Everything you need to know about: the pill
Fact: two-thirds of Australian women aged 18 – 49 use contraception.
Fact: oral contraceptive pills are the most common contraceptive choice.
Fact: apart from its effectiveness as a contraceptive, when choosing a pill women primarily worry about unwanted side effects.
So it makes sense to get clued up on it, right? Not only will it help you make a more informed choice about your preferred method of protection, but it could also help you identify whether or not you’re on the right contraceptive pill for your body. We chat to Obstetrician and Gynaecologist, Dr Neisha Wratten, about how oral contraception works, the potential side effects of the pill, and what to do if you skip or miss a pill.
How does the pill work to prevent you from falling pregnant?
The pill works by stopping the ovary from producing an egg or ova every month. The hormone in the pill blocks the signals from the ovary to the pituitary gland. This gland sits at the base of the brain and produces hormones and chemicals that are then carried in the blood and control a number of body functions, including that of the ovary. Most contraceptive pills contain a hormone called progestagen, which works to actively stop ovulation.
How can you tell if you’re on the wrong pill?
Many women get some side effects (such as spotting, fluid retention and bloating, slight weight gain, headaches, breast tenderness, acne, tummy pains and mood swings) when they first start, or change over to a new pill. But in nine out of 10 cases, these will settle down after three cycles. So if these symptoms are still there after three cycles, it could be an indication that this pill is not right for you. If this is the case, take careful note of your symptoms are and see your doctor to discuss changing pills. Different pills contain different hormones in different doses, each with different side effect profiles, so giving your doctor as much information as possible will help them to select the best pill for you.
Are there any pills available that are known to have reduced side effects?
A lot of pills only contain the hormone progestagen, and a common problem associated with this hormone is irregular bleeding. Pills that contain a combination of progestagen and oestrogen – which helps control any abnormal bleeding caused by the progestagen – can have fewer side effects. These are known as ‘combined pills’. Likewise, the oestrogen we have traditionally used in pills is ethinyl oestradiol, which is similar but not exactly like the oestrogen produced in your own body, and can cause side effects. One of the newer combined pills on the market contains what’s known as a ‘17 beta oestradiol’, which is much closer in structure to the oestrogen naturally produced by women.
Are there any additional health benefits to being on a combined pill?
Contraception aside, there are many other health benefits to being on a combined pill. Women on the pill have less acne, shorter and less heavy periods and less pain – and are at lower risks of iron deficiency. They may have less cyclical symptoms such as mood swings, headaches and premenstrual fluid retention. In the longer term we know they are at a lower risk of cancer of the ovary and cancer of the lining of the womb (endometrium). As a gynaecologist I use the pill to treat many conditions, such as PCOS (polycystic ovary syndrome), PMS (pre-menstrual stress), heavy periods and endometriosis. There are also social benefits to being on the pill as it allows women to choose if and when they want to have a bleed to fit in with their lifestyle.
If you forget to take a pill, is it ok to take a double dose the next day? And how long will it be until you’re considered protected again?
If you miss a pill and it’s been less than 24 hours, take another pill as soon as you remember and you’ll be protected. If it’s been longer than 24 hours or you‘ve missed more than one pill, take one pill as soon as you remember and the next at the usual time the following day. In this instance you’ll also need to use barrier contraception, such as condoms, for the next seven days.
If you miss the pill but have less than seven hormone tablets left in the pack, skip the sugar pills, go straight onto the hormone pills in the next pack, and use condoms for the next seven days. However, if you’re on a pill with different dosages through the month (such as a triphasic pill), you may get bleeding if you do this so it’s best to ring your doctor to check which coloured pill you need to resume with.
Antibiotics are known to reduce the effectiveness of the pill. If you’ve been on antibiotics how long after you’ve finished your course are you considered protected again?
Women on antibiotics should use barrier contraception (condoms) during the course of their antibiotics, and for seven days after they’ve stopped taking the antibiotics. If sugar pills are due to be started within that time it is recommended that you skip the sugar pills and go straight on to the hormone tablets in the next pack.
Women should speak to their doctor about contraceptive options to determine the most appropriate choice for them.
Are you, or have you ever been on the contraceptive pill? Do you have any questions you want answered about the pill?