Birth Control

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Birth control pills or oral contraceptive pills (OCPs) are a very effective, safe and reversible method of contraception. This makes them the most popular method of birth control in the United States, while the intrauterine device (IUD) is the most common contraceptive worldwide. One advantage of birth control pills is that they can also be used as emergency contraceptives (morning after pill) and to delay your period for vacations or special events.

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Written by Dr Kimberly Langdon, MD

Information last reviewed 07/17/19

About

What are birth control pills?

Birth control pills are a type of oral contraceptive used primarily to prevent pregnancy. Aside from this, some birth control pills can also be used to delay your period, reduce period pain and as an emergency contraception. There are several types of birth control pill and it can take a while to find out which one works best for you.

Where do you get contraceptive pills?

You can get contraceptive pills online, from family planning clinics or from a doctor. According to the CDC, the contraceptive pill can be prescribed without needing any blood tests or physical examination other than a blood pressure check. The doctor will also ask if you experience migraines or if you have a family history of blood clots or certain cancers. This is so they can make sure that you get the safest contraceptive pill for you.

What are the benefits of birth control pills?

Contraceptive benefits:

  • More than 99% effective at preventing pregnancy
  • Non-invasive
  • Reversible
  • Easily available
  • Does not require insertion by a doctor
  • Doesn’t interrupt sex

Other benefits:

  • Lighter periods
  • More regular periods
  • Option to delay your period (combined pills only)
  • Can reduce effects of hormones such as acne
  • Reduced period pain
  • Reduced risk of ectopic pregnancy
  • Reduced risk of ovarian, uterine and colon cancer
  • May protect against pelvic inflammatory disease
  • Alleviates symptoms of endometriosis
  • May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease
  • Reduces hair growth in people with polycystic ovarian syndrome (PCOS)

Other uses of birth control

Combined hormonal contraceptives are predominantly used for preventing unwanted pregnancies but they also provide other benefits. Birth control methods like the combined pill, patch and vaginal ring are also used to regulate the menstrual cycle, make your periods lighter and less painful and ease premenstrual tension. Due to the control they give you over your cycle, you can also delay your period. This also makes them a good option for women who suffer from endometriosis. In this case, you would take the pill consistently for several months without the 7 day break. 
If you suffer from acne, combined hormonal birth control methods can also help to decrease the appearance of spots and prevent new ones from forming. 

Myths vs Facts

Myth: The pill makes you gain weight.

Not really true. Some women think they gain weight while others only see monthly fluctuations. When women experience the estrogen-related side effects, they are more likely to have cyclic weight gain that goes away each month during and shortly after their periods.

Depending on the type of progesterone used, the effect on weight will be different. For instance, desogestrel and norgestimate minimize weight gain whereas, levonorgestrel and norethindrone can increase appetite and weight gain.

The main reason OCPs are associated with weight gain is that teenagers and young women often go on them when their weight is increasing from the growth process itself. Weight usually stabilizes around the age of 25, but for the 10 years prior, there is linear weight gain regardless of the use of contraceptive hormones.

Myth: You need to take a break from the pill after a certain amount of time.

This is not true. The overall hormone production from the ovaries is suppressed by the hormones in OCPs. Women think that taking hormones raises their overall hormone level, but the ovaries produce a lot more. So, by suppressing ovulation, the overall effect is lower hormone exposure during each menstrual cycle and throughout your lifetime. Some women will stop having menses because the lining of the uterus is thin from oral contraceptives. This is perfectly safe and will change back to normal bleeding once they stop using The Pill. Taking a break will only increase your risk of getting pregnant.

Myth: All birth control pills are the same.

There are many different types of birth control pill. The active ingredients, type of progestin and the dosage of each hormone can all vary. In addition, some brands of the pill include placebo pills in the pack, to help you keep track of which pills to take on each day.

Progestin-only pills (the Mini Pill) or lower dose combined pills are often given to women who experience estrogen related side effects i.e. breast soreness, nausea, increased vaginal discharge or irritability.

Treatment

Combined oral contraceptive pills

 

Combined oral contraceptive pills (COCs): These pills contain synthetic versions of the female hormones, progestin and estrogen. Each pill contains the same dose of hormones (usually 35mcg of estrogen) and they are generally taken every day for 28 days, followed by a 1 week break. These pills can also be used for period delay and may be used as emergency contraceptives in some cases.

  • Everyday pills: Most combined oral contraceptives are taken every day for 28 days followed by a 7 day break, during which you will have your period. Most people forget to take pills before or after the break, so some brands of pill come with 7 placebo pills to take during the break. This helps you to get in the habit of taking a pill every day and stops you from forgetting to start your pills again at the right time.
  • Low dose: If you experience a lot of side effects from standard strength contraceptive pills, you may be moved onto a lower dose variety. The standard dose of estrogen is usually 35mcg, but lower doses of 20mcg have been found to be equally effective [4] with reduced side effects. Therefore, these low dose pills contain less of the active ingredients, but still protect you against pregnancy. Many women find that the lower dose helps them to avoid the side effects i.e. nausea that they experience on standard dose pills.
  • High dose: Higher dose pills contain a larger amount of the active ingredients than standard pills. Higher dose pills are rarely prescribed, as the standard dose is usually adequate. However, if you experienced a lot of breakthrough bleeding or spotting, you may find that these side effects disappear with a higher dose.

