Birth Control Pills; Overview.More than 45 years since the U.S. Food and Drug Administration (FDA) approved "the pill" in 1960, it continues to be the most popular and one of the most effective forms of reversible birth control ever invented. According to the Johns Hopkins School of Public Health Population Information Program, more than 18 million US women rely on birth control pills, also called oral contraceptives, as their birth control method. Today, American women have more than 40 different oral contraceptive products from which to choose.
Unlike the original oral contraceptives used decades ago, low-dose forms with few health risks are the norm. Today's birth control pills (BCPs) even offer health benefits.
Despite the fact that they are safe for most women, however, BCPs do carry some health risks. For example, if you are over 35 and smoke or have certain medical conditions such as a history of blood clots or breast or endometrial cancer, your health care professional may advise against taking BCPs. Also, birth control pills do not protect you from sexually transmitted infections (STIs), including HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. (human immunodeficiency virus human immunodeficiency virus
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. ), the virus that causes AIDS.
In recent years, birth control pills have been changed to include less hormones, resulting in fewer side effects. In fact, all healthy women who don't smoke may use birth control pills, regardless of their age.
Unlike other forms of birth control sold over-the-counter, you need a health care professional's prescription to purchase BCPs and many health insurers cover their cost. The one exception is the emergency birth control pill Plan B, which was just approved for over-the-counter sale by the FDA. Plan B is expected to be available over the counter by the end of 2006.
How Birth Control Pills Work
At the beginning of each menstrual cycle, estrogen levels begin to rise. Estrogen helps thicken the lining of the uterus (endometrium endometrium /en·do·me·tri·um/ (-me´tre-um) pl. endome´tria the mucous membrane lining the uterus.
n. pl. ) to prepare for a fertilized egg. Once estrogen levels peak, about 14 days into the menstrual cycle, one of the ovaries releases an egg. This monthly release of an egg is called ovulation ovulation /ovu·la·tion/ (ov?u-la´shun) the discharge of a secondary oocyte from a graafian follicle.ov´ulatory
The discharge of an ovum from the ovary. .
After ovulation, progesterone, another reproductive hormone, begins to rise. Over the next seven days, progesterone further prepares the endometrium for a fertilized egg. Conception occurs when a fertilized egg implants itself in the uterine lining.
If conception does not occur, both estrogen and progesterone levels drop, signaling the now thickened uterine lining to slough off or shed, and menstruation begins.
Birth control pills are a synthetic form of the hormones progesterone and estrogen. They prevent ovulation by maintaining more consistent hormone levels. Without a peak in estrogen, then, the ovary doesn't get the signal to release an egg. No egg means no possibility for fertilization and pregnancy. They also thicken cervical mucus so the sperm cannot reach the egg, and make the lining of the uterus unreceptive to the implantation of a fertilized egg.
Types of Birth Control Pills
The three most common types of birth control pills are:
1. Progestin-only pills (POP). This type of pill contains no estrogen. Called the progestin-only pill, or "mini-pill," it's ideal for breastfeeding women because estrogen reduces milk production. It's also ideal for women who cannot take estrogen. Progestin-only pills primarily work by thickening the cervical mucus, thereby preventing sperm from entering the uterus. To work effectively, they must be taken at a certain time every 24 hours.
Advantage of POPs:
decreased menstrual blood loss
decreased menstrual cramps and pain
can be used by breast-feeding women immediately after delivery
an option for women who cannot use estrogen, such as those who are over 35 and still smoke
irregular bleeding patterns, spotting or breakthrough bleeding
must be taken at the same time every day
do not protect against sexually transmitted infections; women at risk must use condoms
may be slightly less effective than combination oral contraceptives
Possible side effects:
amenorrhea amenorrhea (āmĕn'ərē`a, əmĕn'–), cessation of menstruation. Primary amenorrhea is a delay in or a failure to start menstruation; secondary amenorrhea is an unexpected stop to the menstrual cycle. (absence of a monthly period)
Ask yourself the following questions to determine if POPs are the right choice for you:
Are you the type of person who can remember to take a pill at exactly the same time every day?
Will irregular bleeding or spotting bother you or interfere with intimacy?
Are you breastfeeding, but feel that you need contraception?
If you are at risk for sexually transmitted infections, will you use condoms for protection?
Do you need to avoid taking estrogen?
2. Combination pills. When you hear the term "birth control pill," it most often refers to oral contraceptives containing estrogen and progestin. Each pill in the pack contains a combination of these two hormones.
