Until There’s Male Birth Control, There’s still “The Pill”

by  Andrea N. Price, M.D.   

(c) Copyright, 2001, Dr. Andrea N. Price

Since its introduction in 1950, it has been praised, protested, hotly debated and a never-ending topic of discussion in many circles.  I’m talking about the most popular form of reversible birth control, the oral contraceptive pill (OCP) or what’s popularly known as, “the pill”.  The one irrefutable fact is, the pill remains the most widely used form of hormonal birth control and is one of the safest, most effective methods for preventing pregnancy.  While most men will rarely admit in sharing the responsibility or fully understanding birth control, I believe many men are fans of its benefits (if for no other reason than saving themselves a late night trip to the 24-hour drug store).  

Many of my patients and readers are sometimes led to believe they cannot take the pill due to popular myths, prior experience or misconceptions.   One reader recently wrote declaring both her sister and mother were on the pill with no problems however, she experienced side effects and had to stop as a result.  Note: she never indicated what the side effects were.  Without diagnosing her, I suspect like many women, she had yet to find the correct prescription and dosage suited to her body.  

Today there are so many varied prescriptions and dosages of the birth control pill, that there is almost no one who truly can't take them.   I have found that the majority of my patients who discontinue the pill due to "side effects", either a) haven't given the medication a fair trial or b) blame the pill for everything from a bad hair day to a dysfunctional relationship.  Although, most women are likely to experience certain side effects in the beginning, they are normal, mild and temporary.  The key is to consistently take a particular pill for three months before you can determine if that pill is going to work for you or not.  In my never ending quest to inform and stamp out unwanted or unplanned pregnancies (who needs the drama or the heartache?), I think it’s time for a general tutorial on oral contraceptive pills (OCP's).

What are the typical side effects of the pill?

The majority of women who begin taking oral contraceptive pills will experience some combination of mild water retention, spotting, breast tenderness and/or nausea.  This is simply your body getting used to the hormones in the pill.  By the end of the second cycle (or packs of pills), these side effects will mostly cease.  If you are still spotting or experiencing nausea after completing three cycles, then it is time to try a different pill.  I suggest that women take their pills at bedtime.  This way if they do feel nauseated initially, they will sleep through it.  The typical combination birth control pill contains the two main female hormones (estrogen and progestin) and works in two ways:  

1.        It stops ovulation

2.        It thins the lining of the uterus so that a fertilized egg doesn't have a lush place to implant and grow.

Why does the pill make me gain weight?

The pill can cause mild water weight gain of 3-5 lbs.  Any weight gain, over and above that, can not be blamed on the birth control pill.  If you take an honest look at your food intake and your activity level, you will almost invariably find that your caloric intake has increased, while your activity level has decreased or remained the same.   As we age into our mid-twenties and early thirties, our metabolic rate naturally begins to decrease.  If you aren't careful to adjust your diet and exercise accordingly, you will eventually gain weight, even if you are not on the birth control pill.

The pill makes my hair fall out.

Why is it that I hear this complaint almost exclusively from my sisters of color and very rarely hear this complaint from my Caucasian sisters?  Think about it for a moment... we are all too familiar with the love/hate relationship we have with our hair.  Between too tight braids that are left in too long, weaves that need to washed and tightened, home perms, dye jobs and hair that has been fried, dyed and laid to the side, it is amazing that many of us have any hair at all!  Chances are your hair loss probably has more to do with abuse or over processing than the birth control pill.  As a matter of fact, birth control pills are quite effective when used to treat women who suffer from hair loss for hormonal reasons.  Although it is possible, it is very unlikely that your hair problems are in any way related to the birth control pill.

The pill causes cancer.

Quite the opposite is true.  The pill helps prevent cancer.  I advise that all women be on OCP's at some point in their reproductive life, as it decreases the chance of developing ovarian cancer and uterine cancer over your entire lifetime.   The pill has been around for over fifty years and the dosage is at least ten times lower now than it was in it's early years.   Even fifty years later, those women who took the old, high dose pills have shown NO increased cancer risk...and this includes breast cancer as well.

I got pregnant on the pill.

