The Introduction of birth control in
1960 revolutionized contraceptive practices around the
world. Millions of women turned enthusiastically to this
convenient and effective method of preventing pregnancy, but within
a decade reports of serious side effects of the pill began
to appear and the popularity of this method declined
substantially. Now After twenty-five years of observation,
what are the facts about the pill?
There are two types of oral contraceptives
currently in use a combination pill, which contains a
synthetic estrogen and a progesterone -like synthetic substance
called " progesterone," and a minipill with progesterone
only in low dosage. This discussion will focus on combination
pills ( unless otherwise specified ) because they are most
- Women who use oral contraceptives swallow a pill
each day to prevent pregnancy. Combined oral contraceptives
contain two hormones similar to the natural
hormones in a woman's body -- an estrogen and a protesting.
Also called combined pills, COCs, OCs, the Pill, and birth control
- Present combined oral contraceptives contain very
low doses of hormones. They are often called low does
combined oral contraceptives.
- There are two types of pill packets. Some packets have 28
pills. These contain 21 "active" pills, which
contain hormones, followed by 7 " reminder "
pills of a different color that do not contain hormones.
Other packets have only the 21 " active"
Deciding About Combined Oral
How Do they Work?
- Stop ovulation (release of eggs from
- Also thicken cervical mucus, making it difficult
for sperm to pass through
They do NOT work by disrupting
How Effective ?
Effective as commonly used :
6 to 8 pregnancies per 100 women in first year of use (1 in
every 17 to 1 every 12).
Very effective when used correctly and
consistently : 0.1 pregnancies per 100 women in first year of use (
1 in very 1000 ).
Important : Should be taken every day to
be most effective. Many women may not take pills correctly and
thus risk becoming pregnant. The most common mistakes are
starting new packets late and running out of pills.
Advantages and Disadvantages
- Very effective when used correctly.
- No need to do anything at tie of
- Increased sexual enjoyment because no
need to worry about pregnancy.
- Monthly periods are regular:
lighter monthly bleeding and fewer days of bleeding milder
and fewer menstrual cramps.
- Can be used at any age form
adolescence to menopause.
- Can be used by women who have
children and by women who do not.
- User can stop taking pills at
any time .
- Fertility returns soon after stopping.
- Can be used as an emergency
contraceptive after unprotected sex.
- Can prevent or decrease iron
- Help prevent :
- Ovarian cysts,
- Endometrial cancer,
- Pelvic inflammatory disease,
- Ovarian cancer,
- Benign breast disease.
-Nausea (most common in first 3
-Spotting or bleeding between menstrual
periods, especially if a woman forgets to take her pills
or takes them late ( most common in first 3
-Slight weight gain ( some women see
weight gain as an advantage).
-Amenorrhea (some women see amenorrhea as
- Not highly effective unless taken
every day. Difficult for some women to remember every
- New packet of pills must be at hand
every 28 days.
- Not recommended for breastfeeding
women because they affect quality and quantity of
- In a few women, may cause mood changes
including depression, less interest in sex.
- Very rarely can cause stroke, blood
clots in deep veins of the legs, or heart attack. Those at
highest risk are women with high blood pressure and women
who are age 35 or older and at the same time smoke more than
20 cigarettes per day.
- Do not protect against sexually transmitted
diseases (STDs) including AIDS.
Important: Ask the client if she might
have or get a sexually transmitted disease (STD), has more than
one sex partner or could this
happen in future.
If she has or might get an STD , urge her
to use condoms regularly. Give her condoms. She can still use
combined oral contraceptives.
Most Women Can Use Combined Oral
In general, most women can use low dose
combined oral contraceptives safely and effectively. Low dose
combined oral contraceptives can be used in any circumstances by
- Have no
- Are fat or thin,
- Are any age, including adolescents
and over 40 (except women who are age 35 or older and who
cigarettes but are under age
- Have just had abortion or
Also, women with these conditions
low dose combined oral contraceptives in any
- Heavy, painful menstrual periods or
iron deficiency anemia (condition may improve).
- Irregular menstrual period,
- Benign breast disease,
- Diabetes without vascular, kidney ,
eye, or nerve disease,
- Mild headaches,
- Varicose veins,
- Thyroid disease,
- Pelvic inflammatory disease,
- Benign ovarian tumors,
- Uterine fibroids,
- Past entopic pregnancy,
IMPORTANT: Non-medical providers can
safely offer low dose combined oral contraceptives. Non-medical
providers include shopkeepers and community based distributors.
These providers do not need to obtain medical consultation or
approval to provide pills to a woman unless she has a condition
that requires it.
Starting Low-dose Combined Oral
When To Start
A woman can be given combined
oral contraceptives at any time and told when to start taking
them . The following table show when to start.
When to star
The first day of menstrual bleeding is est.
Any of the first 7 days after her menstrual bleeding
starts, if she is cycling normally.
Any other time it is reasonably certain that she is
not pageant. If more than 7 days since
menstrual bleeding started, she can begin combined
oral contraceptives but should avoid sex or also
use condoms or spermicidal for the next 7 days. Her
usual bleeding pattern may change
After childbirth if breast
Note : Can give her pills now. Make sure she knows when
to start taking them
After childbirth if not breast
3 to 6 weeks after childbirth. No need to wait
for menstrual periods to return to be certain that she is not pregnant.
After 6 weeks, any time it is reasonably certain
that she is not pregnant.
Note : If not reasonably certain she should avoid
sex or use condoms or spermicidal until her first period
starts, and then begin combined oral contraceptives.
After miscarriage or
In the first 7 days after or second trimester
Later, any time it is reasonably certain that
she is not pregnant.
Providing Combined Oral
Important : A woman who chooses low dose combined oral
contraceptives benefits form good counseling.
A friendly provider who listens to a woman's
concerns, answers her question , and gives clear, practical
information about side effects, especially nausea and vomiting
and about proper use will help the woman use combined oral contraceptives
with success and satisfaction.
You can follow these steps to provide combined oral
Give her plenty of
pills a year's supply , if
possible. Running our of pills is a major reason for
Explain how to use combined oral contraceptives .
If possible, give her condoms or spermicidal
Until she can
start taking her pills ( if needed)
If she starts a packet of pills late, if
she forgets several pills in a row, or if she stop staking oral contraceptives for any
If she thinks she or her
partner could get AIDS or
any other STD.
Show her how to use condoms or spermicidal.
4. Plan a return visit in time to give her more pills
before her supply runs out.
5. Invite the client to come back any time she has
questions, problems, or wants another method.
For clients who use pill packets
like the one
shown below this drawing can help explain what to do when
they miss pills. Describe the pills by their
pills ? Here's
what to do