ORAL CONTRACEPTIVES

The oral contraceptive - ‘the Pill’ - is the most reliable reversible method of birth control that exist at present, and one of the most widely used.

Oral contraceptives are made of synthetic hormones similar to those that occur naturally in a woman’s body. They prevent pregnancy, and are taken by mouth in pill form. Some oral contraceptives work by stopping ovulation, others by making it difficult for sperm to reach the egg, or for implantation of a fertilized egg in the uterus wall to take place.

The combination pill is made up of oestrogen and protesting, and is taken daily for 21 days, followed by seven-or in some cases six-pill free days in which a withdrawal bleed takes place. The progestin only pill (also known as the mini pill) is taken every day the triphasic pill is a type of combination pill, but contains a different times in the month.

HOW ORAL CONTRACEPTIVES WORK ?

Different types of pill work in different ways. The combined pill has hormones that are very much like those produced by the body when a pregnancy has occurred. This means that the pituitary gland, which normally sends a message to the ovary to produce its monthly egg acts as if the body is already pregnant; it therefore does not send its egg-stimulating hormone and so no ovulation takes place.

The progestin-only pill-the mini pill does not always stop ovulation from occurring. It makes fertilization by the sperm more difficult by thickening the mucus in the cervical channel leading from the vagina to the uterus (womb), and inhibits the formation of uterine lining which is necessary for the fertilized egg if it is to implant itself. As a result, implantation (and pregnancy) do not take place.

DIFFERENT TYPES OF PILLS

There are a number of pharmaceutical companies making these pills, and although some of them have different brand names, they are made of identical chemical constituents. Combination pills have two constituents listed; progestin only have, of course, just one constituent.

Trochaic pills provide different amounts of the two hormones found in an ordinary pill packet for each week of the cycle, and are said to mimic the menstrual cycle more effectively.

The combination pill is taken for 21 days, with a seven-or-six day break every month. Some women prefer to have a pill every day, so there are some 21 day combination pills that include seven dummy tablets to be taken throughout the fourth week. If you think you will find these pills easier to remember, if is worth asking your doctor for them.

The progestin only pills must be taken every day, and can cause changes in periods while they are being taken. Some women don’t have any bleeding for several months, others have frequent breakthrough bleeds during the month. Many women have no problems of this sort at all. Bleeding does not mean that the pill isn’t working properly, but if you find irregular bleeding troublesome ask your doctor’s advice. You are probably not pregnant, but if you are more than two weeks overdue, see your doctor. Which pill you take will be up to you and your doctor. The progestin only pill is thought to involve less change of circulatory problems, so is often a first choice method for those who may be at risk from this kind of disease.

EFFECT ON THE BODY

There are many positive effects of the pill, not least the protection from unwanted pregnancy: 99 per cent or more reliability for the combined pill, 98 per cent for the progestin only pill. The pill can also actively protect a woman from certain kinds of disorders, such as the formation of benign breast lumps, can help to clear up acne, and reduce wax in the ears. Since the body is no longer going through the menstrual cycle many of the problems associated with periods - pre-menstrual tension, pain, or heavy bleeding -can be alleviated. Research also suggests that there may be some protection against thyroid and uterine disorders, but this has not yet been confirmed.

Troublesome side-effects may occur at the beginning of a course of pills. Some women find that when they first start taking the pill they feel slightly sick, or that their breasts become a little swollen and sore. Some women who suffer from migraines may find that their condition is made worse by the pill, although for others the opposite is the case. The pill can also affect the ability to wear contact lenses, since the amount of fluid on the surface of the eye may be reduced. It is also though that the absorption of some vitamins may be slightly reduced, but this does not need to be a problem: the solution is a healthy diet providing more than enough vitamin intake.

Depression can also be caused by the pill, and in some cases so can loss of libido (sex drive). If you suffer from these symptoms when you are on the pill, discuss them with your doctor’s so that an alternative to the combination pill can be considered.

The most dangerous side-effect of the combination pill is the increased likelihood of blood circulatory disorders, such as high blood pressure, thrombosis, heart attacks and strokes. These affect only a tiny minority of women on the pill, and the risk has been greatly reduced by the introduction of those pills containing a lower dose of hormones. However, because the pill does increase the likelihood of these disorders, prospective pill users must be carefully screened to see if they are particularly at risk. Your own medical history, and that of your family, will need to be studied. Smoking, being overweight, and being over 35 years of age all increase the risk of these disorders, so women who are in any of these categories are often advised not to use the combination pill. The progestin-only pill does not seem to carry such risks, and is the one most often prescribed for older women.

The progestin only pill is not quite so effective in preventing pregnancy as the combined pill. There is a tiny risk that if an egg is fertilized it will implant itself outside the womb, since the uterine lining is too soft or spongy enough to receive it. This is called an ectopic pregnancy, and it can take place in one of the Fallopian tubes. The risk of it happening is very small indeed, but it is a dangerous condition, needing immediate treatment. Any pain in the lower abdomen should be reported to your doctor.

The return of the menstrual cycle may sometimes be delayed once a woman is off the pill, but it is now thought that it does not affect fertility in the long run.

The choice of which pill is best for you to start off with will be made by your doctor. Most women start with a low dose combination pill, and are given three months supply. Any immediate side-effects should be discussed with your doctor on your next visit, or sooner if you feel that they are serious.

Your doctor will advise you to start taking the combination pill on either day one or five of your next period. If it is the latter, you will need to take additional contraceptive precautions (sheath or cap, both with spermicidal) for 12 days after your first pill taking day. After that time you are protected by the pill and do not need any extra protection. The combination pill should be taken at whatever time of day is most convenient for you. Many women find that taking it last thing at night becomes part of a routine which is easy to remember. If a pill is forgotten, but you are not more than 12 hours late in remembering to take it, you will still be protected as long as you continue to take the rest of the packet normally. If you are more than 12 hours late you will need to use additional contraceptive precautions for the next 14 days of pill taking, to make provision for the build up of hormonal protection.

The progestin only pill will be taken first on day one of your period, and must be taken at the same time every day, since it is not quite so effective in protecting you against conception as the combination pill. You will need to take additional precautions for the first 14 days. Progestin only pills are at their most effective four hours after they are taken, so it is best to do this at a regular time early in the evening. If you are three or more hours late in remembering to take the progestin only pill, you should consider yourself unprotected.

The effectiveness of both sorts of pill may be affected by a stomach upset (either vomiting or diarrhea), as it could mean that the pill has not been absorbed. Other drugs, such as some antibiotics, drugs for epilepsy, sedatives and painkillers, can also reduce the effect of the pill. Always check with your doctor if you are given any drug, to make sure that there is no risk of this happening.

COMING OF THE PILL

How long a woman stays on the pill will depend on a number of factors, but doctors do recommend that the pill should not be used continuously for more than 10 years, since its very long term effects are still not fully known.

Women who have to have any major surgery, or who are confined to bed for a time or have a leg in plaster, are advised to come off the pill until they are well again, since these conditions in themselves increase the risk of circulatory problems. Anyone who takes the combination pill would almost certainly have to come off it six weeks before an operation. A woman should, in fact discuss this point with her doctor, whatever pill she is taking.