Oral contraception

A. Birth Control Pills
B. Emergency Contraception Pills (morning after pill)
C. Mini-pills (progesterone-only pills)
D. Continuous use (no periods)

A. Birth Control Pills

There are many different brands of The Pill. Some come in packs of 21 or 28 pills. One pill is taken orally (swallowed) every day. The first 21 pills have a combination of synthetic estrogen and progesterone hormones that work to prevent fertilization. The last seven pills of a 28-day pack are hormone-free pills called spacers. The hormones stop ovulation (the process of the ovaries releasing eggs), as well as thicken cervical mucus to make it harder for sperm to enter the uterus. The Pill is 92 to 99.7% effective as birth control, but does not protect against sexually transmitted infections (STI) including HIV/AIDS.

Use

If The Pill is started within six days after an abortion or the start of a period, it is effective immediately. If the Pill is started at other times, it will be effective after one month. Condoms can also be used to lower the risk of pregnancy and sexually transmitted infections.

Starting The Pill:

There are several ways to begin taking The Pill. One common way is to start on the first day of your period or the first day after an abortion. Some women prefer to start on the first Sunday after either of these events.

Continuing:

Take one pill every day until you finish an entire pack. Try to link taking The Pill with a regular activity that you do at the same time every day, like eating a meal or brushing your teeth. If you have a 28-day pack, start a new pack immediately after you finish the old one. If you have a 21-day pack, take one pill every day for 21 days, no pills for seven days, then start the new pack immediately.

Missed Pills

Late Start:

The most common way women get pregnant while using The Pill is starting the next package late.

1 day late starting the next package:  Take two pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks.

2 days late starting the next package:  Take two pills per day for two days, then continue as usual. Use a backup form of birth control for two weeks.

3 or more days late starting the next package: Call the clinic for instructions.

During the Cycle:

1 pill missed: Take it as soon as you remember and take your next pill at your usual time. This may mean taking two pills in one day.

2 pills missed in a row in the first two weeks: Take two pills on the day you remember and two pills the next day. Finish the rest of the pack as usual. Use a backup form of birth control for one week.

2 pills missed in a row in the third week: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for one week.

3 or more pills missed in a row anytime: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for two weeks.

Missing any of the last seven pills of a 28-day package will not raise your risk of pregnancy. Skip the pills you missed, but be sure you start your next pack on time.

Drug Interactions

The effectiveness of the Pill is lowered when taken with certain medications, including antibiotics, anti-seizure, tuberculosis, and migraine medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with The Pill, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control in order to manage drug interactions.

Your Health

Some women may not be able to take The Pill because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not take The Pill:

  • History of heart attack or stroke
  • Blood clots
  • Unexplained vaginal bleeding
  • Known or suspected cancer
  • Known or suspected pregnancy
  • Liver disease

Women who have the following conditions may or may not be able to take The Pill, and must first consult with their clinician or doctor:

  • Migraines
  • Gallbladder disease
  • Hypertension
  • Diabetes
  • Epilepsy
  • Sickle cell disease
  • Have had elective surgery
  • Have a history of blood clots, liver or heart disease

Women who use The Pill have a higher risk of heart attack and stroke. The effects of The Pill on breast cancer are still unknown. The Pill lowers a woman’s chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

Side Effects

As the body adjusts to hormonal changes created by The Pill, women often experience some minor side effects, including:

  • Irregular bleeding or spotting
  • Nausea
  • Breast tenderness
  • Weight gain and/or water retention
  • Spotty darkening of the skin
  • Mood changes

Side effects usually disappear after two to three cycles. If your side effects are bothersome after this time or if heavy bleeding occurs, continue taking your pills and call the clinic for an appointment to talk about your prescription.

Danger Signs

Women who experience any of the following ‘ACHES’ symptoms while taking The Pill should call the clinic immediately

  • Abdominal pains (severe)
  • Chest pain or shortness of breath
  • Headaches (severe)
  • Eye problems, such as blurred vision
  • Severe leg or arm pain or numbness

Missed Periods

Missing a period does not always mean that you are pregnant. Pregnancy is more likely

  • in the first few months of Pill use,
  • if you missed taking any Pills,
  • if you are taking another medication (especially antibiotics), or
  • if you have been sick (vomiting and/or diarrhea).

If you forgot one or more pills and do not have a period that month, we recommend that you have a sensitive pregnancy test done at a clinic.

If you miss two periods in a row, it could either be normal or a sign of pregnancy. Pregnancy tests are recommended right away. If you become pregnant while on The Pill, there is probably no risk of birth defects.

Future Fertility

Women who want to become pregnant may stop using The Pill at any time. Fertility may return immediately or after a few months.

