What
are birth control pills?
Birth control pills (BCPs) or oral contraceptive pills or have been
used in this country for over 40 years. Safe and effective, they
are one of the most extensively studied medications in the US The
first birth control pill, Enovid, was introduced in 1960. Since
then, over 45 brands have become available to women. BCPs have changed
significantly since their introduction. Most importantly, the dosages
of the pills have been markedly reduced. As the dosages have decreased,
the side effects women experienced also decreased. Our currently
prescribed pills have approximately one-tenth the amount of medication
used in the first pills of the 1960's.
How
do BCPs work?
Most BCPs contain two hormones: estrogen and progesterone. These
hormones are synthetic versions of naturally occurring female hormones.
They work primarily by preventing ovulation. There are 2 types of
pill packs:
28
day pill packs: 3 weeks of active hormone pills and 1 week placebo
pills
21
day pill packs: 3 weeks of active hormone pills only.
Your
period occurs each cycle, a few days after completing the active
pills. Pills can be monophasic or triphasic. Monophasic means that
the hormone pills all contain the same dosage. Triphasic pills contain
slightly different amounts of hormone throughout the active pills.
Monophasic and triphasic pills are equally effective and popular.
How
effective are BCPs in preventing pregnancy and STIs?
BCPs are 98% to 99% effective for women who take the pills every
day as directed. Pill-taking mistakes decrease effectiveness. There
are detailed instructions on late or missed pills under the section
-- How do I start taking BCPs? BCPs do not offer any protection
against sexually transmitted infections (STIs).
What
are the side effects of BCPs?
Like all medicines, BCPs have side effects that you need to be aware
of. For BCPs, there are rare but serious side effects and minor
side effects.
Rare
but serious side effects:
Blood
clots
BCPs can make women slightly more prone to form blood clots. A
blood clot can occur in a vein or artery and can have different
symptoms depending on where it forms. Clots can occur in the legs,
abdomen, heart, lungs, eye, or brain. In the brain, a clot could
manifest as a stroke. The risk of these events occurring is very
low, but increases in women over 35, in smokers, and in those
with high blood pressure, heart disease, diabetes, clotting tendency,
or a family history of clotting abnormalities. The warning signs
of a blood clot spell out the word ACHES:
Abdominal
pain
Chest
pain (also shortness of breath)
Headaches
(especially those that are new, severe, or associated with persistent
dizziness, difficulty speaking, fainting,numbness or weakness
in extremities
Eye
problems (blurred vision or loss of vision)
Severe
leg pain (and/or redness and swelling in the calf or thigh)
If
you develop any of the ACHES side effects or jaundice (a yellowing
of the eyes or skin) while on BCPs, call Health Services right
away at 863-1330. If you need emergency medical attention, call
EMS at 863-4111. If you are out of town, contact a local health
provider or go to a hospital emergency room.
High
blood pressure
BCPs can raise your blood pressure. This is why we check your
blood pressure a few months after you begin taking BCPs.
Liver
tumors
BCPs have been associated with an increased risk of forming
benign liver tumors. This is a very rare occurrence, but you
should contact your provider if you develop upper abdominal
pain while taking BCPs.
Breast
cancer risk
Many patients ask about how BCPs affect their future risk of
developing breast cancer. The jury is still out on this issue.
To date, there have been studies which suggest that there is
a slightly increased risk of breast cancer in women who have
used BCPs; however, breast cancer was diagnosed earlier and
had a better prognosis than in women who have never used the
pill. We encourage all women, especially those with a strong
family history, to explore this risk with their provider.
Cervical
cancer risk
The risk of developing this type of cancer is slightly increased
in BCP users. Fortunately, routine Pap smear testing is an excellent
screening tool and is recommended on a yearly basis for women
taking BCPs.
Nausea
Some women experience some mild nausea when first starting BCPs.
Usually this goes away within a short time. Taking your pill with
food or taking it before bedtime may help. If you have persistent
problems or unusually severe nausea, contact your provider.
Spotting
or breakthrough bleeding
This is vaginal bleeding that occurs during your active pills.
This is a very common side effect during the first 3 months of
BCP use.
Breast
tenderness
Mild breast tenderness may occur after starting BCPs. The tenderness
can be reduced by decreasing your caffeine and salt intake and
by wearing a bra with good support. Usually it gets better within
a few weeks. If you notice persistent discomfort or a discrete
lump, make an appointment with your provider.
Mood
changes
Some women may notice changes in their emotional status: depressed
mood or emotional instability. If you have a history of depression,
it is important to monitor your progress carefully when starting
BCPs. If you notice changes in your mood after beginning BCPs,
call your provider.
