Contraceptive pills: how to use, benefits and side effects

Contraceptive pills or birth control pills are effective methods of preventing unwanted pregnancy. They contain artificial combinations of female hormones, essentially consumed by the oral route. Contraceptive pills function by preventing the process of fertilisation through one or the other mechanism.

There are three types of contraceptive pills:

Combined contraceptive pill

Contraceptive pills or birth control pills are effective methods of preventing unwanted pregnancy. They contain artificial combinations of female hormones, essentially consumed by the oral route. Contraceptive pills function by preventing the process of fertilisation through one or the other mechanism.

Mini contraceptive pill

Mini pills or "progesterone-only pills" have just progesterone in their formulation and lack oestrogen. They are another common method of birth control among women and function in a similar manner as combination pills.

Emergency contraceptive pill

Emergency contraceptive pill, also called as the "morning-after pill", is taken after sexual intercourse in order to ward off an unwanted pregnancy. These are the only kind of contraceptive pills which can prevent pregnancy when they are taken after sexual intercourse. These pills have a short window of action and must be necessarily consumed within 3 days to a maximum of 5 days after unprotected sex. It is believed that the sooner you take it, the more effective the pill will be.

Let’s discuss more about each type.

There are three types of contraceptive pills and each has further subtypes and brands unique to them:

• Combined pill
• Mini pill
• Emergency pill

Types and brands of combined pill

The combined contraceptive pill, though having the same hormonal combination, is of different types on the basis of the amount of hormone present:

1. Monophasic 21-day pills: This type contains the same amount of hormone in all pills and one pill is taken for 21 days, following a 7-day rest. This is the most commonly used type of pill.
2. Phasic 21-day pills: This type contains 2 to 3 sections of differently coloured pills, which have varying amounts of hormone as per the colour. These are to be taken in a similar manner but in proper order.
3. Everyday pill: Everyday pills, as the name suggests, are meant to be taken every day, that is, even during the rest days. A pack of these contains 28 pills, of which, 21 are active and 7 are inactive or dummy pills, both of which are taken alike. As opposed to the other two types, there is no break in dosage and these pills are taken continuously throughout.

Its popular brands are Triqular, Trones, Ovral and Unwanted 21.

Types and brands of mini pill

Femfolin is a common brand. In India, this type of pill is mostly recommended only to women who are breastfeeding because estrogen cannot be given to them.

Types and names of emergency contraceptive pills

There are two types of emergency contraceptive pills, which are:

1. Levonorgestrel: An emergency contraceptive pill based on levonorgestrel needs to be taken within the first 3 days of sexual intercourse in order to prevent pregnancy. Its popular brands are Unwanted 72 and i-Pill.
2. Ulipristal  Acetate: An emergency contraceptive pill based on ulipristal acetate is effective when taken up to 5 days after sex. Doctors in India do not recommend using it to prevent pregnancy. It is used to treat fibroids.

Each of the types of contraceptive pills is used differently and has a different dosage, as follows:

Dosage of combined contraceptive pills

Combined contraceptive pills usually come in a pack of 21 pills, which are meant to be taken each day for 21 days. Forth this, you stop taking the pill for a duration of 7 days, which is the period when you will bleed. After 7 days, you resume taking your pills with a new pack of combined pills and the cycle continues. What’s important with this pill is that you have to remember to take the pill every day, most preferably at the same time, in order for the pill to be effective. Not doing so, increases the chances of contraceptive failure and pregnancy. You can fix a particular time or activity so that you remember to take the pill on time. In case of a missed dosage, it is important that you consult with your doctor instead of trying your luck with the pill.

If you have been prescribed with everyday pills, you are required to take a pill from the pack each day without the 7-day rest. The pack of 28 pills has 21 usual pills and 7 dummy pills for the period you will bleed. The next packet is immediately started after the first ends. This type of packing is good for remembering the dose and continuation.

Dosage of the mini pill

Mini pills come in a 28-day pack and are meant to be taken for each day of the month. Unlike combination pills, all the 28 pills are active, that is, have hormonal composition. You are required to take a pill from the pack at the same time each day or at least within a bracket of 3 hours. Reminders or preceding activities may be helpful means of doing so. There are no drug-free weeks in case of a mini pill and you begin with a new pack as soon as the previous ends. You may get your bleed during the fourth week.

Dosage of emergency contraceptive pills

You are required to take an emergency contraceptive pill immediately after unprotected sex. If you have missed the bracket of 3  days for Levonorgestrel, Ulipristal can be taken within the next 2 days. Emergency contraception will not function after 5 days and you may get pregnant despite using the pill. You can also take an emergency contraceptive pill before sexual intercourse in case you feel that your usual method of contraception is failing or if you are going for a vacation and there is a likelihood of missing the pill.