Progestin-only pills

  • Progestin-only pills (POPs or Mini Pills): These pills are taken every day, without a break. The pills contain different doses of the active ingredient, depending upon when in your menstrual cycle they are taken. Progestin-only pills often have less side effects than combined pills. And therefore, unlike COCs, POPs can be taken by people who experience migraines. However, POPs are slightly less effective than combined pills, they need to be taken at the same time each day and many women will experience irregular periods or spotting when using POPs.

    • Type of Progestin: Different progestin-only pills contain different types of progestin (synthetic progesterone) and can produce different side effects. Desogestrel and norgestimate have a low androgenicity. This means they have a low propensity to act like male sex hormones. Progestins with low androgenicity, such as desogestrel and norgestimate, can reduce your chances of the following side effects: weight gain, depression, oily skin and acne. On the other hand, levonorgestrel and norethindrone have high androgenicity and can increase appetite and weight gain, depression, oily skin and acne.

Contraceptive rings

Contraceptive rings are small, soft plastic devices which are inserted into the vagina. They contain the same types of hormones as the combined pill, releasing them into the uterus and ovaries. Once inserted, each ring lasts for 21 days. After this, it is removed and then you wait 7 days until putting a new one in. You’ll still be protected against pregnancy during this time and this is when you have your monthly bleed. This is a good option if you struggle to remember to take the pill everyday.

Contraceptive patches

Contraceptive patches are small, square patches which resemble plasters which are stuck onto the surface of your skin to release hormones into the bloodstream. They work in the same way as the combined pill, containing estrogen and progesterone hormones to stop ovulation from occurring, thickening the mucus around the cervix and thinning the uterine lining. Each patch should be left on for 7 days. After 3 weeks, remove the third one and wait 7 days before applying the next one. 

Other birth control options

There are many other types of birth control, including both long and short term options. These include: 

  • IUD: This is short for the intrauterine device. There are two different types; one contains a type of progestin hormone called levonorgestrel and the other is non-hormonal and releases copper into the womb. It is inserted into the uterus by a trained doctor, with two strings attached which allow you to check it regularly to ensure it’s still in place. The copper IUD lasts for 10 years and the hormonal version lasts for 3-5 years, both are more than 99% effective at preventing pregnancy 
  • Contraceptive implant: the implant is a small plastic rod which is inserted into your upper arm under local anesthetic. It contains a form of progestin hormone which is released steadily into the bloodstream and lasts for three years. This is a progestin only form of hormonal birth control which is over 99% effective. Common side effects may include irregular periods, breast tenderness and altered moods
  • Birth control shot: this involves getting a shot of progestin every 12 weeks which stops you from ovulating. It means you don’t have to think about it in between appointments but you must get your shot on time for it to be effective. Once you stop using it, it can take a while for your fertility to return
  • Diaphragm: a diaphragm is a cup, or cap shaped device made from silicone. It is inserted into the vagina with spermicide to cover the cervix to stop sperm from entering. It can be inserted up to two hours before sex and needs to be left in for at least 6 hours afterwards. A cap is slightly smaller and can be left in for up to 42 hours before sexual intercourse. After removing it, you can wash it for reuse. Both the diaphragm or cap is 92-96% effective
  • Male condom: a condom is made from latex and is placed over the length of a man’s penis before sex, stopping sperm from entering the vagina. They are 98% effective and readily available from pharmacies and drugstores. Condoms are the only method of birth control that prevents the spread of STIs
  • Female condom: Similar to a male condom, the female equivalent is placed into the vagina before sex. It has a soft ring on one end to keep it in place. It blocks sperm from entering and also protects against STIs. They are about 95% effective if used correctly
  • Sponge: the sponge works in a similar way to a diaphragm. Made from a soft, sponge-like material, it is inserted into the vagina and blocks sperm from entering through the cervix. Once it is in place, it can be left in for up to 24 hours and you can have sex multiple times

Q&A

Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. US Food and Drug Administration. FDA approves a new vaginal ring for one year of birth control. August 10, 2018. Source Accessed November 26, 2018.
  2. Population Council. FDA approves the first one-year contraceptive fully under a woman's control. August 10, 2018. Source Accessed November 26, 2018.
  3. US Food and Drug Administration. Annovera prescribing information. Source Accessed November 26, 2018.
  4. Poindexter A. The emerging use of the 20-microg oral contraceptive. Fertil Steril. 2001 Mar. 75(3):457-65.

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