"Hey girl, I'll trade you two of my blue pills for one of your pink ones", or "give me your Thursday cause I left my Wednesday at home."  If this scenario sounds familiar to you, chances are you and your girlfriend’s two kids will grow up together as playmates! Guess what?  If you want the pill to work, you must take it! Before an exam I usually ask my (non-pregnant) patients, “are you sexually active”?  Women who have been married for a while sometimes respond “no I just lay there”.  Humor aside, whether passive participant or eagerly amorous, the truth is if you take your pills as directed, the chance of becoming pregnant is extremely low.  Statistically speaking, OCP’s are greater than 99% effective.  This means less than one woman out of 100 will get pregnant over a year’s time if taken exactly as directed.   In addition to increasing your chance of pregnancy, women who take your pills incorrectly, take them late, or miss pills completely, will cause irregular bleeding or spotting.  Also, don't forget that certain antibiotics will cause your pills to be less effective.  If you are on antibiotics, especially penicillin or tetracycline type drugs please use a backup method of birth control such as condoms for the remainder of that cycle.

The pill causes mood swings.

Actually, the pill often helps mood swings or PMS by suppressing the body’s own hormone levels.  Many common menstrual complaints are the result of the natural fluctuations in hormone levels that occur during a womans menstrual cycle as she builds up her uterine lining, develops an egg, ovulates, and later sheds the uterine lining if pregnancy doesn't occur.  On the pill these hormones are kept at a steady level, the same as if you were pregnant which often improves PMS symptoms.

What if I miss a pill?

Refer to the instructions that came with your pack of pills for specific instructions.  In general, if you miss a pill during the first 21 days of a pack, you should take the missed pill as soon as you remember and the next pill at the regular time.  This means you will have to take two pills the same day or even two at once.  If you miss two pills in a row, then you should take two pills a day for the next two days until you catch up and then continue as usual.  If you make up the missed pills as described your chances of pregnancy are still very low.  However, if you miss three pills in a row you should discontinue the pack, let your period come and start a new pack the following Sunday.  In this case you must use a backup method of contraception for a month to avoid pregnancy.  If you are unsure what to do, DO NOT SIMPLY STOP YOUR PILLS! Call your doctor or pharmacist for instructions.

What health benefits does the pill have?

Besides decreasing the risk of uterine and ovarian cancer, the pill is extremely useful in treating a myriad of problems.  It is truly the most versatile and useful drug that we as OB/GYN’s have at our disposal.

·         Women who take OCP’s have shorter periods, less bleeding and virtually no cramping.    Because periods are lighter, there is less chance of anemia. 

·         You will know exactly when your period is coming, and if you use the Sunday start regimen, you will have period free weekends. 

·         OCP’s are often used to treat chronic pelvic pain, irregular bleeding, hirsuitism (excess facial hair), acne, endometriosis, and prevent ovarian cysts. 

·         One recent formulation of the birth control pill actually decreases bloating caused by water retention.

OCP’s and Perimenopausal Women

Low dose birth control pills are especially useful for women nearing menopause.   They help to ease the transition into menopause by controlling hot flashes, balancing mood swings and regulating increasingly irregular menstrual cycles.  I have many Perimenopausal patients in their late 40’s and early 50’s (many of whom had their tubes tied years ago) whom are happily choosing to initiate OCP’s and stay on the pill right up to menopause.  If a patient so chooses, she can eventually switch off of the pill and transition directly into estrogen replacement therapy.

The pill isn’t for everyone

I would be remiss if I didn’t point out that NOT EVERYONE IS A CANDIDATE FOR THE BIRTH CONTROL PILL.  Women over the age of 35 who smoke, those with a history of deep blood clots in the veins, those with liver disease, those with heart disease and those with uncontrolled high blood pressure are not candidates for OCP’s.  However, many patients who can not take the combination birth control pill can take the “mini pill” or the Depo-Provera shot.  These forms of birth control do not contain estrogen, but progesterone only.  While these methods are very safe and effective, they tend to cause more irregular bleeding and weight gain than the combination pill.

What’s new?

For those of you who simply can’t remember to take those pills…you now have some very cool new options at your disposal.  Combination birth control is now available in the form of a monthly injection called Lunelle.  Also, the FDA has just approved a new contraceptive patch, which is worn on the abdomen and changed twice weekly. 

Final Thoughts

Fifty years later “the pill”, while still controversial in some circles, has proven to be an effective reliable method of birth control and demonstrated its usefulness in treating numerous gynecologic conditions.   Further, its benefits have helped millions of women in their family planning goals.  Discuss with your physician which formulation of the pill is appropriate for your needs.  As always, in the midst of an active (or not so active) sex life, remember that birth control pills are no substitute for condoms and safe sex.  So protect yourself, plan wisely and love yourself.  

P.S. If you haven’t already done so today, let me remind you to take your pill.