Advantages

  • Can regulate periods or lighten them
  • Easy to use
  • Does not harm future fertility
  • Does not interrupt sex play
  • May protect against uterine and ovarian cancers
  • May reduce acne
  • Can be used for Emergency Contraception

Disadvantages

  •     Does not protect against sexually transmitted infections, including HIV/AIDS
  •     Must be taken every day
  •     Less effective when taken with some medications
  •     Raises risk of heart attack and stroke
  •     Requires a prescription

B. Emergency Contraception (The “Morning After” Pill)

You can prevent pregnancy after unprotected intercourse by having a copper IUD inserted within one week of unprotected intercourse or by taking emergency contraception pills (the morning after pill). The pills work best in the first 24 to 48 hours but may work for several days. You can get one brand, Plan B, from your local pharmacy or at Cedar River Clinics in Renton or Tacoma.

To find Emergency Contraception, see this website: ec.princeton.edu. If you already have birth control pills in your possession, this website explains how to use them as emergency contraception.

Some women are buying Plan B in advance so they will have it on hand if they need it.

C. What are Mini-Pills?

Mini-Pills are progesterone-only birth control pills. Mini-Pills come in packs of 28 pills and you take one every day. They contain a synthetic form of the progesterone hormone and no estrogen. The Mini-Pill affects the mucus around the cervix and makes it harder for sperm to enter the uterus. It also affects the transport of the egg through the fallopian tubes. In these ways, the Mini-Pill prevents fertilization. Mini-Pills are 87-99.7% effective, slightly less than regular birth control pills. They do not protect against reproductive tract infections, including HIV/AIDS. They are called “mini” because they contain less hormones than regular pills.

Use

There are hormones in each Mini-Pill; there are no spacer pills. It is important to take a pill every day, preferably at the same time each day. Forgetting a Mini-Pill or taking it late increases the chance of pregnancy more than missing a regular birth control pill.

You can improve the effectiveness of Mini-Pills by adding a backup method, like condoms or spermicide. This is most important during the first three months and days 8-18 of your menstrual cycle after the first three months.

Starting Mini-Pills:

Take the first pill on the first day of your period. Take one pill daily, at the same time of day, even during your period.

After the First Pack:

As soon as you finish one pack, begin the next one. Start your next pack even if you are still bleeding or have not started your period. Continue taking one pill every day.

If you have problems with the Mini-Pill, call the clinic. DO NOT stop taking the Mini-Pills unless you want to get pregnant or can use another method of birth control.

Your Health

Every woman is different and Mini-Pills are not recommended for all women. Due to the risk of serious health problems, women with the following conditions should not use Mini-Pills:

  • Unexplained vaginal bleeding
  • Known or suspected pregnancy
  • Breast Cancer

Mini-Pills may not be recommended for women who are concerned with weight gain, have liver disease, gallbladder disease, heart disease, diabetes, or a history of depression.

Health Risks

Mini-Pills increase the risk of having functional ovarian cysts. They also very slightly increase the risk of ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg attaches and grows outside the uterus. This can be very dangerous and requires emergency medical attention. Find more about treatment for Ectopic Pregnancy at http://www.ectopic.org.uk.

To protect your health, watch out for the Mini-Pill’s danger signs.

Benefits

Women on Mini-Pills have a decreased risk of endometrial cancer and pelvic inflammatory disease. You may have less menstrual cramping and pain, fewer periods, and less chance of anemia.

Side Effects

The most common side effect for women using Mini-Pills is irregular bleeding. While many women on Mini-Pills have normal periods, others may have irregular periods, spotting between periods or no periods at all. If you do not bleed for 60 days, call the clinic to arrange for a pregnancy test but continue taking your pills.

Other possible side effects of the Mini-Pill are mood changes, headaches, and lowered sex drive.

Some of the typical side effects of regular birth control pills, such as nausea, and breast tenderness, usually do not occur with Mini-Pills.

Drug Interactions

The effectiveness of Mini-Pills is lowered when taken with certain medications. These drugs include rifampin and anti-seizure medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with Mini-Pills, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Missed Mini-Pills

3 or more hours late: Take a mini-pill as soon as your remember. Use a backup method for 48 hours.

1 mini-pill missed: Take a mini-pill as soon as you remember and take the next one at the usual time. This may mean taking two pills in one day. If you only miss one mini-pill and make it up, you probably will not get pregnant. Use a backup method for 2 weeks.

2 mini-pills missed: Take 2 mini-pill each day for the next 2 days. Use a backup method for 2 weeks. You may have some spotting or bleeding. If the bleeding is like a period, call the clinic.

3 or more mini-pills missed: Use a backup method and call the clinic for instructions.

NEVER TAKE MORE THAN 2 MINI-PILLS IN 1 DAY.

Advantages

  • Avoids typical side effects of regular birth control pills.
  • Has no estrogen.
  • Easy to use.
  • Does not harm future fertility.
  • Does not interrupt sex play.

Disadvantages

  • Does not protect against sexually transmitted infections, including HIV/AIDS.
  • Must be taken every day at the same time.
  • Less effective when taken with some drugs.
  • Increased risk of functional ovarian cysts.
  • Increased risk of ectopic pregnancy.
  • May cause irregular bleeding.
  • Requires a prescription.

