"The future belongs to those who believe in the beauty of their dreams" ~ Eleanor Roosevelt
Good to Know: You do not need a pelvic exam or
pap smear to obtain contraception!
If your gynecologist doesn't agree,
ask what one has to do with the other.
It's worth a conversation.
Oral Contraceptive Pills: “The Pill”
You’ve made your decision. You’ve considered all of your options, from IUD to arm implants, to a vaginal ring to shots and have decided to join many of your girlfriends and take the pill. It’s a rite of passage for young women. Most of us have been on the pill at one point in our life, for one reason or another. Even very young, newly pubertal girls are sometimes prescribed the oral contraceptive pill to help control bad cramps or heavy bleeding. There are many non-contraceptive benefits to taking the pill.
Other benefits of oral contraceptives:
· regular menstrual periods
· less cramping
· reduced menstrual flow
· improvement of acne
· less anemia
· decreased ovarian cysts
· decreased ectopic (tubal) pregnancy.
· protection from ovarian and endometrial cancers
· decreased pelvic inflammatory disease
· decreased non-cancerous breast problems.
Efficacy: when taken properly, birth control pills is a very effective form of contraception. The failure rate is 0.1% when pills are taken perfectly (same time every day, no missed pills), the actual failure rate is 8%, due to missed pills or forgetting to restart the pill after the seven-day pill-free interval.
Condoms: are the only way to prevent STDs (herpes and HPV are not completely prevented with condoms, but HIV, gonorrhea, chlamydia, syphilis, hepatitis B & C are protected.)
Hormonal methods of birth control only protect against pregnancy. You need condoms to protect against STDs. There is no other way to think about it.
Starting your first cycle of the pill: You have a choice:
“Sunday Start”
Take the first pill in your first pack on the Sunday of your period. If your period starts on a Sunday take your first pill that same day. If your period starts on M-T-W-Th-Fri or Sat take your pill on the first Sunday that you come to (whether you are bleeding or not). You then take one pill each day for 28 days. When you have taken all 28 pills, open up the next pill package and continue as before. ONLY the first pill of the first package is based on when your period starts. Use condoms to prevent STDs.
“First Day Start”: My first choice
Take your first pill of your first package on the day your next period starts. You then take one pill a day until you have finished all the pills in the pack. Place the “day label”, from the package that your pills came in, on your pill pack. Place the “day label” on every pill pack as you open it. When you have taken all 28 pills you go immediately to the first pill in your next pack and continue as before. Only the first pill of the first pack is based on when your period starts. You are protected from pregnancy beginning the first day of your first pack, but we recommend condoms to prevent STDs.
“Quickstart”
As long as you know cannot be pregnant, and you'd like to get started on the pill right away: take your first pill today, or whatever day we mutually agreed on. You are protected from pregnancy after you have taken 7 pills correctly, but remember you will always need condoms to prevent STDs.
Get in a habit
Take one pill at the same time each day; associate it with a meal, brushing teeth or some other regular daily activity. Just find the best time for YOU! It is very important to take your pill at the same time every day for at least two reasons:
1. Proper contraceptive protection
2. Breakthrough bleeding can occur when you miss pills...
When to expect a period
The most common birth control pill is taken on a 28-day cycle with 21 to 24 days of hormone pills followed by 4 - 7 days of placebo pills, depending on brand. Your withdrawl bleed (not a true "period"), should occur during the fourth week of the pill pack: the "placebo week." However, it is extremely common and nothing to worry about if you have irregular breakthrough bleeding or spotting in the first 3 months, after starting a new oral contraceptive.
Extended Cycling Pills : Is there any medical benefit to having a monthly bleed?
No! Newer formulations of the birth control pill allow you to have four periods/year. All active pills are identical. It is completely safe and reasonable to do, especially if you have bad cramps, anemia or endometriosis. You may have breakthrough spotting during the week you are suppressing your period, but overall will have fewer bleeding days/year than on the traditional pill formulas.
Possible Side Effects of taking the Pill
The serious side effects from birth control pills are related to blood clots, which can occur anywhere in your circulatory system. Heart attack, stroke, pulmonary embolism, and deep vein blood clots in your leg are serious.
