Oral contraceptives, often called birth control pills or “the Pill,” were first introduced in the U.S. in 1960. Over the last 50+ years, the typical dose of hormones found in birth control pills has dropped dramatically, and much has been learned not only about the risks of this type of medication, but also its benefits. Birth control pills are very popular with our Queens and Long Island patients, and are now one of the most common types of prescription medication taken in the nation.
The Woman’s Health Pavilion offers a range of contraceptive solutions. To find the right one for you, request an appointment with a gynecologist or support staff at any of our Long Island locations. We see patients 7 days a week and offer same-day appointments for urgent conditions.
How the Pill Prevents Pregnancy
Traditional “combined” birth control pills contain a combination of two female hormones: estrogen and progesterone. When taken consistently, formulations containing both of these hormones suppress ovulation and prevent pregnancy with minimal side effects.
Remember that birth control pills do not prevent sexually transmitted infections (STIs). For women with more than one sexual partner, including women practicing “serial monogamy” (e.g., a new boyfriend every 6 to 12 months), the combination of birth control pills and condoms provides reliable protection against pregnancy, while also protecting against sexually transmitted infections.
Effectiveness of the Pill
When taken as directed, less than 1% of women taking the Pill will get pregnant each year. With “typical” use, however, about 3 to 8% of women taking oral contraceptives will get pregnant each year; most of these “failures” are related to incorrect use (for example, missed pills). In our experience, women usually know in advance whether they will reliably take a pill every day. Women who say, “I’m not good with pills,” will usually be better served by another birth control option.
Types of Birth Control Pills
There are dozens of types of birth control pills available today, but they are more similar to each other than they are different. Think of the various available brands as the “Coke” and “Pepsi” of the contraceptive world. Specific distinctions include:
Low-dose pills: Some formulations of the Pill are specifically designed to give women a very light period. Women are occasionally uncomfortable with this idea, but there is absolutely nothing unhealthy about it, and women can expect their periods to revert to normal once they go off the Pill.
Extended-cycle pills: Some newer formulations are designed to offer women just 4 periods per year—again, a real bonus for some women. Unfortunately, most of these “extended-cycle” pills cause a lot of breakthrough bleeding in the first few months of use; women frequently give up on these pills before they get to enjoy their less frequent periods.
While the combined birth control pill contains both estrogen and progesterone, the progesterone component does an excellent job of preventing pregnancy on its own. This is the basis for the progestin-only pill, commonly known as the “minipill”. Failure rates for the minipill are just slightly higher than combination oral contraceptives, and certain side effects related to the estrogen component (such as nausea) do not occur with progestin-only pills.
Progestin-only pills are especially useful for women who cannot take combination oral contraceptives because of risks or side effects. Women who shouldn’t use combination birth control pills, but who can use progestin-only pills include those who:
- Are breastfeeding (the estrogen component in combination pills decreases breast milk production)
- Are over age 35 and smoke
- Have other cardiovascular risk factors (e.g., obesity, diabetes, and hypertension)
The chief disadvantage of the minipill is that it does not provide the same near-perfect menstrual cycle control as combination birth control pills: Irregular periods and spotting in between periods are common, especially in the first few months of use. To prevent irregular bleeding—and also to ensure contraceptive efficacy—it is especially important to take the minipill at the same time every day.
How to Take the Pill
If you are starting the Pill, it is important that you make an effort to take it correctly. There are a number of different ways to start: Women may be instructed to start the Pill on the first day of their period, or on a specific day (e.g., Sunday) after they get their period. Either way is acceptable, but the Pill must be started within 5 days of getting your period if it is to be effective during the first month of use.
There are some techniques that can help you to remember to take your pill every day.
- Keeping your pill pack near your toothbrush can be a helpful daily reminder.
- Your smartphone can also be set to remind you to take your pill daily.
- If you can, enlist your partner or your friends to help you remember.
Remembering to take the Pill every day is crucial. If you forget one day’s pill, you can “double up” as soon as you remember; if you forget two days in a row, however, you should throw out your pack and start a new one when your period arrives. If you have to re-start your pills, make sure you use an alternate form of contraception in the meantime.
