Since it was legalised in the US in the 1960s, the contraceptive pill has fast become one of the most popular methods to prevent pregnancy. In fact, recent research shows that among the 1.9 billion women of reproductive age (15-49 years) living in the world, 151 million take the contraceptive pill.
Here are some need-to-know facts about the contraceptive pill, including its effectiveness, side effects and possible health risks.
What types of contraceptive pills are available?
“There are many different contraceptive pills on the market,” says obstetrician gynaecologist and specialist urogynaecologist, Dr Frances Paterson, who works at Netcare Park Lane in Johannesburg and the Urology Hospital in Pretoria.
“Combined oral contraceptives (COPs) generally, apart from a few exceptions, contain the same type of oestrogen (in various amounts), and different progesterones. They work by suppressing ovulation, which means that the ovary can’t release an egg into the fallopian tube. This makes it virtually impossible to fall pregnant.”
For those who can’t take oestrogen, there’s a progesterone-only pill (also known as the mini-pill or POP) which prevents pregnancy by thickening the mucus in the cervix to stop sperm from reaching the egg. This interferes with plantation by thinning the endometrial lining and preventing ovulation. Some progesterone-only pills suppress ovulation too, but not consistently, according to the Mayo Clinic.
How effective is the contraceptive pill?
“The contraceptive pill is approximately 98% effective, but this depends on various factors, including whether you’re on other medications, as some can make the contraceptive pill less effective,” says Johannesburg-based GP, Dr Tracy Paiken.
These include certain antibiotics, St John’s Wort (a herbal remedy used to treat mild to moderate depression), medications to treat epilepsy, as well as HIV. These are regarded as enzyme-inducing medicines - which simply means they speed up the rate at which the liver breaks down hormones, thereby reducing the level of the hormone in the bloodstream.
If you’re on other medications, be sure to discuss them with your healthcare provider, to determine how they’ll interact with the contraceptive pill.
Other factors that can influence the effectiveness of the contraceptive pill include whether you take it consistently every day, (forgetting to take an ‘active’ pill in the pack means there’s a chance you could get pregnant, not that you definitely will fall pregnant), as well as extreme heat or cold. To be on the safe side, keep your packet out of direct sunlight and never store it in the fridge.
How do you take the combined oral contraceptive pill?
Dr Paiken says it’s best to start taking the pill on the first day of your period and to make sure you take it at the same time every day thereafter. “The pill generally takes a month to be fully effective, so use additional protection for that first month,” she adds.
“The placebo pills, or white pills, are the ones with no hormone in them. They’re also referred to as reminder pills to help you stay on track, but they will allow you to bleed and have a short period. If you have a holiday or special occasion coming up and you want to delay your period, you can skip the placebo pill and just continue with the active pill.”
How do you take the progesterone-only pill (mini pill)?
For those taking the mini pill, it's important to start taking it on the first day of your menstrual cycle and continue taking it at the same time every day. You should also have a new pack ready as you finish your current pack as there’s no hormone-free window with the mini pill and skipping it for a day or even a few hours is risky.
Who should you see for a prescription?
A GP can prescribe the pill, but if you have any concerns or health issues then it’s best to see a Gynaecologist, advises Dr Paiken.
What are the pros and cons of being on the contraceptive pill?
According to Dr Paterson, the pros of taking the pill include:
· Some pills are very effective at controlling premenstrual syndrome (PMS) symptoms
· They’ve been found to be protective against ovarian cancer
· You’re in control of when you have a period and can prevent a bleed when wanted
· Periods are also generally lighter and less painful on the pill
Some cons to consider when taking the pill include:
You may experience some unpleasant side effects from the oestrogen and progesterone in the combined oral contraceptive pill. For instance, these hormones can cause mood changes, weight gain, bloating and other irritating issues.
But, Dr Paterson maintains that these can be mitigated by finding the right progesterone and using the lowest dose of oestrogen that still maintains good cycle control.
Oestrogen can cause blood clots in the leg called deep vein thrombosis (DVT), the complications of which can be life-threatening. However, this is rare and is generally seen in women who are otherwise at risk for DVT, such as those with pre-existing clotting disorders or who are obese.
Are there any additional health concerns to be aware of when taking the pill?
It’s important to ask questions and discuss any risks of taking hormonal treatment with your doctor, who should have a detailed description of your health history, says Dr Paiken. Before taking the pill, you should look at whether you have familial breast or uterine cancer, if there are any clotting disorders in your family or history of strokes, and if migraines and headaches are a problem for you, as there have been cases of women suffering from additional headaches on the contraceptive pill.
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