These are very rare except in patients who have a genetic predisposition to blood clots. The high risk group is women over 35 years old, obese and who smoke, but these side effects can happen to young women.
The symptoms of serious side effect include: “ACHES”:
A=severe abdominal pain
C=severe chest pain, and shortness of breath
H=severe headache
E=eye problems (loss of vision, flashing lights, etc)
S=severe pain in the calf or thigh
Possible nuisance side effects of the Pill include:
- Nausea: Nausea can usually be eliminated by taking your pill with food and by having a snack 4-6 hours after taking your pill. For some it works well to take the pill at bedtime, then the nausea occurs while you are sleeping.
- Breakthrough bleeding is common in 40%: if you have bleeding or spotting when you are taking your “active” (hormone) pills in the first 2-3 months. After this time, if you have been taking your pills correctly, you should make an appointment for a pill follow-up and possible change of pill. If the bleeding is heavy, let us know.
- Breast changes: If you have breast enlargement and/or tenderness that last 2-3 cycles you may need a pill change. If you have breast enlargement and this is not a problem for you then nothing needs to be changed.
- Weight: A weight gain is not expected when you begin oral contraceptives, but may occur for some women on some pills. A gain of 10lbs or more will require an appointment and possible pill change. A gain of 2-3 lbs. is not medically significant. Watch your junk food and appetite the first two months and you should be fine.
- Depression: If you become depressed or depression increases with oral contraceptives let us know, and we’ll work on other options.
- Vomiting a pill within 2 hours: take another pill of the same color. It is a good idea to have an “extra” pack of pills on hand for just this reason.
- If you have vomiting or diarrhea for more than one day, continue your pills and use backup contraception (condoms) or abstain for 2 weeks after the illness has passed. You may not be protected.
- Missed pills: If you miss any of your pills, please refer to the pill pack insert or follow the attached flow chart for missed pills.
- Missed pills are a common cause of pregnancy! In general, an active pill should be taken as soon as possible after a pill has been missed. Backup birth control should be used for seven days if more than two pills are missed.
Most NUISANCE side effects will disappear after 2-3 cycles of use. If you are experiencing these, do not stop taking your pills mid-cycle (during the active hormone pills), call the office. Please keep track of when in your pill pack the side effects occur.
Give the pill prescribed for you for 2-3 cycles (packs) before giving up due to nuisance side effects. (Unless you are experiencing a problem that you cannot tolerate for 2-3 cycles.)
If you miss a period on the pill and have taken all of your pills correctly, the likely hood of being pregnant is very small, continue taking your pills. If you are uncomfortable with this call the office and we’ll reassure you. Ideally you should wait and see if you miss a second period. If you do, call. We will do a pregnancy test and discuss changing your pills.
Pill FAQs
- Medication Interactions: Some medications may interfere with the effectiveness of your birth control pills. (Not commonly used antibiotics like amoxicillin, but anti-TB, anti-HIV, anti-malarial drugs and certain anti-seizure meds. Review ALL your meds with us.)
- Over the counter interaction possible: St. John’s Wort may cause combination contraceptive to be less effective.
- Pills can expire. Always check the expiration date on your pill pack.
- The pill is safe long-term. Most women can be on the pill indefinitely. There is no need to take rest periods or breaks from birth control pill; there is no truth to the myth that the pill can cause infertility.
- STDs: the pill cannot protect you from sexually transmitted infections; this is why you should always use CONDOMS, too for STD protection.
- Cost: Birth control pills may be purchased with a prescription at a drugstore. They cost about $10–$60 a month. Private health insurance may cover the pill.
- Adjusting: If you are having difficulty adjusting to birth control pills, let us know. A pill change may solve the problem. If you decide to stop taking the pill, make an appointment to discuss an alternative method of birth control. This is a high-risk time for unintended pregnancy! Try to continue the pills in your current pack until your appointment.
- Don't give up on condoms, especially now!
- Follow-up appointment: Please see us in 3 months after starting the oral contraceptive. At that time you will have a blood pressure check, your weight checked and discuss any concerns, and strategize for the coming year.
"Well-behaved women never make history." - Maria Shriver
