ORAL CONTRACEPTIVES

What you should know

In today’s world, women play different roles, giving equal importance to career and family. While juggling these roles in life, it is very important for them to plan their pregnancy. Since oral contraceptives were introduced 40 years ago, the idea of modern contraception has developed drastically. The awareness about reproduction and contraception has improved. However, women still seem to be in two minds about using these pills. The reason is the myths and stories linked with these pills.

About the pill

In 1960, after more than a decade of research, the United States Food and Drug Administration [USFDA] approved the first oral contraceptive pill, which contained high doses of hormones oestrogen [150 ?g] and progestin [9.85 mg]. These pills satisfied women’s need for convenient, safe and reliable contraception. However, some users experienced side effects such as headache, nausea, cramps and weight gain. Though these side effects were temporary, they led to more research and lowering of the hormonal doses in the pills. Today’s pills contain around 20-35 mg of oestrogen. This has significantly reduced the side-effects also.

Types of pills

For basic understanding, the oral pills can be broadly classified into:

• Combined oral contraceptive pills — These contain oestrogen and progestin. These are the most commonly used oral pills.
• Progestin-only pills — These contain only progestin. These were developed in the early 1970s. Although these are not as effective as combined pills, these are a good option for breast-feeding mothers who have resumed menstruation and want oral contraception. In this case, these pills are better as they do not reduce the quantity of milk production unlike the combined oral pills.

Working of the pill

The pills primarily act by preventing ovulation [the release of egg from the ovary]. As the egg is not released, conception cannot take place. The pills also help in making the mucus secreted from the cervix thicker, so the sperms have difficulty in moving forward.

Using the pill

The current packaging of pills includes 21 active pills. Then seven days pill-free interval, during which there is withdrawal bleeding and at the end of it, the new pack has to be started.

Generally, there is no need to take regular breaks from pill use. As with modern low-dose pills, the side effects are reduced. However, even if there are some mild side effects, they usually occur in the earlier months and eventually subside with regular use. Taking a break and restarting could mean experiencing the side effects all over again.

Effectiveness

When used as instructed, oral pills provide almost complete protection from pregnancy. In practice, pregnancy rates among pills users are about six to eight per 100 women in the first year of use.

Pill use and smoking

Women who smoke have a higher risk of stroke than non-smokers. Particularly for older women, the combination of oral pills and smoking can increase their risk of stroke and blood clots.

Common myths

The oral pill causes weight gain

This is probably the most common myth about the pill. Different factors like lifestyle, diet and exercise contribute to variations in weight. Because these changes are so common, women often feel the culprit is the pill. Weight gain may be associated with the earlier contraceptive pills that contained higher doses of hormones. However, the latest pills contain lower doses of oestrogen also called low-dose pills [LDP]. Studies have shown that these LDPs are likely to have very little effect on the body weight.

The pill changes a woman’s sex drive

Sex drive is different in every woman and it also varies from time to time. Researchers find that some women while using the pills find a decreased sex drive, while some enjoy it all the more. But there is no evidence that the pills affect women’s sexual behaviour.

The pill causes infertility

A woman is protected only as long as she is consuming the pills. On discontinuation of the pill, she regains the fertility she previously had. The bleeding pattern of a woman generally returns after she stops the pill. Some women may experience a delayed return of their usual bleeding pattern.

The pill causes birth defects

Good evidence shows that oral contraceptive pills do not cause birth defects. Also, they do not harm the foetus, even if the woman accidentally takes the pill when she is already pregnant.

Emergency contraceptive pills [ECPs]

Oral pills are also useful as an emergency contraception. That means they can prevent pregnancy when taken after unprotected intercourse or in cases where the women feel the regular method failed.

• ECPs can help only if taken within 72 hours of unprotected intercourse. Pills from an ordinary oral pill packet can be used as emergency pill, if the pills contain the progestin hormone.
• Emergency pills may prevent ovulation or fertilisation [the union of sperm and egg] or may prevent implantation [attachment of the fertilised egg to the womb]. However, these pills are ineffective if implantation has already occurred.
• Pills that are specially designed for emergency contraception are available. However, it is necessary to follow the instructions mentioned on the packet and seek medical advice as required.
• As the name suggests, emergency pills are only for certain urgent situations. Also, they are more likely to cause nausea and vomiting than oral pills taken daily. Hence, emergency pills should not be used regularly as a substitute for ongoing contraception.

So it is necessary that women seek advice from their physician and make an informed choice. After all, it is an important decision that will set them free to achieve their goals in life and plan a family when they wish.