What It Is

The birth control pill ("the Pill") is one of the most effective forms of birth control. It is taken orally and contains synthetic forms of hormones that are produced by your body. There are two types of pill: the "combination pill," which contains both estrogen and progesterone, and the "mini-pill," which contains only progestin (a form of progesterone). Both types of pills are 97 to 99 percent effective in preventing pregnancy when used correctly.

How It Works

The pill works by increasing your body's levels of estrogen and progestin—or in the case of the mini-pill, progestin alone—which simulates pregnancy and prevents ovulation. The hormones also thicken the cervical mucus, which blocks sperm, and thin the endometrial lining of the uterus, making it more difficult for a fertilized egg to attach to the uterus.

Advantages

• Highly effective
• Easy to use
• Does not interfere with spontaneity during sex
• Helps regulate your period, reduce menstrual flow, and lessen cramping

Disadvantages

• Need to remember to take it every day
• Requires a prescription
• Does not protect against HIV or other sexually transmitted infections.

Who Should Not Take The Combination Pill

You should not take combined oral contraceptives if you:

• are over 35 and smoke
• have or suspect you have breast cancer
• are taking certain medications (see drug interactions, below)
• have undiagnosed vaginal bleeding
• have blood clots or a history of blood clots
• have liver tumors or acute liver disease
• have diabetes with vascular disease
• have migranes with preceeding visual aura
• have a history of heart attack or stroke
• have high blood pressure
• have active mononucleosis or viral hepatitis

Health Benefits

The combination pill has been shown to reduce the risk of endometrial and ovarian cancer, pelvic inflammatory disease, and benign breast disease. It can also reduce heavy menstrual bleeding, symptoms of polycystic ovary syndrome, and bone loss. The mini-pill does not offer the same benefits, but may offer some protection against uterine and ovarian cancer, benign breast disease, and pelvic infection.

Possible Side Effects

Most side effects of the pill are bothersome, but not serious. They include breast tenderness, headaches, nausea, missed periods, depression, and weight gain or loss. In addition, the progestin-only pill may also cause mid-cycle bleeding and spotting, and prolonged or irregular menstrual bleeding. Most side effects go away after a few months, as your body adjusts, but if they continue to be a problem, you might talk to your clinician about switching to a different version of the pill or another method of birth control.

Health Risks

In rare cases, taking the Pill can raise your risk for cardiovascular disease, stroke, and high blood pressure, as well as blood clots in the legs, lungs, heart, or brain. The mini-pill poses other risks, including a greater chance of ectopic pregnancy, ovarian cysts, and vaginal bleeding. Despite evidence on both sides, most experts now believe that oral contraceptives do not increase your risk for breast cancer. Before using the pill, be sure to ask your health care provider about any medical conditions that might exclude you from using hormonal contraception.

How To Use The Pill

Pills come in packs of 21 or 28. If you use the 21-pill pack, take one pill at the same time each day for 21 days, then wait seven days before starting the next pack. You will have your period during the seven days you don't take a pill.

If you use the 28-pill pack, take one pill at the same time each day for 28 days. The last seven pills are sugar pills that contain no hormones. You will have your period during those seven days.

Do not skip any pills, and try to take them at the same time each day. If you are taking the mini-pill, take it in the morning, since taking it at night could make it less effective.

Begin taking The Pill on the first day of your next normal period. If you start your pills within the first 24 hours of your period, they will protect you against pregnancy right away. If you start any later, they will not protect you against pregnancy for one week, so you should use another method of birth control for the first week, such as a male condom, female condom, or diaphragm. if you have one. Take one pill each day until you finish the pack. When you finish, start a new pack on the next day.

You can start on the first Sunday after the next normal period, too. The Pill will not protect you against pregnancy for one week, so you should use another method of birth control that first week, if you have one. Take one pill each day until you finish the pack. When you finish that pack, start a new pack on the next day.

Missed Pills

When you're on The Pill, you should have a back-up method of contraception [LINK TO A1a] available at all times just in case you forget to take your pill. If you miss one pill, you won't need to use a back-up method of birth control, but if you miss two or more, you will. You should also know how to obtain emergency contraception, should the need arise.

If you do miss one pill, take it as soon you remember. Take the next pill at your usual time. If you miss two or more pills, call your clinician for advice. Missing pills may cause spotting or light bleeding and an increased risk of pregnancy.

Dietary Concerns

If you take birth control pills, you are at risk for nutritional deficiencies involving B vitamins, Vitamin C, folic acid, zinc, and magnesium. You may also experience a buildup of fluid caused by the hormones. To stay healthy:

• Increase the amount of fruits, citrus juices, and dark green and yellow vegetables you eat.
• Steam rather than boil vegetables.
• Eat vegetables raw in salads and as snacks when possible.
• Increase your use of dried beans, such as navy beans, kidney beans, and lentils.
• Eat more whole-grain cereals and breads
• Decrease the amount of salted snack foods you eat, such as potato chips and dry roasted nuts.
• Avoid eating too many canned foods, which contain high amounts of salt and worsen bloating.
• Go easy on processed meats, such as hot dogs, bacon, and ham.
• Consider taking vitamin supplements if it is difficult to maintain a well-balanced diet. Some health care providers recommend 20-50 mg. of Vitamin B for those feeling moody or depressed while on The Pill.
• If your appetite increases to an uncomfortable level and you feel bloated much of the time, talk to your clinician.
• Consider taking a multi-vitamin and mineral supplement once a day.

When to see a doctor

If you experience any of the following problems, while taking the Pill, call a doctor immediately:

• Unusual pain or swelling in the arms or legs
• Sharp chest pain
• Coughing up blood
• Shortness of breath
• Sudden severe headaches
• Vision changes (blurring, doubling, loss of vision)
• Fainting or dizziness
• Severe stomach or abdominal pain
• Jaundice (yellowing of skin or eyes)
• Severe depression
• Heavy, prolonged vaginal bleeding

Drug interactions

Keep in mind that the pill is a medication. Like all drugs, the pill can interact with other substances, including drugs such as tetracycline, Dilantin, and St. John's wort, an herbal supplement used to treat depression. Several other drugs also should not be taken with the pill. Be sure to discuss any medications that you are currently taking with your health care provider.  

How to Protect Against STIs and HIV/AIDS

The only way to guard against getting sexually transmitted infections (STIs) is not to have sex or to have sex only with partners who you know are free of infection. If you do have sex, you should use a latex barrier, such as a male condom, a female condom, or a dental dam, every time. Condoms provide protection against against STIs, including HIV, the virus that causes AIDS. Tapestry Health clinicians recommend using such barriers even in combination with other methods of birth control. Latex condoms are preferred to lambskin condoms for the prevention of STIs. Using a spermicide together with a latex barrier can also help keep you from getting an STI.

If you have any questions about The Pill, talk to your clinician.