (if needed) at any pharmacy, including CHS Pharmacy, or ask your health care provider.

WHAT DO I DO IF I MISS A PERIOD? 

If you took all your active pills and skip a period, it is unlikely that you are pregnant. It is common for pill users to occasionally miss periods and for their periods to be very light and last only one day or less. If you skip a period and are concerned about your risk of pregnancy, contact your health care provider and ask for a pregnancy test. Even if you did not have a period, you should start a new package of pills at the regularly scheduled time. If you skip two periods in a row, contact your health care provider.

WHEN SHOULD I BE SEEN AGAIN BY MY HEALTH CARE PROVIDER? 

See your health care provider once a year for a well woman visit if you are under 21.  A well woman exam is recommended yearly if you are 21 or older. If you will run out of your pill prescription, you should make an appointment with your provider before the refills on your pill prescription run out. Do not wait until the last minute to make your appointment. If you have problems at any time, contact your health care provider.

WHAT SHOULD I DO IF I RUN OUT OF MY PILLS? 

First, make sure you have enough pills/prescription refills to last through the holidays, semester breaks, and summer recess before you leave the campus. If you miscalculate or lose your pills, contact your pharmacy immediately. If you cannot get more pills, use a backup method of birth control such as condoms. If your backup method fails, consider taking emergency contraception.

SHOULD I TELL OTHER MEDICAL PROVIDERS THAT I AM TAKING THE PILL?

Yes. Birth control pills are a medication. Make sure that all of your health care providers know about all of the medications you are taking, including the pill.

DO I NEED TO TAKE A REST FROM THE PILL?

Current data indicates that there is no need to stop the pills at intervals. You should not stop taking the pill without using alternative contraception if you want to avoid pregnancy. Many women become pregnant soon after they stop taking the pill.

WHAT DO I DO IF I DECIDE I WANT TO GET PREGNANT? 

If you decide you want to get pregnant, call 919-966-2281 to make an appointment for preconception counseling with the Prenatal Nurse in Women’s Health before you stop taking the pill. This counseling will provide you with important information before conception.  For example, you should take at least 400mcg of folic acid daily, preferably for at least three months before you stop the birth control pill.

Once you have completed the last pill pack, it is best to use another reliable method of contraception until you have had one to two normal menstrual periods before attempting to conceive. There is no evidence that the pill decreases subsequent fertility, and the return to fertility is usually rapid. Usually women go back to the pattern of menstruation that was normal for them before they took the pill. Reports have confirmed that inadvertent pill use during early pregnancy does not increase the risk of fetal malformations.

WHAT IF I SWITCH FROM THE PILL TO A DIFFERENT KIND OF HORMONAL CONTRACEPTIVE?

When switching from one kind of pill to a different pill, it is not necessary to use a back-up method of contraception as long as you begin the new pill pack at or before the time you would have started a new pack of your current pill. However, when switching from the pill to other hormonal methods (e.g. NuvaRing®, OrthoEvra® patches, or Depo-Provera® injection), timing is critical. Ask your health care provider if or for how long you might have to use a back-up method of birth control, such as condoms, if you switch from the pill to a different hormonal method.

ARE THERE ANY DRUG INTERACTIONS WITH THE PILL? 

Yes, some medications may decrease the effectiveness of the pill and pregnancies have been reported. The pill may also change the effects of other medications.

DRUGS THAT REDUCE THE EFFECTIVENESS OF THE PILL  

Some drugs induce liver enzymes, resulting in lower hormone levels. If you must take one of these medications for only a short time, use a backup method of birth control, such as condoms, while you are taking the interfering drug and for 4 weeks after finishing the drug. If you must take the interfering medication on a long-term basis, you should check with your health care provider because you may need to consider an alternative form of contraception. Some of these drugs may be more likely to reduce the effectiveness of the pill than others; consult your health care provider. Note: this is not an all-inclusive list.

  • Some Antibiotics: [rifampin (Rifadin, Rimactane)]
  • Seizure medicines/mood stabilizers: carbamazepine (Tegretol), felbamate (Felbatol), lamotrigine (Lamictal), Oxcarbazepine (Trileptal), phenytoin (Dilantin), primidone (Mysoline), topiramate (Topamax)
  • Antifungals: griseofulvin (Gris-Peg)
  • Barbiturates: phenobarbital (in Donnatal), secobarbital (Seconal), butalbital, (Fiorinal, Esgic Plus)
  • Some Antivirals for HIV infection: lopinavir (Kaletra), nelfinavir (Viracept) and others
  • Some Herbal Products: St. John’s Wort
  • Others: modafinil (Provigil)

Reduced effectiveness of the pill caused by antibiotics has been a controversial topic. There are anecdotal case reports of women who were taking the pill who became pregnant after taking an antibiotic. There have been conflicting recommendations from health care resources regarding this possible interaction, many based on legal concerns rather than scientific evidence. The latest recommendation from the World Health Organization, American College of Obstetrics and Gynecology, the20th Edition of Contraceptive Technology, and the US Medical Eligibility Criteria state that antibiotics (except rifampin) do NOT reduce the efficacy of oral contraceptives.

DRUGS WHOSE EFFECTS MAY BE CHANGED BY TAKING THE PILL

This is not an all-inclusive list. If you are taking any medications for these medical problems and want to begin taking the pill, you should talk to your health care provider to decide whether any changes need to be made.

  • Drugs for seizure, mood disorders (e.g. lamotrigine-Lamictal), blood clotting disorders, diabetes mellitus, high blood pressure, anxiety, depression, or immune suppression

WHAT IF I HAVE MORE QUESTIONS?

If you have any questions or concerns regarding the pill or other birth control methods, consult your health care provider or a Sexual Wellness Specialist in Student Wellness. You can have a confidential online chat with a Sexual Wellness Specialist or make an appointment by calling 919-962-WELL.

While any health care provider at Campus Health can help you with your birth control questions and needs, Campus Health Service has a Women’s Health specialty clinic offering gynecologic and obstetric care. If you would prefer a Women’s Health practitioner, specify your request when making an appointment at 919- 966-2281. 

 

Last update: December 2013