The Pill may not be appropriate for some women who already have risk factors for cardiovascular disease. We may recommend another form of birth control for patients with any of the following risk factors:
- Over age 35
- High blood pressure
Minor Side Effects When Starting the Pill
Some women experience minor side effects in their first few cycles after starting the Pill, including:
- Breakthrough bleeding, spotting, periods that drag on, or a few days of staining between periods
- Breast tenderness
Taking the Pill on time every day minimizes breakthrough bleeding. With the current generation of low-dose pills, missing a day will frequently result in spotting. These symptoms often improve over time; a different birth control pill may be prescribed if side effects remain troublesome. Taking birth control pills in the evening can be helpful for women who feel nauseous on the Pill, since peak blood levels will occur overnight, during sleep.
Serious Side Effects
It’s important to be aware of some serious side effects of the Pill such as:
- Blood clots in the legs (deep vein thrombosis)
- Heart attack
These side effects are extremely rare in women without risk factors: Tens of thousands of healthy, slim, non-smoking women in their 20s would have to take birth control pills before one developed a blood clot or had a stroke. For women over 35, especially those who smoke, the risk is much higher. Certain pills have a higher propensity for causing blood clots than others. YAZ and Yasmin contain the hormone drospirenone, which has been linked to a higher risk of deep vein thrombosis than other formulations.
Warning signs of potentially serious complications while taking the Pill include:
- Chest pain
- Visual disturbances
- Severe, unremitting headache
- Swelling, pain, or redness in the legs
If you have any of these symptoms while taking the Pill, be sure to get to a doctor immediately.
Will the Pill Make Me Gain Weight?
In our experience, the single biggest barrier for young women considering birth control pills is the fear that they will gain weight. This has been studied extensively, and the scientific consensus is that most women don’t gain weight on the Pill, and those that do generally gain just a few pounds over several months. There are no calories in the Pill (for those of you on Weight Watchers, there are no “points” either!). Certainly, a small amount of water retention, or perhaps an increase in your bust due to the hormones in the Pill is possible…but women do not blow up like the Nutty Professor when they start taking oral contraceptives.
Most of the real, scientific study on this question suggests that the Pill has little effect on weight gain. So why have so many young women heard stories of weight gain from their friends? It’s possible that many young, single women focus more on diet, physical fitness and weight control when they are single, or “between boyfriends.” Once they get comfortable with a new partner, they also get more comfortable with themselves: They may spend less time in the gym, and more time eating out. At the same, they decide that if they’re going to be serious with their boyfriend, they are going to need some reliable contraception. When they put on a few pounds, they are quick to blame the Pill, when in fact it’s a change in lifestyle that’s responsible. In other words, the Pill doesn’t make them put on pounds, but their boyfriend does!
More Than Birth Control
While there are some risks with taking the Pill, there are also many benefits that go beyond simply providing reliable contraception. Non-contraceptive benefits of birth control pills include:
- Lighter periods: Women with heavy periods will usually find that their periods are much lighter on the Pill. Extended-cycle pills may even allow you to skip most periods altogether.
- Relief from menstrual cramps: Menstrual cramps are usually markedly improved while on the Pill. Women who still have severe cramps despite taking the Pill, should discuss the possibility of endometriosis with their provider.
- Improvement in PMS symptoms: Mood swings, bloating, headaches and other symptoms may be reduced.
- Treatment of acne: The Pill does wonderful things for most women’s skin. In fact, many dermatologists recommend birth control pills to their young patients with acne.
- Prevention of ovarian cysts: Because the Pill suppresses ovulation, women prone to functional cysts of the ovary typically find that they do not form new cysts while on the Pill.
In a 2011 study, 14% of women indicated that they use the Pill exclusively for non-contraceptive benefits, and 58% said that they use birth control pills “in part” because of non-contraceptive benefits.
Not only does the Pill improve symptoms like heavy bleeding, menstrual cramps, PMS, and acne, but taking the Pill for a few months significantly reduces your chances of ever having cancer in the ovaries or uterus. Evidence suggests that taking birth control pills also decreases the risk of colon cancer. In some cases, the magnitude of the risk reduction is quite significant: In the case of ovarian cancer, for example, studies suggest that 5 years of birth control pill use actually cuts the risk of developing ovarian cancer in half. That’s HUGE. Since ovarian cancer is the deadliest gynecologic cancer, this is an extremely compelling benefit of oral contraceptives.
Is There a Birth Control Pill for Men?
Patients often ask us if there is a birth control pill for men. At the time of this writing, there is no such pill available—though several promising compounds are being studied. Birth control for men is still years away from the marketplace.