Monophasic pills. Each of the 21 active pills in one of these packs contains the same amount of estrogen and progestin. The other seven pills are placebos and contain no hormones; menstruation occurs while they are being taken. In September 2003, the Food and Drug Administration (FDA) approved a 91-day oral contraceptive regimen called Seasonale, in which you take a pill containing progestin and estrogen for 12 weeks (84 days), followed by one week of placebo tablets. If you use this product, you only menstruate men·stru·ate
To undergo menstruation. about once every three months instead of once a month.
Multiphasic pills. Also called biphasic and triphasic, multiphasic oral contraceptives contain varied amounts of hormones and are designed to be taken at specific times throughout the entire pill-taking schedule. Multiphasic pills contain various levels of estrogen and progestin throughout the month. They were developed to reduce side effects of oral contraceptives, including breakthrough bleeding, spotting and amenorrhea, associated with higher levels of hormones.
Continuous use pill. In May 2007, the FDA approved Lybrel, first continuous use birth control pill. It is a multiphasic pill that comes in a 28-day pack and is designed to be taken continuously, with no break in between pill packets. That means you won't have a period. However, you may have some spotting or breakthrough bleeding, particularly when you first start using Lybrel.
Advantages of combination pills:
reduces risk of ovarian cancer and endometrial cancer
prevents ectopic pregnancy (pregnancies that occur outside the uterus, usually in the fallopian tube)
decreases menstrual blood loss and pain and cramps
less severe premenstrual symptoms
more regular menstrual cycles
prevents bone density loss in women who have attained their peak bone mass (generally women over 30)
less risk of ovarian cysts
improves excessive body hair, particularly on the face, a condition called hirsutism Hirsutism Definition
Excessive growth of facial or body hair in women is called hirsutism.
Hirsutism is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by.
improves symptoms of rheumatoid arthritis
beneficial effects on cholesterol (HDL (Hardware Description Language) A language used to describe the functions of an electronic circuit for documentation, simulation or logic synthesis (or all three). Although many proprietary HDLs have been developed, Verilog and VHDL are the major standards. and LDL LDL - ["LDL: A Logic-Based Data-Language", S. Tsur et al, Proc VLDB 1986, Kyoto Japan, Aug 1986, pp.33-41]. )
decreases benign breast disease benign breast disease See Fibroadenoma, Fibrocystic disease, Mastopathy. or breast cysts
reversible with quick return to fertility
treats the emotional and physical symptoms of premenstrual dysphoric disorder Premenstrual Dysphoric Disorder Definition
Premenstrual dysphoric disorder (PMDD) is a collection of physical and emotional symptoms that occurs 5 to 11 days before a woman's period begins, and goes away once menstruation starts. (PMDD PMDD
premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD)
Premenstrual syndrome (PMS); symptoms including back and abdominal pain, nervousness and irritability, headache, and breast tenderness ), a severe form of PMS (Pantone Matching System) A color matching system that has a unique number assigned to more than 500 different colors and shades. This standard for the printing industry has been built into many graphics and desktop publishing programs to ensure color accuracy. . Only one combination OC has been shown to be clinically effective for this use. It contains the progestin drospirenone and ethinyl estradiol, a form of estrogen.
could cause nausea, vomiting, headaches and/or spotting, particularly with the first few cycles
may lead to hypertension (less than one in 200 women)
may causes blood clots in a small percentage of users
may contribute to the formation of gallstones and rare benign liver tumors
Possible side effects:
nausea and vomiting Nausea and Vomiting Definition
Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling of undigested food through the mouth.
weight gain or weight loss due to changes in eating habits
increased breast size
Ask yourself the following questions to determine if combined birth control pills are a good option for you:
Are you the type of person who can remember to take a pill every day?
If you are at risk for sexually transmitted infections, will you use condoms?
Do you need relief from endometriosis, severe menstrual pain or anemia?
If you still smoke, are you under 35?
If breastfeeding, is your baby six months or older?
Do you have high blood pressure?
Have you done well with combination pills in the past?
3. Emergency contraceptive pills (ECP). ECPs are not intended to be used regularly as a contraceptive. They are designed to prevent pregnancy after unprotected sex (when standard contraceptives fail or no method was used). The FDA has approved one emergency contraception pill called Plan B, which contains the progestin levonorgestrel levonorgestrel /le·vo·nor·ges·trel/ (-nor-jes´trel) the levorotatory form of norgestrel; used as an oral or subdermal contraceptive.
n. . And women over 18 will soon be able to buy Plan B without a prescription--probably by the end of 2006--due to recent OTC OTC
See over-the-counter market (OTC). approval by the FDA. Plan B will be available behind pharmacy counters to ensure that women who purchase it are 18 or over. In addition, certain regular oral contraceptive pill packs can be used for emergency contraception if you take several pills at the same time (the exact quantity depends on the brand), with guidance from your health care professional.
