Oral Contraceptives (Birth Control Pills)

Instructions for Oral Contraceptive (Birth Control Pill) Use

The birth control pill works primarily by preventing ovulation (release of an egg). if there is no egg to meet the sperm, pregnancy cannot occur. The pill also works by making cervical mucous thick and unreceptive to sperm and by making the lining of the uterus (endometrium) unreceptive to implementation of a fertilized egg, should one get as far as the uterus. The pill is one of the most effective, reversible contraceptive methods available. If taken correctly, less than one (1) woman in 100 will become pregnant over the course of one year of use. Aside from contraception, your provider may prescribe the pill for other purposes, such as to control irregular bleeding, to control cramps associated with your period, or to control mood swings or acne.

The birth control pill consists of 21 to 24 active pills, which contain your two (2) female hormones, estrogen and progesterone. A 28-day pill pack also contains 4-7 placebo (sugar pills). A 21-day pill pack only contains 21 days of active pills and no placebo.

Getting Started on the Pill

1. There are several ways to start taking your pills. The two most common ways are: 1) the “Sunday Start” and 2) the “Quick Start.” Your provider will discuss with you which method you should use.
   • “Sunday Start”: Start your first pack of pills on the first Sunday after the first day of your period if that day falls on Monday through Saturday. All new packs after your first one will begin on a Sunday, unless your provider tells you otherwise. If your period begins on a Sunday when you are to start your first pack of pills you begin your pills that very day.
   • “Quick Start”: Begin your pills on the day of your office visit. We will first do a urine pregnancy test in our office as part of our protocol. Your next period will be delayed until you finish the active pills and start the placebo pills.

Whether you use the “Sunday Start” or the “Quick Start” method, you will need to use a backup form of birth control (such as a condom) for the first week of the first month that you are on the pill. Keep this backup method handy and use in case you:

• Run out of pills
• Forget to take your pills
• Discontinue the pill
• Need protection from sexually transmitted diseases (STDs). The pills DO NOT provide protection from STDs, including HIV and AIDS.

2. Take one pill a day until you finish the pack. Then, if you are using a 28-day pack, begin a new pack immediately after finishing your previous pack. Skip NO days between packs. If you are using a 21-day pack, stop taking pills for 4-7 days, and then start your new pack.

3. Try to associate taking your pill with something you do at about the same time every day, like brushing your teeth in the morning, eating a meal, or going to bed. Keep the pill near the place where you engage in the selected activity. Establishing a routine will make it easier for you to remember to take your pill. Try to take your pill at about the same time every day. Check your pack of pills each morning to make sure you took your pill the day before.

Common Side Effects of the Pill

There are some common side effects of the pill. These side effects are not harmful in most cases. Most side effects go away within three months after you begin taking the pill. If they do not go away or are severe, call your provider. Switching to another pill may help. It is important, however, in most cases, to give the pill a full three months before one should consider changing the pill. The side effects include:

• Nausea (taking a pill with a meal or before bed may help)
• Spotting or bleeding between periods
• Headaches (over the counter-the-counter pain meds often help)
• Irritability, moodiness
• Bloating
• Breast tenderness (reducing your caffeine intake may improve the symptoms)

Continuous Cycling

Your provider may suggest continuous cycling. In this situation, you take your alive pills (the ones with estrogen and progesterone) daily for a 3 to 4 month period, or perhaps longer if your provider suggests this. You then take your placebos (the sugar pills) for 4 to 7 days at the end of that prolonged cycle. This method results in a period every 3 to 4 months. It is important to understand that this method of taking your pill will NOT create any reproductive health problems with your uterus.

Breakthrough bleeding can occur with this method of cycling, especially in the first couple months. As long as you are taking the active pills daily and at the same time every day, your risk of pregnancy is minimal. If you have breakthrough bleeding and have been on your active pills for at LEAST 4 WEEKS, you can stop taking the pills for a 3 to 4 day interval and allow yourself to have a “mini” period. Restart your active pills after your 3 to 4 day interval off the pills.

Reminder: DO NOT TAKE A “MINI” PERIOD BREAK UNTIL YOU HAVE BEEN ON THE PILL FOR AT LEAST ONE MONTH.

