How much do you know about the contraceptive pill?

Women’s role in society and their freedom to choose any form of lifestyle have undergone tremendous transformations throughout history. In the past, birth control existed only in closed circles and it was used solely for women with severe menstrual disorders, not as a contraceptive.  Fortunately, nowadays this is not the case. We can now talk openly about birth control, discuss different methods to prevent pregnancy and even encourage women to decide which way to choose when it comes to motherhood.

In 1960, the contraceptive pill was approved by the Food and Drug Administration (FDA) in the USA, and it quickly became the most popular form of birth control around the world. Today, the two most popular types of pills available are the combined pill and the progestogen-only pill. 

Commonly referred to as simply the pill, the combined pill contains two hormones – oestrogen and progestogen.  These are similar to the natural hormones women produce in their ovaries. The first thing the pill does is stops the ovaries from releasing an egg each month.  Secondly, it thickens the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg.  Finally, it makes the lining of your uterus (womb) thinner, so it is less likely to accept a fertilised egg.

The second most popular type of pill is the progestogen-only pill (POP).  It contains the hormone progestogen but doesn't contain oestrogen. The progestogen-only pill works by thickening the mucus in the neck of the womb, just like the combined pill does. This makes it harder for sperm to penetrate the womb and reach an egg.  Sometimes, depending on the type of progestogen-only pill, it may also prevent ovulation. This type of pill can be used by women who can't use contraception that contains oestrogen. This will usually be because they have high blood pressure, had previous blood clots or are overweight.

Advantages of taking the pill over other forms of contraceptive

The contraceptive pill is highly effective if your objective is to choose a method that works immediately, can be temporary and reversible, as well as help you conceive and give birth in the future.

If you are unsure about the future, however, contraceptive pills are still a wiser choice than other birth control methods.

Compared to other forms of contraceptives, birth control pills are 99% effective and are reversible. The pill isn't just for birth control: it can also protect against certain life-threatening cancers and help relieve some painful period symptoms.  

Taking oral contraceptives (OCs) can slash your risk for both endometrial and ovarian cancer by more than 70% after 12 years; even just one to five years may lower your risk by 40%.  Oestrogen, the female hormone found in most OCs, helps clear your skin by decreasing levels of testosterone, a male hormone that stimulates oil production. 

When you're on the pill, you don't ovulate therefore your uterine lining doesn't build up as much. So most OC takers bleed less for a shorter time and have little or no cramping.  Also, the pill can provide relief by steadying hormones.  

Endometriosis, a condition in which uterine-lining tissue grows in other pelvic areas, can lead to scarring, severe pain, and sometimes infertility. The pill stops the growth of tissue in other areas by reducing the hormones that cause the lining to build up.

Interestingly, women on the pill can reschedule their period so it doesn't come at inconvenient times. Oestrogen also helps regulate periods and unwanted hair growth.

The right way to take the pill 

The combined pill
You need to take the pill every day for 21 days, then stop for seven days, and during this week you have a period-type bleed. You start taking the pill again after seven days.  You need to take the pill at the same time every day. You could get pregnant if you don't do this, or if you miss a pill, vomit or have severe diarrhoea.  The combined pill is not suitable for women over 35 who smoke, women with certain medical conditions, who are very overweight or who take certain medicines.  

The chance of getting pregnant after missing a pill depends on when the pills are missed and how many pills are missed.  If you miss a pill, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

You should also not take the pill if you have (or have had):

• Thrombosis (a blood clot)
• A heart abnormality or heart disease, including high blood pressure
• Severe migraines
• Breast cancer
• Disease of the gallbladder or liver
• Diabetes with complications or diabetes for the past 20 years

If you have recently had a baby and are not breastfeeding, you can start the pill on day 21 after the birth and you will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next seven days.  

If you are breastfeeding a baby less than six months old, the oestrogen in combined hormonal birth control can lower your milk supply.  It is recommended that you use a different method of contraception until you stop breastfeeding. Progestin-only pills, an implant, both kinds of IUDs, or birth control shots do not affect your milk supply and are a good option for breastfeeding women.

If you have had a miscarriage or abortion, you can start the pill up to five days after this and you will be protected from pregnancy straight away. If you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for seven days.

The progestogen pill

You have to take a pill every day, with no break between packs of pills. There are 28 pills in a pack of progestogen-only pills. You need to take one pill every day.  When you finish one pack, you start the next one the next day.

You must take the progestogen-only pill at the same time each day.  If you take it more than three hours late (or 12 hours late if you take a Desogestrel pill, such as Cerazette) it may not be effective.  You will need to use additional contraception, such as condoms for two or seven days (depending on what pill you are taking) after missing a pill.  

As with the combined pill, if you’re sick or have severe diarrhoea, the progestogen-only pill may not work.  Also, some medicines may affect the pill's effectiveness. The same conditions apply to the progestogen pill regarding taking it after you have just had a baby, or if you have had a miscarriage or abortion.

Most women can use the progestogen-only pill.  You can take it even if you're over 35 and you smoke.  If you are healthy there are no medical reasons why you should not take the progestogen-only pill.  You can take it until your menopause or until you are 55.

However, you may not be able to use it if you have had:

• Heart disease 
• Liver disease 
• Breast cancer 
• Cysts on your ovaries
• Unexplained vaginal bleeding

The progestogen-only pill is safe to use if you are breastfeeding. Small amounts of progestogen may pass into your breast milk, but this is not harmful to your baby. The progestogen-only pill does not affect the way your breast milk is produced.

Your reaction to the hormones in contraceptive pills depends on the chemistry in your body and the mixture of the hormones in the pills.  Also, because combination pills prevent you from ovulating, you won’t have the subtle increase in libido that some women report during ovulation.

With all this in mind, the pill is there to help you be in control of the type of life you choose for yourself: the number of children you have (if any), the age when you are ready for motherhood, the length of your career and the time and financial management you crave for in your personal life.  

If you are not sure which is the right contraceptive pill for you, our dedicated GPs can be of great help. They can talk through your medical history, and any side effects that you may be afraid of and determine which treatment is suitable for you.