While the Plan B label calls for a two-dose regimen, with the first dose taken within 72 hours of unprotected sex and the second 12 hours later, studies find that both pills can be taken at the same time, and that Plan B is effective up to 120 hours after unprotected intercourse.
To learn more about how ECPs work and how to get them, ask your health care professional or pharmacist. Or visit the Internet site for emergency contraception operated by Association of Reproductive Health Professionals and the Office of Population Research at Princeton University (www.not-2-late.com or ec.princeton.edu). Emergency contraception used to be available by prescription only, although the FDA has just approved Plan B without a prescription, which is expected to be available over the counter by the end of 2006.
Advantages of ECP:
reduces the chance of unintended pregnancy
can be obtained easily--Plan B will soon be available over the counter for women 18 and over
can be obtained in advance and kept handy in case of an emergency such as condom breakage, missed oral contraceptives, late contraceptive injections or forced sex
timing, because you must take the first dose within 120 hour of having unprotected sex. The sooner you take them after unprotected intercourse, the more effective they are. That's why it's a good idea to have a prescription or a supply of emergency contraceptive pills available should the need arise.
Possible side effects:
nausea, vomiting, dizziness, fatigue and headache
an earlier next period, or, in rare instances, a later next period
heavier or lighter menstrual bleeding
Ask yourself the following questions to determine if you should have ECPs on hand or know where to find them:
Have you ever made love unexpectedly?
Have you ever been forced to have sex?
Has a partner had a condom break, slip or come off?
Have you ever forgotten to take several birth control pills?
Have you expected your partner to pull out before ejaculation, but he didn't?
Has your diaphragm slipped?
Have you been late for your Depo-provera or Lunelle shot and had unprotected sex?
Health benefits, risks and other medical issues about birth control pills
Birth control pills provide certain health benefits in addition to preventing pregnancy. Before you start taking oral contraceptives, discuss the health benefits and risks associated with them with a health care professional. Like any other medication, birth control pills can also cause side effects; they may interact with other medications you may take; or they may not be a good choice for you because of your personal health history. Benefits and risks associated with birth control pills are listed below:
Prevent pregnancy. First and foremost, birth control pills are one of the most effective forms of reversible birth control. If used correctly, the odds are that only five in 1,000 women is likely to get pregnant in the first year of use.
Improve your menstrual cycle. Birth control pills can improve your menstrual cycle in at least for ways, including:
less bleeding during periods; one product is designed to eliminate your periods entirely
more regular and consistent menstrual cycle patterns
relief from pelvic pain during menstruation
relief from primarily mood-related symptoms of premenstrual dysphoric disorder (PMDD), a condition that causes many of the same symptoms as PMS, but with more intensity. A combination oral contraceptive containing drospirenone, a progestin, and ethinyl estradiol, a form of estrogen, was recently approved by the FDA. Known as "YAZ," this OC was shown to be clinically effective both for the prevention of pregnancy and for the emotional and physical symptoms of PMDD.
Prevent cancer. Birth control pills have been shown to protect women from ovarian and uterine cancer, and possibly from colorectal cancer.
Improve bone density. Some studies have shown that it's possible that bone density improves while taking birth control pills. However, it has not been shown that BCPs make a difference in reducing bone fractures.
Protect you from ovarian cysts. If you take BCPs, you may have about one-fifth less risk for developing ovarian cysts than women using nonhormonal methods of contraception, such as diaphragms or condoms. Women using low-dose pills (20 mcg of estrogen) or multiphasic pills may not get the same benefit.
Heart attack. The chances of BCPs contributing to a heart attack are small (less than three additional heart attacks per million American women per year) unless you smoke. Studies have shown that smoking dramatically increases the risk of heart attack in women age 35 years or older, which is why BCPs are generally not prescribed to women in this age group who smoke. The American College of Obstetricians and Gynecologists (ACOG ACOG American College of Obstetricians and Gynecologists.
ACOG American College of Obstetricians & Gynecologists ) notes that POPs may be appropriate for women with coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. , congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. or cerebrovascular disease. However, combined pills are not recommended for these women.
Ischemic stroke. There is a small, but significant increase in ischemic stroke risk when using birth control pills. This was a particular concern with early oral contraceptives that contained higher doses of estrogen, but newer preparations containing less estrogen are associated with a lower risk of stroke. In otherwise healthy young women (non-smokers without persistent high blood pressure), the risk is low.
