Birth Control Pill

When taken consistently, birth control pills, also known as oral contraceptives, are one of the most effective methods to prevent unplanned pregnancy and/or regulate menstruation.

How to use oral contraceptives

• Sunday Start Method: Start your first pack on the first Sunday after your period begins. For example, if your period starts on a Wednesday begin your pills on that following Sunday. If your period begins on Sunday, begin your pills that same day.
• First Day of Your Period Method: start your pills the day your period begins.
• Today!
• Other: __________________________________________

We recommend that you continue to use a contraceptive back-up method (e.g. a condom) for the first pack of pills, because it may take you a while to adjust to a new habit (i.e. taking a pill at the same time each day). Please be aware that changing the time you take the pill or missing a pill will decrease the effectiveness of the contraceptive.

Swallow one pill at the same time every day until you finish the package. If you are using a 28 day pack, begin a new pack immediately; if you have a 21 day pack, wait 7 days then start a new pack. Associate taking the pill with some regularly scheduled activity such as meals or bedtime. Check your pack each day to be sure you took your pill the day before.

Menstrual periods

The week that you are off pills or taking the placebo pills is the week that you will have your period. Bleeding usually begins on the 2nd or 3rd day of the placebo week. The first few months you may have bleeding at other times as well. This is normal and usually stops by the time you have taken three pill packs. Continue taking your active pills until all 21 days are completed; then take 7 days of placebos; then start a new pack. Bleeding may last a shorter time and may be lighter than before you started pills.

Periods may be short and scanty for women on pills. You may see no fresh blood at all. If you do not have your period when expected while taking birth control pills, you should consult a clinician. If you have not missed any pills and you have no signs of pregnancy, then pregnancy is unlikely. Call Gannett (255-5155). You should have a pregnancy test if you do not have bleeding for two months in a row.

Side-effects

Common side-effects (which should disappear in 2-3 months) of the pill include:

Spotting or breakthrough bleeding may occur between periods while your body adjusts to the hormone dose. Breakthrough bleeding does not indicate diminished contraceptive protection unless you have taken pills irregularly (in which case additional contraception is recommended). If your bleeding resembles a period, it is advisable to use backup contraception for the rest of your cycle. Continue to take your pills at the same time each day.

Nausea
If nausea occurs, try taking your pill with food, milk, or before bedtime.

Breast fullness and/or tenderness may be related to the estrogen or progestin in the pill and should diminish with time.

If any of these problems persist after three pill cycles, call for an appointment with a clinician or nurse. Most common problems can be relieved by changing to a different pill.

Symptoms of serious side-effects

• It is important to be aware of very rare but potentially serious complications that may arise as the result of pill use (e.g. gall stones, blood clots). The following are important symptoms that should not be ignored:
• severe abdominal pain lasting more than 30 minutes
• severe chest pain or shortness of breath
• increase in frequency or severity of headaches, especially if associated with weakness, numbness, or vision disturbances
• loss of vision, double vision, or blurred vision
• speech problems
• severe pain in the calf or thigh
  

If you experience any of the symptoms listed above, call Gannett immediately at 255-5155. After hours, call this number to reach the on-call provider. If you are out of town, see your personal physician or go to the emergency room at the nearest hospital. If you are unable to obtain medical care, stop taking the pill and use another form of contraceptive method until you speak with a health care provider.

Deciding when to stop the pill

Clients occasionally stop their pills because they are annoyed by common side effects. Most side effects disappear if the pill is taken consistently for three cycles. We encourage you to continue the pill for the entire three cycles because frequent starting and stopping may prolong adjustment to the pill. If you feel that you must stop taking the pill and continue to be sexually active, make sure that you have obtained and learned how to use another form of contraception (you can always call 255-5155 or stop by Gannett for contraceptive supplies and information). It is possible to become pregnant as soon as you stop the pill.

There are no medical benefits to stopping the pill periodically, after a certain number of years or at a certain age. Each individual should consult with her clinician before assuming it is necessary to stop the pill.

When to use a back-up method (e.g. condom)

If you miss one pill, take it as soon as you remember. Then, take your next pill at the regular time. You probably will not get pregnant but to be sure, you may want to use a back-up method for seven days after the missed pill.

If you miss two pills in a row, then take two tablets as soon as you remember and take two tablets the next day. Then return to your regular schedule but use a back-up method of birth control for seven days after the two missed tablets.

If you miss three pills in a row, you will probably begin your period. Whether or not you start menstruating, throw away the rest of your pack and begin the next pack as you did when you first started the method. For example, if you are a "Sunday Starter," begin your next pack on Sunday (if a Tuesday starter, start pill the following Sunday, etc.). Use a back-up method of birth control until you have been back on pills for seven days.

If you are still not sure what to do about pills you have missed, use a back-up contraceptive, keep taking your pills, and call Gannett (255-5155) for more information.

If you are taking certain medications

Prescription and non-prescription medicines and recreational drugs may interfere with the effectiveness of your birth control pills. Known interactions occur with high doses of vitamins, anticonvulsants, Valium, diuretics and short-term antibiotics. To insure your contraceptive’s effectiveness ask about interactions with any medicine you take, and make sure that your health care provider/pharmacist is aware that you are taking the pill. You must inform all health care providers that you use the pill if you are in a leg cast or scheduled for surgery. If you have any questions, ask.

