Oral contraceptive pills (OCP) are one of the most common methods to prevent unwanted pregnancy. The widespread use of contraceptive pills in India is alarming as most women using these pills are unaware of its mechanism, side-effects, and safety precautions. Dr. Rajeshwari Pawar, Consultant Obstetrics & Gynaecology, Motherhood Hospital, Pune explains about oral contraceptives that every woman needs to know to find out if contraceptive pills are a good option for contraception!
What are oral contraceptive pills?
Also known as birth control pills, oral contraceptives are hormonal pills which are available over the counter. These pills are considered to be an effective option to prevent unwanted pregnancy in a sexually active woman.
What are the types of contraceptive pills?
There are two types of oral contraceptive pills available in the market:
1. Combination pills or combination oral contraceptive (COC) pills which contain the hormone estrogen and progesterone
2. Progesterone-only pills (POP) or mini-pills which contain the hormone progesterone
How do oral contraceptive pills work?
A woman gets pregnant when an egg released by the ovaries is fertilized by a sperm. The fertilized egg is then implanted into the uterus, which grows into a fetus and is delivered after nine months.
Oral contraceptive pills contain hormones which create an artificial hormonal environment. This interferes with the process of fertilization and implantation, which prevents conception.
The hormone progesterone prevents ovulation by blocking the release of the egg from the ovaries. It thickens the cervical mucus, which makes it difficult for the sperm to enter the uterus and fertilize the egg. It also inhibits the growth of the endometrial lining, so even if the egg is fertilized, the embryo can’t be implanted in the uterus.
The hormone estrogen suppresses the follicle stimulating hormone (FSH), which plays a key role in the ovulation. Low levels of FSH prevent ovulation which in turn reduces the chances of pregnancy.
What are the side-effects of oral contraceptives?
There are few common side-effects of contraceptive pills such as:
-Upper abdominal pain
-Pain between the shoulders
These side-effects are quite common in women with a thin body-frame. These symptoms usually subside within a week after taking medications such as antacids or anti-nausea medication. If these symptoms persist, then consult your doctor immediately. Also, if a woman is experiencing severe abdominal pain or spotting between periods, then it is a sign to consult a doctor. Some of the adverse side-effects include a severe headache, swelling and aching of legs, chest pain, high blood pressure and thrombus (clot in the blood vessel).
Hence, it is advised that every woman must consult a gynaecologist before taking these pills. This is because doctors conduct a routine examination where they check the blood pressure and conduct blood tests such as a liver function test to rule any health problems.
How effective are oral contraceptive pills vs injections vs patches?
The oral contraceptive injections contain only one hormone: progesterone. Injectables are oil-based preparations which are administered intramuscularly. When injected, it causes a gradual release of the hormone progesterone and works for a span of around three months. The continuous presence of the hormone prevents ovulation, which in turn prevents pregnancy.
Patches are more commonly used as hormone replacement therapy for menopausal women but as contraceptive methods, they are not much used in India.
Combination pills are more than 99% effective if used regularly. If a woman misses a pill or forgets to take pills for two to three days and starts off again, then the efficacy is reduced and the chances of getting pregnant are high. It’s better to use other contraceptive methods like condoms during this cycle.
The efficacy of progesterone only pills is around 99%. This is because the pill should be taken at the same time every day. If it is delayed by more than two hours, the effect is reduced. Also, if a woman is partially breastfeeding, then the effect is further reduced.
Injectables are more effective (more than 99%) as they are directly released into the body. Moreover, unlike pills, you do not have to take injections on a daily basis, which further increases its effect.
Points to keep in mind while taking oral contraceptive pills
1. Just because your friends or cousins are taking birth control pills, it doesn’t mean you can take the same type of birth control pills without consulting an expert. It is highly recommended to consult a gynaecologist the first time you are taking oral contraceptives in order to know what type of pills suit you and how to take it.
2. Oral contraceptive pills are not advised for women who are obese, smoke and above 35-45 years because the risk of complications and side-effects are higher in these women. Combination pills are not prescribed in breastfeeding woman usually during the first six months as estrogen can decrease the milk production.
3. Oral contraceptives do not offer protection against sexually transmitted diseases (STDs). To ensure you are protected against STDs, it is important to use condoms in addition to the pills.
4. Take your pills around the same time every day because it helps you to maintain the hormone levels.
5. If you miss a pill, then take it as soon as you remember even if it means taking two pills in one day. If you miss taking more than two pills or have a doubt about taking two pills in a day, consult your gynaecologist.
6. The oral contraceptives are not only recommended to prevent unwanted pregnancies, but in some cases, they are prescribed to maintain the hormonal balance in women suffering from hormonal conditions such as polycystic ovarian syndrome (PCOS), irregular periods, or heavy bleeding. Hence, it is important to inform your doctor if you are already taking any hormonal pills so as to adjust the dose and type of contraceptive pills accordingly.
7. Some medications such as certain antibiotics, certain HIV medications, and some antiseizure medications can make the pills less effective. Hence, if you are taking any of these medications, it is wise to inform your gynaecologist about the same before taking contraceptive pills.
8. Most women tend to take birth control pills for years at a stretch which can lead to hormonal complications in the long run. Hence, if your doctor informs you to take oral contraceptive pills only for a limited period of time, then do follow the instructions to the T. Do not start a new course of the pills without informing the gynaecologist.
9. Progesterone only pills are given to breastfeeding woman because there is some natural contraceptive effect that comes because of exclusive breastfeeding. When mothers are given a smaller dose of these pills, it adds to the natural contraceptive effect of breastfeeding known as “lactational amenorrhea method,” or “LAM”. Read more on Natural Birth Control Methods To Prevent Pregnancy.
10. It is believed that oral contraceptive pills lower the risk of endometrial and ovarian cancer. This could be attributed to the presence of hormone progesterone in the contraceptive pills which prevents ovulation and uncontrolled growth and multiplication of the endometrial cells. As cancer is caused due to uncontrolled growth and division of the cells, it can indirectly lower the risk of ovarian and endometrial cancer.