As discussed, each type of contraceptive pills is used and taken differently. Beyond that, there is a specific time when each has to be taken:

When to start taking the combined contraceptive pills

The beginning dose of these pills is started relative to your menstrual cycle, based on which, the need for additional contraception during the initial days is also determined. Usually, if you are prescribed with these pills beginning on the first day of your menstrual cycle, it functions effectively, and there is no need for additional contraception.

If the pill is started a bit later during your cycle, say, on the fifth day, you will require some additional form of contraception, like condoms, before the pill becomes active. After 7 days of taking the pill, you can discontinue extra contraception as the pill has become effective.

When to start the mini pill

Progesterone-only pills can be started at any time during the menstrual cycle. It will be effective within 48 hours of dosage and will offer birth control. If you have sex within 48 hours of intake, it is important that you make use of a condom.

When to take the emergency pill

This is taken after having unprotected intercourse. Depending on the type, it has to be taken with three or five days of having sex.

Different types of contraceptive pills work as follows:

How do combined contraceptive pills work

The pill functions by preventing fertilisation in the following manner:

• Preventing the release of ova each month.
• Thickening the layer of mucus at the end of the uterus, so that the sperm is unable to penetrate and reach the egg inside.
• Thinning of the uterine lining so that the fertilised egg is unable to implant itself within the uterine wall for growth.

How does an emergency contraceptive pill work

Emergency contraceptive pill functions by interfering with the process of ovulation, primarily by having an effect on the hormone progesterone. Levonorgestrel works by increasing the levels of progesterone whereas Ulipristal hinders the normal functioning of this hormone.

Birth control pills are an effective and beneficial method of birth control. Each type of pill has its own benefits, which are explained below:

Benefits of combined contraceptive pills

• The combined pill is 99% effective for contraception when used correctly.
• The oral route is a non-painful method of administration as opposed to the intravenous route or IUDs.
• It is a reversible method of contraception, with the effects of the pill lasting only for the duration you take the pill. It does not affect your fertility and you can get pregnant as and when you stop taking the pill. This duration is a bit longer for IUDs.
• Pills can be easily taken at home and do not require frequent clinic visits.
• Taking pills also regularises the menstrual cycle as your periods naturally occur during the 7 days you do not take the pill or take an inactive one.
• Pills do not interfere with your sexual activity like the use of barrier contraceptive devices.
• Taking pills may help to correct menstruation-related disorders, thereby reducing the risk of fibroids, ovarian cysts and PCOS.
• Some studies even suggest its possible role in protecting against certain types of cancers and reducing acne.

Benefits of mini pill

Benefits are the same as the combined pill. In India, this is specifically used for new moms who are breastfeeding as they cannot be given estrogen. 

Benefits of emergency contraceptive pills

• It is the only method which caters to provide immediate birth control and saves you from unwanted pregnancy after having unprotected sex.
• It does not affect the functioning of other contraceptive pills you may be taking.
• It comes in handy in case of barrier contraceptive device failure like condoms.
• It does not cause abortion or affect your fertility or sexual activity.

If taken properly with the advice of a doctor, there are no serious side effects of birth control pills. But there are some possible side effects that you should be aware of:

Side effects of combined contraceptive pills

• Temporary side effects seen after the initial days of therapy include headache, nausea, breast tenderness and mood swings.
• Bleeding between periods and spotting are some of the common side effects during the initial months.
• Prolonged use of contraceptive pills increases the risk of serious side effects including the risk of breast cancer and thrombosis.
• Taking birth control pills can also lead to elevated blood pressure. (Read more: high blood pressure treatment)
• Lastly, birth control pills fail to provide any protection against STDs and you still need to use barrier devices like condoms, if you happen to have multiple sexual partners.

Side effects of mini pill

Side effects of the mini pill are the same as those of the combined contraceptive pill but some women may experience more severe menstrual changes with the use of the mini pill. Spotting throughout the month or occasional absence of monthly periods are some of the side effects noted in addition to those described above.

Side effects of emergency contraceptive pills

The emergency pill has no serious side effects, but the following may be noted with its use:

• Headache
• Stomach pain
• The feeling of being sick
• Disturbance in the next menstrual cycle. Your periods can be lighter or heavier or you may experience more pain or discomfort than the usual. (Read more: Period pain treatment)

In rare cases, the use of an emergency contraceptive pill can cause an ectopic pregnancy.

The action of emergency pill is effective only for short-term use. if you have unprotected sexual intercourse a few days after taking the pill, it would be rendered ineffective and you’d still get pregnant. So, it is important that you switch to your normal method of contraception even after its use.

If you feel too sick after taking the pill, it is important that you talk to your physician as this could point towards a serious side effect. Severe pain in the lower abdomen could be indicative of ectopic pregnancy.