Birth Control Pills: How To Use Them

The ‘pill’ is a most comforting friend for a women in early years of reproductive life. It not only gives protection from chances of getting pregnant but also helps in reducing excessive bleeding or pain during menses. However, if one fails to take them regularly pregnancy may happen. Also as women age and acquire other health risks, the safety profile is less reassuring. Read below to find out in detail about who should take OCPs (Oral Contraceptive Pills) and how should it be taken.

What do birth control pills contain

Most birth control pills contain hormones estrogen and progestin but there is one that contains only progestin. These hormones are secreted by the body at different concentrations during the menstrual cycle naturally. This leads to ovulation in each cycle and thus chances of pregnancy. By continuously providing these hormones from outside, ovulation is prevented and hence chances of getting pregnant

Birth control pill packets usually include 4 to 7 days of hormone-free pills each month. It is during these hormone-free days that women get their period

Some other pills such as ‘Saheli’ etc. are non hormonal, but majority of the OC pills are ‘Combined Oral Contraceptive’ pills

Who should not take the birth control pill

Women who fall into the following categories should NOT take the pill because of an increased risk of complications. Women who :

  • Are 35 years or age or more, and smoke cigarettes (high risk for heart related complications)
  • Have had blood clots or a stroke in the past, because these women are more likely to have blood clots while taking the pill
  • Have a history of an estrogen-dependent tumor (eg, breast or uterine cancer)
  • Have abnormal or unexplained menstrual bleeding (the cause of the bleeding should be investigated before starting the pill)
  • Have active liver disease (the pill could worsen the liver disease)
  • Have migraine headaches associated with visual or other neurologic symptoms (eg, aura), which increases risk of stroke

Special concerns — Some women may take the pill under certain circumstances, but need close monitoring:

  • Women with high blood pressure can experience a further increase in blood pressure and should be monitored
  • Women who take certain medication for seizures (epilepsy) and take the pill have a slightly higher risk of pill failure (pregnancy)
  • Women with diabetes mellitus who are on the pill may need a slightly higher dose of insulin or oral diabetes medication. Women with diabetes and vascular complications from diabetes should not use the pill.

Medication interactions

Anti epilepsy drugs , rifampicin used to treat tuberculosis and St. John’s wort, an herbal supplement sometimes taken to treat depression, may reduce the effectiveness of birth control pills.

Starting the pill

Ideally, the pill should be started on the first day of the period to provide maximum contraceptive effect in the first cycle; this provides protection from pregnancy immediately.

The pill may also be started on the day it is prescribed, if the user is unlikely to be pregnant already. A back-up form of birth control (eg, condoms) is needed for the first seven days after such start.

Many women start their pill on the first Sunday after the period starts (because most pill packs are arranged for a Sunday start). Some form of back-up contraception is needed for the first seven days after the Sunday start.

How to take the pill

Traditionally, the pill is taken on a 28-day cycle with 21 days of hormone pills followed by 7 days of placebo pills (“sugar pills”). It is not necessary to take the placebo pills, but women find it easier to remember to start their next pill pack if they have taken the placebos. The period should occur during the “placebo week.” However, some women have irregular breakthrough bleeding or spotting in the first few months.

Some women prefer to take birth control pills continuously.

In this regimen, the woman takes the first three weeks of a pill pack, then immediately starts a new pack (without a break); the last week of (placebo) pills is not used. This can be continued for as long as desired. This regimen is a particularly good treatment for women with painful periods or endometriosis, as well as those who want to avoid a monthly bleed.

What to do about missed dose/doses

If you have forgotten one dose, take it as soon as you remember. If you have forgotten two or more doses, take emergency contraceptive dose of the same pill. Also use condoms till your next period

What are the side effects of OCPs

Minor side effects of the pill include feeling of vomiting, breast tenderness, bloating, mood changes and Irregular vaginal spotting. These settle within a few months

But the serious side effect for which one has to be vigilant is the risk of thrombosis or blood clot formation in the veins. This most commonly effects veins of leg or of the dural sinuses in skull. The warning signs will be either a swelling and pain in feet or headache, diminished vision and weakness of some part of the body.

Let us find out how the risk increases with OCPs in women aged 15-50 years. Research has shown that the risk increases by nearly three times. But even in absence of OCP intake in these women, risk of venous thrombosis is 110 per 100,000 women.

Therefore, young women we active lifestyles, no smoking or diabetes are advised to take the pill for contraception and told to report early, should any warning signs appear. But women 35 or more, with diabetes, high BP or smoking or family history of blood clots are advised to go for other forms of contraception

Read more about other contraceptive choices

Should you still ask your partner to use condoms

If you are in a committed relationship and are sure that your partner is also monogamous and does not have STDs, then condoms may not be needed. But, if you are unsure of your partners status or not in a monogamous relationship and definitely yes! Ask him to wear one for each act. Read about correct use of condoms