Oral Contraception (Birth Control Pills)

Millions of women in the US safely use birth control pills to prevent pregnancy.  If taken correctly, only one woman in 1000 (0.1%) will become  pregnant.  However, human error, i.e., most often cause is taking the birth control pill at incorrect times, results in "fallible percent" of 1 woman in 100 or 3% may become pregnant. 

How Does the Pill Work?

Birth control pills contain synthetic hormones called estrogens and progestins. These similar to hormones naturally produced by the female body. Pills may keep you from ovulating, or releasing an egg from the ovary each month.  

Combination pills also make the uterine lining unable to support a pregnancy.  And thickening of the cervical mucus by progestins, creates a barrier at the opening of the uterus to prevent sperm from reaching an egg if it was released. 

Advantages of the Pill:

• regulates menstrual flow and cycles

• lightens flow and cramping

• may relieve PMS symptoms

• may improve acne 

• helps strengthen bones

• can help period from falling over the weekend 

• helps protect against ovarian and endometrial cancers

• helps prevent ovarian cysts and benign breast tumors

• helps limit or stop endometriosis (growth of uterine lining outside of the uterus)

Common Side Effects of the Pill: 

• nausea

• headaches

• fluid retention

• breast tenderness

• change in mood or sex drive

• break through bleeding (bleeding at other times than during period)

• missed or light periods

• darkening of facial hair (rare)

**most of these side effects disappear in 1-3 months after initiation of the pill.

Disadvantages of the Pill:

• does not provide protection of sexually transmitted infection (STIs)

• must be taken at the same time every day

• some medication interactions may cause the pill to be less effective.

Serious Side Effects: 

The pill is associated with an increased risk of blood clots. It is rare but the below acronym ACHES is helpful in monitoring for any symptoms. 

• Abdomen pain

• Chest pain or shortness of breath not related to physical activity

• Headaches not controlled with acetaminophen or ibuprofen

• Eye pain; visual change; acute or sudden onset

• Severe leg cramp  unilateral

**If you experience any of the above symptoms, you must alert your provider immediately. 

How to take the Pill

• before starting the pill make sure you are not pregnant. If there is any chance of pregnancy, take a pregnancy test first.  starting the pill on the 1st Sunday following your period can eliminate most concern of pregnancy and can ensure you not to have your period fall on  the weekend. 
• take one pill at the same time every day.
• use a back up method for 1 week 
• the last week in your pill pack contains "placebo or sugar" pills. You do not need to take these but it is recommend to do so to keep yourself on routine schedule.  It is during this week that you should have your period.  
• if you do not get your period, do not panic, you are most likely not pregnant. continue with your pills as directed. if no menses after second pill pack, you should see your provider and take a pregnancy test. Again, you are most likely not pregnant but do need to discuss this with your provider. 

What to do If I Forgot a Pill: 

• if you miss a pill, take it as soon as you remember and take the next pill at regularly scheduled time. 

• if you miss two pills in a row, take both as soon as you remember and use a backup method through remainder of pill pack. 

• if miss three pills, stop taking the medication and use back up method, and discuss with your provider. 

Who Should Not Take the Pill?

• Smokers: smoking can increase your chance of strokes and heart attacks 3-4 times greater in woman taking OCPs than non-smokers on OCPs. If you smoke, you should quit.  If you continue to smoke and use OCPs, the pill is not as safe for you as it is for nonsmokers. 

• Hypertension (High Blood Pressure):

• Gallbladder or liver disease:

• Migraine Headaches: however, any history of migraines associated with menses OCPs may be beneficial. 

• Diabetes Mellitus:  woman with diabetes must discuss birth control options with their primary care provider. Pregnancy can cause multiple complications and the risk of using OCPs may be much less than pregnancy. 

• Possibility of pregnancy: woman who are pregnant should not start on OCPs, please discuss with primary care provider prior to initiating OCPs. 

• History of blood clots, heart disease, stroke, or cancer of breasts, cervix, or uterus.  

• Undiagnosed vaginal bleeding: 

• Women over the age of 35