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Contraceptive pill or ‘the pill’ is taken by women to prevent unwanted conception. They are either taken regularly over a monthly schedule or are used immediately after coitus for the purpose of contraception.

Pills which are taken after coitus are known as emergency contraceptive pills. These are meant to be taken within 72 hours of sexual activity to prevent pregnancy.

Contraceptive pills or birth control pills which are taken over a monthly cycle, come in two formulations, that is, as a combined pill and a mini pill. Both these pills come with different drug compositions.

These pills function by interfering with the process of the ovulatory cycle, that is, the reproductive cycle in females which releases an egg each month and makes it available for fertilisation.

All the types of pills are effective in the process of birth control but have their own set of benefits, risks and side effects, which is why they must not be taken without your physician’s consult. When using these pills with a prescription, it is important that you be careful to take them on the specified time and never miss a dose as this reduces its contraceptive actions.

Let’s discuss more about the mechanism, benefits, dosage, risks, uses and side effects of these pills through this article.

  1. Types of contraceptive pills
  2. Combined contraceptive pill
  3. Mini pills
  4. Emergency contraceptive pills

Contraceptive pills or birth control pills are effective methods of preventing unwanted pregnancy and are usually taken by women. 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 pill
  • Mini pill
  • Emergency pill

Let’s discuss each separately.

The combined pill contains artificial versions of both progesterone and estrogen, which are primary female hormones. When used correctly, the pill is about 99% effective and has minor side effects.

Types of combined contraceptive 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 a 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.

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.

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.

How do combined contraceptive pills work (mechanism of action)

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.

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.

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.

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.

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.

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.

Benefits and side effects of mini pill

Benefits and side effects are the same as the combined 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.

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.

Types

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 a pregnancy.
  2. Ulipristal  Acetate
    An emergency contraceptive pill based on ulipristal acetate is effective when taken up to 5 days after sex.

How does an emergency contraceptive pill work (mechanism of action)

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.

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.

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.

Side effects of emergency contraceptive pills

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.

If you experience nausea or vomiting 2 to 3 hours after taking the pill, it is recommended that you check in with your doctor since you would be required to take another pill.

With all these available choices of contraceptive pills, it could be a little confusing to make the right choice. Consulting a doctor is the best choice in such cases who will determine the type of pill to be taken based on the uses and indications while also weighing the benefits and side effects.

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References

  1. National Health Service [Internet]. UK; Combined pill
  2. Planned Parenthood. How do I use the birth control pill?. Planned Parenthood Federation of America
  3. National Health Service [Internet]. UK; Emergency contraception
  4. Center for Young Women's Health. Birth Control Pills: General Information. Boston Children's Hospital, US
  5. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Birth control pills - overview
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