D. Continuous Use – No Periods – Quarterly Periods – Periods when you want them

Continuous Use of Birth Control Pills is an evidence based variation of the standard way to take birth control pills. Research shows it is safe and effective to use some birth control pills continuously without stopping for a “period” so long as four placebo periods per year are still taken. Talk with your health care provider about finding the right pill for you.

Continuous hormonal birth control pills work the same way as regular birth control pills – by stopping ovulation and preventing ovaries from releasing eggs.

With regular birth control pills, you take hormonal pills for three continuous weeks then a one week break during which you would have a “withdrawal bleed.” A withdrawal bleed is different from a natural period. When a woman is not on hormonal birth control, the lining of the uterus thickens in preparation for a possible pregnancy. After ovulation, if no pregnancy implanted, the uterus sheds that thick menstrual lining.

With continuous hormonal use the lining of the uterus does not thicken and thus there is nothing or very little for the uterus to empty.

It is possible to use birth control pills and the Nuva Ring in a continuous fashion. Most packages of birth control pills contain 3 weeks of hormone pills and one week of sugar pills, or spacer pills. By only taking the hormone pills and not taking the one week break there will be no withdrawal bleeding.

This has been done for years for a variety of reasons.

  • Continuous hormonal birth control can help relieve symptoms of PMS, menstrual migraines, and anemia.
  •  Athletes and women planning their wedding or vacation have been using this method to “skip their periods” for many years.
  • A lot of women like the idea of not having the bother with the inconvenience of a period, but the most compelling reason to choose continuous hormonal use is to decrease the risk of unwanted pregnancy.

It is also referred to as “extended cycle” oral contraceptive.

Use

Birth control pills : Only monophasic birth control pills can be used. Monophasic pills contain the same amount of hormones in each pill. Take a hormonal pill every day. Do not take the spacer pills.

Your Health

Women who use hormonal birth control have a slightly higher risk of heart attack and stroke. The effects of hormonal birth control on breast cancer are still unknown. Hormonal birth control lowers a woman’s chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

Side Effects

As the body adjusts to hormonal changes, women often experience some minor side effects, including:

  • Irregular bleeding or spotting
  • Nausea
  • Breast tenderness
  • Weight gain and/or water retention
  • Spotty darkening of the skin
  • Mood changes

Break through bleeding, or bleeding mid cycle is very common in the first six months of continual hormonal use. Over time your body will get used to the constant level of hormones and this side effect will usually disappear within 4-6 months of continuous hormonal use.

Non-steroidal anti-inflammatory medications (naproxen or ibuprofen) can decrease bleeding and make you more comfortable during this adjustment time. If your bleeding continues after one week on an anti-inflammatory, consult your health provider.

Some women may not be able to use hormonal birth control because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not use birth control pills:

  • History of heart attack or stroke
  • Blood clots
  • Unexplained vaginal bleeding
  • Known or suspected cancer
  • Known or suspected pregnancy
  • Liver disease

Women who are under 35 and smoke, have migraines, gallbladder disease, hypertension, diabetes, epilepsy, sickle cell disease, elective surgery, a history of blood clots, liver or heart disease may not be able to take hormonal birth control. Your clinician or doctor can advise.

Future Fertility

Women who want to become pregnant may stop using hormonal birth control at any time. Fertility may return immediately or after a few months.

Continual Use Advantages

  • Decrease risk of unwanted pregnancy
  • While break through bleeding, or bleeding mid-cycle is very common, most women will have no monthly bleeding after continuous use for 6 months.
  • Easy to use.
  • May relieve some PMS symptoms including menstrual migraines and anemia
  • Does not harm future fertility.
  • Does not interrupt sex play.
  • May protect against uterine and ovarian cancers.
  • May reduce acne.

Continual Use Disadvantages

  • Does not protect against sexually transmitted infections, including HIV/AIDS.
  • Pills must be taken every day.
  • Less effective when taken with some drugs.
  • Raised risk of heart attack and stroke.
  • Requires a prescription.

Quarterly Periods • Controlling Periods

To have quarterly periods – Take the birth control pill that contain hormones for three full months. Then take the spacer pills (sugar pills, placebo pills) for one week before returning to the hormone pills. Work with your health care provider on a type of pill and regime that works for you. It is recommended that you give yourself four breaks or “periods” each year. Some birth control pills are specially pre-packaged for quarterly periods or 4 periods per year.

To decide when to (or not to) have your period: You are likely to have withdrawal bleeding during the week of spacer non-hormonal pills. You get to decide when to take the full week of spacers. For example if you have a big special event or trip scheduled, then take the hormone pills continuously through the event or trip. Then after the big event or trip, take 7 days of the spacer pills and have your period.

From the Feminist Women’s Health Center and Cedar River Clinics website.