Birth Control Pills (Oral Contraceptives)

What are birth control pills?

Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. The hormones also help prevent pregnancy in 2 other ways. They cause a thickening of the mucus on the cervix and they change the lining of the uterus. The thickened mucus on the cervix makes it hard for sperm to enter the uterus. The change in the lining of the uterus helps prevent a fertilized egg from attaching to the uterus.

The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: estrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.

How are the pills used?

The combined pills usually come in a package of 28 pills. They are also available in 21-pill or 91-pill packs. You and your health care provider will decide which type of package is best for you. Your provider will probably advise you to start taking the pills on the Sunday after your period has started or on the first day of your next period, depending on your preference.

• Try to take your pill at the same time every day. This will help you remember to take the pills. It will also help keep hormone levels steady.
• Use a backup method of birth control (such as condoms and spermicide) until you have been taking the pills for 2 weeks.
• Use condoms, even though you are taking birth control pills, for protection against sexually transmitted disease unless you have a long-term, single-partner relationship.
• If you have bleeding between periods for several cycles you may need a different pill. Call your health care provider for an appointment.
• Any time you are seen for medical reasons, be sure to mention that you are taking birth control pills. This is particularly important if you are admitted to the hospital or having surgery.

21-day pill pack

If you are using the 21-pill pack, take 1 pill every day for 3 weeks. Stop taking the pills for 7 days and then start a new pack. Your period comes during the week that you are not taking pills.

28-day pill pack

If you are using the 28-day package, take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills are inactive and contain no medicine for birth control. They just keep you in the habit of taking a pill every day. Your period comes during the week that you are taking the last 7 pills.

91-day pill pack (Seasonale)

If you are using the 91-day pill pack (Seasonale), you take 1 pill of active medicine every day for 12 weeks (84 days). Then you take 1 inactive pill every day for 1 week (7 days). You will have your period while you are taking the inactive pills. This means that you have a period just once every 3 months.

What if I forget to take a pill?

Your risk of pregnancy increases when you miss any pills.

If you forget 1 pill, take it as soon as you remember, even if it is the next day. Take the next pill on time.

If you miss 2 or more doses in a row, see the information sheet that comes in the medicine package or ask your health care provider what to do. Use an additional method of birth control, such as condoms or spermicide, until your next period starts.

What are the benefits?

The benefits are:

• Birth control pills are 95 to 99% effective in preventing pregnancy. This means that, for every 100 women who use the pills for a year, no more than 5 will become pregnant by the end of the year.
• You do not have to interrupt lovemaking to use a birth control device or spermicide.
• Periods become regular and usually lighter. Menstrual cramps may be less severe.

What are the disadvantages?

One disadvantage of birth control pills is that you must remember to take a pill every day.

The pills usually have no side effects. If you do have side effects they may include:

• irregular menstrual bleeding for the first few months after you start birth control pills or no menstrual periods
• nausea and vomiting
• weight gain
• breast swelling and tenderness
• increased appetite
• depression
• headaches
• yeast infections
• scant or missed periods
• high blood pressure
• dizziness
• vision changes
• jaundice (yellow eyes and skin).

You should not smoke if you take birth control pills. Smoking can increase your risk of severe problems such as heart disease and blood clots.

Birth control pills do not protect you from sexually transmitted diseases such as AIDS. Latex or polyurethane condoms are the only safe way to protect against AIDS.

Some medicines can affect the way birth control pills work in your body. Birth control pills may not keep protecting you against pregnancy if you are taking certain antibiotics or medicines for seizures or fungal infections. Tell your health care provider about all medicines or natural remedies you are taking. You may need to use an additional form of birth control while you are taking these medicines.

When should I call my health care provider?

Call right away if you have:

• pain, swelling, and redness in the calf of one of your legs
• shortness of breath, sharp chest pain, or coughing up blood
• blurred vision or slurred speech
• severe headaches
• severe abdominal pain.

Call during office hours if you have:

• jaundice (yellow eyes and skin)
• numbness or tingling
• problems with your menstrual periods, such as bleeding between periods, prolonged periods, or missed periods, or you think you are pregnant
• increasing headaches
• severe mood changes.