Common Questions asked about the Pill

1. What happens if I forget to take my pill(s)?
   • If you miss one pill, take the forgotten pill as soon as you remember it, and take that day’s pill at the regular time. No back-up method of birth control is necessary if you miss only one pill. You may get a little queasy when you take 2 pills in one day. It may help to take them with food.
   • If you miss two pills in a row in the first or second week of your pack, take 2 pills on the day you remember and 2 pills for the next day. Then take one pill a day until you finish your pack. You MUST USE A BACK-UP FORM OF BIRTH CONTROL FOR 7 DAYS after you miss 2 pills in a row.
   • If you miss two pills in a row in the third week of your active pills, keep taking 1 pill a day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of pills that day. You may not have a period this month. This is normal. Use your back-up method of birth control for 7 days as discussed above. If you miss your period on the second month, contact your provider.
2. What happens if I have bleeding between my periods? Does this mean my pills aren’t working?
   • If you have not missed any pills, the likelihood of being pregnant is extremely small (less than 0.4%). Do not stop taking your pills. Try to take them at the same time every day. If you have spotting (light bleeding between periods) for several cycles after the first three months on the pill, call the office for advice.
3. Is it normal for my period to be short and light on the pill?
   • Is it normal for my periods to be short and light on the pills?
     Yes, this is normal. Sometimes, you may only have a brown “smudge.” This happens because the estrogen and progesterone in your pill cause the lining of your uterus to thin out. You may also have no bleeding at all. As long as you haven’t missed any pills, your chance of being pregnant is very small. If you miss a period, however, it is a good idea to perform a home pregnancy test just to be sure. Call the office if you have any questions.
4. I’ve heard that you can skip the “sugar” pills and keep taking the “active” pills so that you don’t get a period every month. Is this true?
   • Yes, this is an acceptable way to take the pill. Refer to the above section on “Continuous Cycling.” This method is especially helpful if you have bad cramps while on your period even while on the pill, if you experience premenstrual syndrome, or if you just don’t want to have a period monthly. Check with your provider before initiating this method of pill taking, to make sure it is right for you.
5. What if I get sick with vomiting and diarrhea?
   • If you have severe vomiting and diarrhea and are unable to keep your pills down for more than one day, use your back-up method of birth control as described above
6. Do certain medications like antibiotics decrease the effectiveness of the pill?
   • Most antibiotics to not decrease the effectiveness of the pills. There are some anti-tuberculosis drugs and anti-seizure drugs that do decrease the effectiveness of the pills, however. Always let your provider know that you are on the birth control pill whenever new medications need to be prescribed to you.
7. Will I gain weight on the pill?
   • Numerous research studies have proven that most women DO NOT gain weight on the pill. Your weight may fluctuate several pounds a month around the time of your “pill period” but his also happens during your regular cycle when you are not on the pill.

Risks Associated with the Pill

For most women, taking the pill is very safe. In some women, it can cause serious illness, however. This is extremely rare. The most serious problem that may arise is a heart attack, stroke, or blood clot. The risk is highest for women who are smokers, especially if you are 35-years old or older. We WILL NOT prescribe the pill to anyone who is 35 or older and a smoker. Women who are younger and who smoke are also at risk and are STRONGLY urged to stop smoking if using the pill.

Signs of Complications

Call our office immediately if any one of these danger signs (called “ACHES”) appears:

• Abdominal pain (severe)
• Chest pain (severe), shortness of breath
• Headaches (severe and persistent)
• Eye disturbances (blurred vision, loss of vision)
• Severe leg pain (thigh or calf)

Finally, the pill is a safe and effective way to prevent pregnancy. It is easy to use, convenient, and reversible. The pill may protect against some cancers, including ovarian cancer, colon cancer, and endometrial cancer. This benefit lasts years beyond its use. For almost all women, the benefits of pill use far outweigh the risks. Keep in mind that it works only when used as prescribed and does not protect against STDs. If you neglect to follow these directions and think that you may have gotten pregnant within 72 hours, call the office for advice about emergency contraception.