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
commonly used.
- 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
pills.
- 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"
pills.
Deciding About Combined Oral
Contraceptives
How Do they Work?
- Stop ovulation (release of eggs from
ovaries).
- Also thicken cervical mucus, making it difficult
for sperm to pass through
They do NOT work by disrupting
existing pregnancy.
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
Advantages
- Very effective when used correctly.
- No need to do anything at tie of
sexual intercourse.
- 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
deficiency anemia.
- Help prevent :
-
Ectopic pregnancies,
- Ovarian cysts,
- Endometrial cancer,
- Pelvic inflammatory disease,
- Ovarian cancer,
- Benign breast disease.
-Nausea (most common in first 3
months)
-Spotting or bleeding between menstrual
periods, especially if a woman forgets to take her pills
or takes them late ( most common in first 3
months).
-Mild headaches,
-Breast tenderness,
-Slight weight gain ( some women see
weight gain as an advantage).
-Amenorrhea (some women see amenorrhea as
an advantage).
- Not highly effective unless taken
every day. Difficult for some women to remember every
day.
- New packet of pills must be at hand
every 28 days.
- Not recommended for breastfeeding
women because they affect quality and quantity of
milk.
- 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
Contraceptives
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
women who:
- Have no
children,
- Are fat or thin,
- Are any age, including adolescents
and over 40 (except women who are age 35 or older and who
smoke).
- Smoke
cigarettes but are under age
35,
- Have just had abortion or
miscarriage.
Also, women with these conditions
can use
low dose combined oral contraceptives in any
circumstances:
- 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,
- Malaria,
- Schistosomiasis,
- Thyroid disease,
- Pelvic inflammatory disease,
- Endometriosis,
- Benign ovarian tumors,
- Uterine fibroids,
- Past entopic pregnancy,
- Tuberculosis
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
Contraceptives
When To Start
Important :
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.