Decreased sex drive
While your sex drive is affected by many things, the hormones
in BCPs can be a factor in decreased sex drive. If you are noticing
this side effect, let your provider know. A change to another
pill can improve this.
Weight
gain
Many patients ask about this side effect. Studies have shown that
weight changes in young women on BCPs are no different than women
who don't take BCPs. Some women have noticed mild weight change
(1 to 2 pounds) and mild fluid retention on some types of BCPs.
Contrary to popular opinion, taking BCPs should not make you gain
10 or 15 pounds.
Gallbladder
disease
BCPs may accelerate the formation of gallbladder stones in women
who have a strong family history of gallstone disease.
Cervical changes
BCP usage, as well as pregnancy, have been associated with some
cellular changes on the cervix, called a cervical ectropion. The
delicate mucus secreting cells that line the inside of the cervix
become present at the outer opening of the cervix. This can make
the cervix more vulnerable to sexually transmitted diseases.
Vaginal
discharge
All menstruating women have a cyclical vaginal discharge. BCP
users may notice subtle changes, but most women won't notice any
changes.
What
are the benefits of taking BCPs? Regular cycles
BCPs are great at regulating the menstrual cycle, and this is especially
helpful for women with periods that come too often or too infrequently.
Reduced
menstrual cramps
BCPs can offer significant relief to women with painful menstrual
cramps. They also reduce the amount of blood flow during the period.
Less blood loss is helpful in preventing anemia.
Acne
We have known for years that BCPs can improve some women's acne.
There are a few heavily marketed brands that are felt to be beneficial
for acne. Some women have a marked improvement, others less. If
this is a concern for you, discuss it with your provider.
Other
important benefits
The risk of developing benign breast cysts, ovarian cysts, pelvic
inflammatory disease, and tubal pregnancy are reduced by taking
BCPs. They also are associated with a markedly decreased risk of
uterine cancer and ovarian cancer.
Where
can I get BCPs?
For you to receive a prescription for BCPs, your medical providers
will need to see you for a visit to take your medical history and
perform an exam that usually includes a gynecological examination
and Pap smear. If you have had such an exam within the last 12 months,
you don't have to repeat it-but your medical provider will want
to get a copy of the results. If you have never had a gynecological
exam, call Health Services at 401.863-3953 to schedule an appointment.
Let our staff know this is your first exam. The medical providers
are very sensitive to and supportive of women having their first
exams. The only charges during your visit will be for lab testing.
You can choose to pay for any of our services directly if you don't
want charges to appear on insurance bill or the Bursar's bill.
After
you and your provider choose a pill, you will probably receive a
prescription for 1 month of pills with 2 refills. You will need
to return for a brief appointment during the 3rd pack for medical
provider to see how you are doing and to check your blood pressure.
If you are doing well, you will be given a prescription to last
6 to 9 months. Women on BCPs should get a gynecological exam with
a Pap smear once a year.
You can have your prescription for BCPs filled at the Health Services pharmacy
or at a local pharmacy. Some insurance plans cover BCPs, some don't.
Our pharmacy is open 9:00am to 5:00pm Monday through Friday, with
some exceptions. Click here
for the current pharmacy schedule. You can call the pharmacy at
401.863-7882 if you can't make it in during those times and they can
arrange for a late pick up. If you run out of pills for any reason,
always call Health Services, and we can help out until your next
appointment.
How
do I start using BCPs?
There are two ways to begin:
Sunday
Start
Start the first pill of your pack on the Sunday following the first
day of your period. If your period begins Monday, Tuesday, Wednesday,
Thursday, Friday or Saturday, start taking the pill that Sunday.
If your period starts on a Sunday, begin taking your pill that very
day.
First
Day Start
Start your first pill during the first 24 hours of your period.
Be aware that during this first pack of pills, you will have two
periods: one during the first week of pills and one on the fourth
week of pills. After this first pack, you will get a period only
once a month, on the fourth week of the pack, during the placebo
pills.
How
long before the pill is effective?
When starting BCPs, it will take 7 days for the pill to become effective
at preventing pregnancy. You will need to use a second method of
contraception during these 7 days. We recommend using condoms. In
fact, we recommend using condoms consistently with BCPs to protect
against sexually transmitted infections. Remember that BCPs offer
no protection from acquiring STIs.
Be aware
that your first and last active pills are the most important pills
in your pack. Being late starting your next pack or forgetting your
last active pill will lengthen the time off the active pills. Lengthening
this pill-free interval can allow your body to ovulate. Try to plan
carefully when you need to start or purchase your next pack. Remember
your pills when you go away for weekends or vacations.
To help
you remember to take your pill every day, it is useful to link taking
your pill with some daily activity like brushing your teeth or eating
a certain meal. Some women set a watch alarm to go off as a reminder.