Migraines and stroke. Women who take oral contraceptive and have a history of migraines have an increased risk of stroke compared to nonusers with a history of migraine. Your risk is greatest if you have migraines with "aura"--neurologic symptoms related to vision, such as blurred vision, temporary loss of vision or seeing flashing lights or zigzag lines. As a result, both the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) have concluded that for women over age 35 who get migraines, the risks of BCPs use usually outweigh the benefits.
Venous thromboembolism thromboembolism /throm·bo·em·bo·lism/ (-em´bo-lizm) obstruction of a blood vessel with thrombotic material carried by the blood from the site of origin to plug another vessel.
n. (VTE). This rare condition causes clots to form in your blood vessels and can cause symptoms including pain, swelling, and varicose veins, and may block the flow of blood. The risk may vary with the type of progestin used in the pill.
Worsen severe diabetes. The estrogen in birth control pills may increase glucose levels while decreasing the body's insulin response, while the progestin in the pills may encourage overproduction o·ver·pro·duce
tr.v. o·ver·pro·duced, o·ver·pro·duc·ing, o·ver·pro·duc·es
To produce in excess of need or demand.
o of insulin. Use of birth control pills by diabetic women should be limited to those who do not smoke, are younger than 35 and are otherwise healthy with no evidence of persistent high blood pressure, kidney disease, vision problems or other vascular disease.
Possible acceleration of gallbladder disease. Estrogen may cause bile to become oversaturated with cholesterol, which can lead to gallstones.
No decreased risk of sexually transmitted infections. Birth control pills do not protect against sexually transmitted infections (STIs). But women who use birth control pills are less likely to develop symptomatic pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. (PID (1) (Process IDentifier) A temporary number assigned by the operating system to a process or service.
(2) (Proportional-Integral-Derivative) The most common control methodology in process control. ), which is an infection of the uterus, fallopian tubes or other reproductive organs. PID is a complication of STIs, especially chlamydia or gonorrhea, and may make you to infertile or cause chronic pain. If you are at risk for contracting an STI STI systolic time intervals. , you should consider also using condoms.
Lupus/sickle cell anemia. The American College of Obstetricians and Gynecologists notes that birth control injections or implants are safer alternatives than birth control pills in women with these health conditions.
Possible drug interactions
Some drugs can reduce the effectiveness of oral contraceptives. Likewise, oral contraceptives can interfere with the effects of some drugs.
Seizure medications: phenytoin phenytoin /phen·y·to·in/ (fen´i-toin?) an anticonvulsant used in the control of various kinds of epilepsy and of seizures associated with neurosurgery.
n. , carbamazepine carbamazepine /car·ba·maz·e·pine/ (kahr?bah-maz´e-pen) an anticonvulsant and analgesic used in the treatment of pain associated with trigeminal neuralgia and in epilepsy manifested by certain types of seizures. , primidone, ethosuximide, methylphenobarbital, paramethadione, phenobarbital, topiramate
Tuberculosis medication rifampin
Antifungal drug griseofulvin griseofulvin /gris·eo·ful·vin/ (gris?e-o-ful´vin) an antibiotic produced by Penicillium griseofulvum ; used as an antifungal in dermatophytoses.
Anti-anxiety drugs containing benzodiazepine benzodiazepine (bĕn'zōdīăz`əpēn'), any of a class of drugs prescribed for their tranquilizing, antianxiety, sedative, and muscle-relaxing effects. Benzodiazepines are also prescribed for epilepsy and alcohol withdrawal.
Bronchodilators such as theophylline theophylline /the·oph·yl·line/ (the-of´i-lin) a xanthine derivative found in tea leaves and prepared synthetically; its salts and derivatives act as smooth muscle relaxants, central nervous system and cardiac muscle stimulants, and
St. John's wort
If you take any medication either on a short- or long-term basis, be sure to ask your health care professional or pharmacist about possible interactions with birth control pills, and how you should avoid or manage them.
For example, you may need to use an additional contraceptive (such as condoms) as a backup contraceptive method, or take a higher or lower-dose pill formulation.
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Keywords: birth control pills, birth control, women, oral contraceptives, progestin-only pills, estrogen and progestin, side effects, possible side effects, emergency contraception, failure rates, combination pills, sexually transmitted infections, sexually transmitted diseases, hypertension, diabetic women, risk of breast cancer, risk for breast cancer, bone density, ovarian cysts, heart attack, ovarian cancer, endometrial cancer, cervical cancer, colorectal cancer