A Complete Guide To Oral Contraception- Straight From A Gyanecologist
If you wish to avoid pregnancy or have plans to maintain a good gap between your babies, then it is important for you to choose an effective birth control method.Even though there are several methods available to avoid pregnancy like intrauterine contraceptive, birth control products, and emergency contraceptive pills, an effective contraceptive counselling of a woman’s preferences and medical history, as well as the risks, benefits, adverse effects, and contraindications of each is required. Only then can the decision for opting for anyone of them, including oral contraceptive pills (OCPs) be reached.
Oral contraceptives (the pill) are hormonally active pills which are usually taken by women daily. These are the artificial versions of the hormones naturally produced by the ovaries. They contain either two hormones combined (progestogen and oestrogen) or a single hormone (progestogen). Combined oral contraceptives suppress ovulation whereas both types cause a thickening of the cervical mucus, blocking sperm penetration. When given in certain amounts and at certain times in the menstrual cycle, these hormones prevent the ovary from releasing an egg for fertilisation.
A woman can decide to start taking the pill if she is sexually active and is certain she is not pregnant. Oral contraceptives should be taken in order, at a convenient and consistent time each day. They are appropriate for women who are willing to use a method that requires action daily and who will be able to obtain supplies on a continuous basis.
- Oral contraceptives are 92–99 per cent effective when taken as per advice.
- The perfect use failure rate in the first year is: 0.3% per cent
- The typical use failure rate in the first year is: 8 per cent
OCPs are available in 3 different types: triphasic, biphasic, and monophasic pills.
- Monophasic: Monophasic pills are designed to release the same amount of oestrogen and progestin throughout the cycle.
- Biphasic: Biphasic tablets release a high amount of oestrogen and a low ratio of progestin during the initial half of your menstrual while progestin dose is increased halfway through the cycle.
- Triphasic Birth Control Pills: Triphasic pills have 3 different doses of progestin and oestrogen that change approximately every 7 days.
How to take Contraceptives Pill
Most women can start the pill at any time in their menstrual cycle. There is a special guidance if you have just had a baby, abortion, or miscarriage.
- Starting on the first day of your period: If you start the combined pill on the first day of your period (day 1 of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
- Starting on the fifth day of your cycle or before: If you start the pill on the fifth day of your period or before, you will still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you will need additional contraception, such as condoms, until you have taken the pill for 7 days.
- Starting after the fifth day of your cycle: You will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for 7 days.
What if you miss a dose?
If you’re on the combined contraceptive pill and you miss a pill, what you need to do depends on:
- How many pills you’ve missed (you’ve missed a pill when it’s more than 24 hours since you should have taken it)
- When you missed your pill (where you are in the pack)
- The type of combined pill you are taking
If you’ve missed 1 pill anywhere in the pack, you should take the last pill you missed now, even if this means taking 2 pills in 1 day. Carry on taking the rest of the pack as normal.
What if I’ve missed 2 or more pills?
If you’ve missed 2 or more pills anywhere in the pack, your protection against pregnancy may be affected. You should take the last pill you missed now, even if this means taking 2 pills in 1 day. Leave any earlier missed pills and carry on taking the rest of the pack as normal use. Make sure you use extra contraception such as condoms for the next 7 days.
Advantage of Contraceptive Pills
Some advantages of the pill include:
- it does not interrupt sex.
- it usually makes your bleeds regular, lighter, and less painful.
- it reduces your risk of cancer of the ovaries, womb, and colon.
- it can reduce symptoms of premenstrual syndrome (PMS).
- it can sometimes reduce acne.
- it may protect against pelvic inflammatory disease.
- it may reduce the risk of fibroids, ovarian cysts, and non-cancerous breast diseases.
- the pill offers continuous protection against pregnancy.
The pill does NOT protect against sexually transmitted infections (STIs, including HIV). To protect against STIs, a male or female condom must be used.
Research is ongoing into the possible link between breast cancer and the pill. It suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.
Research has also suggested a possible link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing womb (endometrial) cancer, ovarian cancer, and colon cancer.
Absolute contraindications include:
- Thrombophlebitis or thromboembolic disorders
- Cerebrovascular or coronary artery disease
- Carcinoma of the breast or other oestrogen-dependent neoplasia
- Undiagnosed abnormal genital bleeding
- Known or suspected pregnancy
- Benign or malignant liver tumor
- Age over 45
- Gallbladder disease
- Gestational cholestasis
- History of renal disease
- Impaired liver function
The effectiveness of the pills can be retarded by the use of rifampicin, certain oral yeast infection medicine, some HIV medicine, and certain anti-seizure drugs. The potency of the pill is also affected if the woman is having diarrhoea or vomiting.
Emergency Contraceptive Pill
Here, two doses of the pill, separated by 12 hours, are taken within 3 days (72 hours) of unprotected intercourse. Depending on the time of menstruation it is taken at, it can prevent ovulation, fertilization, or implantation of the fertilized egg. It is available without a prescription. Its uses include prevention of pregnancy after condom tear/slips, when two oral pills are missed in succession, when an intrauterine device is expelled and there is fear of conception, or in case injectable contraceptives are delayed by more than 2 weeks.
Dr. Rachna Singh is a Consultant- Obstetrics and Gynaecology at The CK Birla Hospital for Women. She is also a health council member at Healthhunt.