Additional protection (barrier methods or abstinence) will ensure your contraceptive’s effectiveness when taking medicines. If you experience break-through bleeding while taking other medications, it may indicate a decrease in the pill’s effectiveness. Use a back-up method and consult with a health care provider.

If you are experiencing vomiting or diarrhea

If you have vomiting or diarrhea, you may not be absorbing the pill and you should use a back-up method of birth control for up to one month while you keep taking your pills on schedule.

Remember emergency contraception

• If you've had vaginal intercourse and then realize you've missed one or more pills
• If you've missed one or more pills at the beginning or end of a pack (so the pill-free interval is pro- longed beyond seven days)
• If you missed two or more pills during the pill cycle, you may want to consider getting emergency contraception.
• Emergency contraception (EC), sometimes called “morning after pills”, consists of 2 doses of hormone (oral contraceptive) pills taken within 12 hours of one another.
• EC should be started within 5 days (120 hours) of unprotected vaginal intercourse.
• EC is given in a higher dose than is normally used for contraception in order to disrupt the hormonal patterns that establish a pregnancy.
• Emergency contraception is reasonable if you are worried or wish to avoid even a small risk of pregnancy.
• EC is available for purchase without a prescription at the Gannett Pharmacy (if you are over 18 years of age) or by prescription with a nurse visit (if under 18 years of age)
• If you have questions or concerns about EC, call Gannett (255-5155) for more information. 
  

Most birth control pills are made up of two synthetic hormones, an estrogen and a progestin. To minimize health risks, clinicians prescribe pills which contain the lowest amount of hormone. Birth control pills are the most extensively studied drugs ever prescribed. They provide just enough estrogen each day to prevent the release of FSH (follicle stimulating hormone) and LH, thus inhibiting ovulation. The progestin component of the pill causes the cervical mucus to thicken and dry creating a barrier to sperm. Progestin also makes the lining of the uterus unsuitable for egg implantation. The effectiveness of birth control pills is maximized when they are taken consistently at about the same time of day, every day.

Is “the pill” right for you?

The birth control pill is one of the most effective reversible contraceptives available. Many women choose to take the pill simply because of its beneficial side-effects:

• maintains regular periods
• permits sexual spontaneity
• relieves some menstrual problems (may decrease the number of days of bleeding and the incidence of iron deficiency anemia;
• minimizes cramps; corrects menstrual irregularity/amenorrhea) rarely has dangerous side effects
• prevents and or treats endometriosis
• decreases the incidence of ovarian cysts, fibrocystic breast syndrome and fibroadenomas of the breast
• lowers the risk of osteoporosis in estrogen deficient women
• lowers the risk of ovarian and endometrial cancer for some women, it also reduces premenstrual tension and diminishes acne. 

Drawbacks include

• it does not protect against STIs (sexually-transmitted infections) such as chlamydia, HPV, HIV, herpes
• possible temporary side effects: small amount of weight gain (3-5 lb. average), nausea, headache,mood swings
• it may not be effective when used with certain medications
• initial need for back-up method (e.g. condom)
• it must be taken at about the same time every day 
  

What are the risks?

Cigarette smoking
Smoking increases the risk of serious cadiovascular problems from oral contraceptive use. The risk increases with age and the amount of smoking (15 or more cigarettes per day). Women who use oral contraceptives are strongly urged not to smoke.

Chronic conditions
If you are seeing a health care provider for a chronic medical problem, you will need to discuss the risks of taking the pill as it relates to your particular situation. Most of the time, taking the pill is safer for you than a pregnancy would be. If you have any of the following conditions, check with your clinician about your ability to use oral contraceptives:

• thrombophlebitis, thromboembolic disorders, cerebral vascular disease, coronary artery disease or past history of these conditions
• markedly impaired liver function or hepatic adenoma
• undiagnosed breast masses or known or suspected carcinoma of the breast undiagnosed abnormal genital bleeding
• known or suspected pregnancy
• known or suspected estrogen dependent tumor
• history of migraines
• history of lipid disorders
• hypertension with resting diastolic BP of 90 or greater over several visits 
  

Offers no STI protection
The birth control pill does not protect against STIs (sexually-transmitted infections) such as chlamydia, human papilloma virus, HIV/AIDS, herpes, etc. Additional safer-sex supplies (such as condoms) must be used for adequate protection against STIs.

Decreased effectiveness with certain medications
Some prescription, non-prescription medicines and recreational drugs may interfere with the birth control pill’s effectiveness (see “When to Use a Back-Up Method” section above).

Picking up your pills

Most pill prescriptions from Gannett are written for one year. You may purchase pills from the Gannett Pharmacy (Check current Pharmacy hours.) If this is your first prescription for pills, you will be asked to have a health check by a nurse after three months on the pill.

If you already have a prescription
Women who bring in a prescription that was written elsewhere, may fill the prescription at the Gannett Pharmacy.

Print our Fact Sheet (pdf) on this topic.