Each morning check your pack to make sure you took yesterday's pill.
What
if I'm late taking pills or I miss a pill?
Taking your pill consistently every day gives you the best protection
against pregnancy. Occasionally you may be late taking a pill or
forget to take a pill. Spotting is likely to occur if you miss pills,
but more importantly, the effectiveness of your BCPs can also be
compromised. Here are some instructions to help enhance the effectiveness
of your BCPs in those situations:
If
you are less than 12 hours late for your pill, take it. You may
wish to consider using a condom for the next 7 days, if you are
not already consistently using condoms for STI protection.
If
you forget 1 pill and 12 to 24 hours have elapsed since your last
pill, take it as soon as you remember, then take your regular
pill for that day at the same time you usually take it. Use condoms
for the next 7 days.
If
you forgot 2 pills in a row in the first 2 weeks, take 2 pills,
6 hours apart, on the day you remember, and 2 pills, 6 hours apart,
the next day. Take 1 pill per day until the pack is finished.
Use condoms for at least 7 days.
If
you forget 2 pills in the 3rd week OR you miss 3 pills or more
in a row at any time:
Sunday Starters
Keep taking a pill every day until Sunday. On Sunday throw away
the unused portion of the pack and start a new pack. Use condoms
for at least 7 days.
First Day Starters
Throw out the rest of the current pack and start a new pack the
same day. Use condoms for at least 7 days.
If you
had intercourse without a condom during a time when you made a pill
mistake, call Health Services to discuss whether you should consider
emergency contraception.
What
should I do if I don't get my period?
While your period may be much lighter on BCPs, you will get a period.
Sometimes, however, no period occurs for a number of reasons: the
low doses of the hormones, stress, or illness. If you've taken your
pills regularly, pregnancy is unlikely. However, we do recommend
taking a pregnancy
test to rule out this possibility before starting
your next pack of pills. We perform confidential urine pregnancy
tests at no cost. If you aren't getting a regular period on BCPs,
we may suggest a different pill.
What
if I lose a pill?
If a pill is lost, you should replace it from a separate pack of
pills. Call Health Services if this happens. Advice may vary depending
on where you are in your pack and what type of pill you are on.
What
if I am vomiting or have diarrhea?
If you vomit within two hours of taking your pill, you should consider
that pill missed, and take another from a separate pack, as soon
as you can keep things down. If you have 3 or more loose bowel movements
for 2 days, the effectiveness of the pill may be reduced. We recommend
that you abstain from sexual activity or use a condom for the duration
of your illness and the 7 days afterwards.
Can
I skip a period on purpose?
There may be a week when you would really like to avoid your period
because of a special trip or event. You may accomplish this by not
taking the placebo week of pills. Instead, throw them out and start
your next pack of pills. Your period should hold off until you finish
this new pack. This works a bit better with monophasic pills than
with triphasic pills. We encourage women to try this only after
they have been using BCPs successfully for a few months and have
seen how their bodies adjust to BCPs. If you'd like to try this
method, call your provider to discuss the details.
What
happens if I take antibiotics while I'm on the pill?
We do know there are certain medicines that diminish the effectiveness
of BCPs. The common antibiotics we use shouldn't affect the metabolism
of BCPs. However, there have been some anecdotal reports by pill
users who became pregnant while taking antibiotics. While the risk
is very low, we encourage women to use condoms for the duration
of their antibiotic prescription and for the following 7 days.
What if I have breakthrough bleeding?
Spotting or bleeding during the active pills of your pack is termed
breakthrough bleeding. It is extremely common during the first three
months of pill use. This bleeding can usually be ignored and should
resolve by the third pack. If light bleeding persists for more than
5 to 7 days or heavy bleeding persists for more than 2 to 3 days,
call your provider. We will sometimes recommend taking two pills
a day (one it the morning, one in the evening) until the bleeding
stops. The extra pills should be drawn from a separate pack of pills.
Usually the extra pills need to be taken for 2 to 3 days.
Breakthrough
bleeding can also occur if you are late or forgot a pill. If you
are experiencing breakthrough bleeding after your 3rd month of pill
use for no obvious reason (you've taken your pills perfectly), you
should call your provider.
Do
I need to stop using the pill from time to time?
There is no evidence that you should "rest" your body
from the pill periodically. It's generally not recommended to stop
the pill unless you plan to stay off for 3 months. The best time
to stop is at the end of your pack. Stopping during a pill cycle
will usually be followed by some bleeding; count this as a menstrual
period. Remember that you could become pregnant as soon as you stop
taking the pills. However, your next normal period may be delayed.
If normal menstruation does not return in 8 weeks, see your provider
to determine why.
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.
