PRICING ALERT!
For many years, the Duke University Student Health Center Pharmacy has obtained contracts with major manufacturers for special prices on contraceptives, and we have passed these special savings on to our patients. However, as a result of recent changes in federal legislation, reduced price packs of oral contraceptive pills will soon become unavailable to university health centers. Because of these changes, the Student Health Center Pharmacy will have to charge students more for some of the same prescriptions they have previously received. Learn more here.
What is the Pill and how does it work?
The Pill is a reversible, prescription method of birth control. It is a monthly series of pills which are taken on a daily basis, and it is one of the most effective forms of contraception.
Pills are classified according to the synthetic hormones which they contain. One type of pill contains only one hormone, progestin, and is often called the "progestin-only pill" or the "mini-Pill." The mini-Pill contains a synthetic version of a sex hormone produced normally in your body. It works by changing the cervical mucus, thus helping to prevent the sperm from reaching the egg and by preventing the development of the egg.
Most pills contain a combination of two hormones, progestin and estrogen, and are called either the "combination oral contraceptive," or simply "the Pill." In the combination pill, the estrogen prevents pregnancy primarily by stopping the release of an egg from the ovaries (ovulation). The progestin changes the mucus in the cervix and helps prevent the sperm from reaching the egg. Also, the lining of the uterus does not become fully developed so that there is little likelihood that a fertilized egg will become implanted in the uterus.
The latest development in oral contraception is the "phasic contraceptive." In the phasic pill, the progestin and estrogen hormone levels are phased throughout the menstrual cycle so that there is more hormonal balance during the cycle. Overall hormonal doses are lower than most constant-dose oral contraceptives. The cycle becomes more regular and side effects are lower than with other pills.
When taking the Pill, you must take one every day in order to be protected. If you forget to take two or more pills, you must use another birth control method for the remainder of your cycle.
How effective is the Pill?
The theoretical effectiveness rate of Combination Oral Contraceptives is 99.1%, for Progestin Only Pills it is 99.5%. These rates are based on studies that have been done to determine how effective a method itself can be, apart from user behaviors. The actual effectiveness rates are 95% for both types of pills, reflecting what happens to the pregnancy rate in a group of people who do not use this method correctly some of the time and who do not use this method every time they have intercourse.
How is the Pill used?
There are two pill-taking programs for combined oral contraceptives: the 21-day regimen and the 28-day regimen. With the 21-day regimen, you take one pill each day for three weeks and then for one week you do not take any pills. The cycle is then repeated. With the 28-day regimen, you take 21 pills first, then seven sugar pills or placebos, which contain no active drug. Most women prefer the 28-day regimen because they find it easier to remember to take a pill every day of the year.
Progestin-only pills come in 28 day packs. Similar to the combined oral contraceptives, menstruation will occur during the 4th week. All progestin-only pills are active and must be taken daily at the same time. It is very important to take progestin-only pills at the same time everyday – there is a very narrow margin of error. If you are more than 3 hours late taking it, use a back up method for the following 48 hours.
Some drugs can interfere with the way birth control pills work in your body. If you are taking any medications, tell your health care provider and/or pharmacist. You may need to use an additional form of birth control while you are taking these medications.
What if I forget to take a pill?
Combined Oral Contraceptives
If you forget to take one pill at your usual time, take a pill as soon as you remember. If you miss two consecutive pills, take two pills each day for two days and then go back to your regular schedule. If you miss three consecutive pills, begin a new pack 7 days after the last pill was taken and use an additional method of contraception until your next period. If you miss pills, you may have menstrual bleeding at unpredictable times. Remember that if you forget to take two or more pills, you must use an additional method of birth control for the remainder of your cycle. If you continue to miss pills, you may want to consider using a different method of birth control.
Progestin-Only Pills
If you forget to take one pill, take it as soon as you remember. Take the next pill at the same time you would normally take it, even if that means you are taking 2 pills in one day. If you miss two or more pills in a row, there is an increased risk of pregnancy. Begin to use a back-up method of birth control (condoms, female condoms, diaphragm, etc.) right away. Begin to take your pills again by taking 2 pills a day for 2 days and then go back to your regular schedule.
Should I take a break from the Pill?
Generally women with no gynecologic problems prior to taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. As such, there is no advantage to "taking a break" from birth control pills unless you have problems specifically related to the pills.
What are the benefits?
- is safe for most women
- is convenient to use and does not interrupt sex
- provides shorter, more regular periods with fewer cramps
- increases protection against ovarian cysts, ovarian and endometrial (lining of the uterus) cancer, non-cancerous breast tumors, Pelvic Inflammatory Disease (PID), and anemia.
- may improve acne
Specific to progestin-only pills
- No estrogen
- Immediately reversible
- Not confusing (same thing everyday – there is no pill-free week or placebo week)
What are the disadvantages?
Problems you may have while you are taking birth control pills include:
- irregular bleeding for the first few months after starting birth control pills
- must be taken every day
- increased appetite
- depression or moodiness
- headaches and/or dizziness
- nausea and/or vomiting
- scant or missed periods
- weight change
- high blood pressure
- breast tenderness
- no protection against sexually transmitted diseases (STDs)
Specific to Progestin-Only Pills
- Very important to take it at the same time everyday
- Less available
- Extremely low dose contraceptive
If these symptoms continue after a few months, contact your health care provider. Many times these symptoms can be alleviated by changing your pill prescription.
Are there any serious complications associated with the Pill?
Serious problems related to use of Birth Control Pills are very rare. However, the chances of developing blood clots, heart attack, high blood pressure, stroke, or liver tumors are slightly greater in women who take birth control pills.
The risk of these disorders is increased in women who:
- have a history of previous blood vessel disorders
- have high blood pressure
- smoke
- have diabetes
- have high cholesterol levels
- have migraines
- are over age 35
When should I call a health care provider?
Call a health care provider if you have the following signs:
EARLY PILL DANGER SIGNS:
Abdominal pain (severe)
Chest pain (severe), cough, shortness of breath
Headache (severe), dizziness, weakness, or numbness
Eye problems (vision loss or blurring), speech problems
Severe leg pain (calf or thigh)
Remember: ACHES
Source: Robert A. Hatcher, et al. Contraceptive Technology, 17th ed. (New York: Irvington Publishers, Inc., 1998)