Contraception - the contraceptive pill
Written by Dr David Delvin, GP and family planning specialist
Is the Pill popular?
If you're thinking of going on the Pill, you'll be joining a band of about 100 million women worldwide who use this method.
Did you know?
More than 100 million women worldwide use the contraceptive pill- of these 3.5 million live in the UK.
Is it safe?
So is the Pill safe? Basically, yes. But very occasionally, it can have serious side-effects, which we'll deal with in a moment.
For that reason, most doctors do not think that it should be 'dished out' to absolutely everyone, without any need for a prescription. However, in 2007 there was a suggestion by medical experts that it should be provided 'over the counter'! This change is unlikely to occur soon.
So when you want to start on the Pill, you should see a doctor (or Family Planning Nurse) and have a short check-up.
The main purpose of this is to see if you have any 'risk factors' (see below) which would make you more liable to heart attacks or strokes.
Warning!
A very tiny number of women should not take the Pill, because they have serious medical conditions.
What is the Pill?
The Pill is a tablet containing two female-type hormones – an oestrogen (pronounced 'ee-stro-jen') and a progestogen.
Various different oestrogens and progestogens are used in the many different types of Pill which are available. There are currently 22 brands on the market in Britain.
What these two hormones do is to stop you from ovulating ('producing an egg') each month. And if you don't ovulate, you won't get pregnant.
In addition, the hormones thicken the secretions round your cervix – thus making it more difficult for sperm to get through. Also, they make the lining of your womb thinner, so that it is less receptive to an egg.
Is the Pill the same as the mini-Pill?
Pill versus mini-Pill
The two are not the same. The Pill contains two hormones; the mini-Pill only one. The mini-Pill has fewer side effects but is also less effective.
How effective is the Pill?
It's very effective indeed — which is why so many millions of women rely on it. If you take it exactly as prescribed, then its effectiveness is likely to be almost 100 per cent.
Put it another way: let's say that 100 women use the Pill for a year, and that all of them never forget to take the little tablet. It is likely that not a single one of them will get pregnant.
In contrast, if they were all relying on the condom instead, then probably about five of them would become pregnant. And if they used no contraception at all, then at least 20 of them would fall pregnant!
So the Pill is just about the most effective method of contraception there is, apart from sterilisation .
How do you take it?
In the UK, you're given a pack containing 21 Pills and you take one every day for three weeks. At the end of those three weeks, you 'break' for a week. During those seven days, you'll have your period.
It is stopping the Pill at the end of the pack that brings on the period.
After the week's break, you start on your next packet. So it's 'three weeks on and one week off' throughout the year.
If you want to, you can set your mobile phone so that it beeps at the same time every day, to remind you to take your Pill.
But how do I get started?
Go to a GP or a Family Planning Clinic to get a prescription. In Britain, it is now the practice to take your first-ever Pill on the first day of your period. If you do this, you should be protected immediately – so you can have sex whenever you like.
Practices vary in other countries, and their Pill packs may contain more than 21.
In the USA, it is extremely common for women to have packs containing 28 tablets – but seven of them are 'dummies.' These dummy tablets are taken during the week's break from the Pill, and the idea is to try and make it easier to remember to swallow a tablet at the same time every day!
If that idea appeals to you, then you can easily obtain 'dummy-containing' packets in Britain. They are referred to as 'ED' brands (ED meaning 'every day').
What are the good points about the Pill?
The Pill has now been shown to have certain major health advantages:
- it abolishes period pain
- it makes periods shorter
- it makes them lighter.
. Because of this, you are less likely to get anaemic.
If you have acne, the Pill should improve it.
In addition, it decreases your chances of getting certain cancers (though it increases the risk of others). Please see the section on cancer, below.
But can't it give you a lot of side effects when you start? During the first few packs of the Pill, many women get minor, passing side effects, such as:
- headaches
- nausea
- breast tenderness
- slight weight gain
- slight 'spotting' of blood between the periods.
These side-effects usually go away after the first few packs. If they don't, it's very easy to get rid of them by simply switching to another brand of the 22 available brands of Pill.
(For a full list of possible side-effects, see the package leaflet.)
What about serious side-effects, like thrombosis?
There is no doubt at all that the Pill can occasionally cause serious problems like:
Fortunately, these events are very rare. BUT ... they are much more likely to happen if you have certain 'risk factors,' which include:
- being a smoker
- having a bad family history of thrombosis or some similar illness (say, if your mother had a heart attack at 40)
- being severely overweight
- being diabetic (though quite a few non-smoking diabetics do use the Pill, under careful supervision)
- having high blood pressure
- having a high blood cholesterol level
- a 'past history' of phlebitis (vein inflammation) or thrombophlebitis
- being immobile for a while (especially when having a surgical operation).
There are other 'risk factors' – for instance, making a very long journey in a plane or a cramped car seat. Your doctor or Family Planning nurse can give you more details.
The risk is now known to be greater in the first year of taking the Pill. But it also increases a little as you get older – see below.
Varicose veins
A lot of people (including some doctors) have the idea that 'you can't take the Pill if you have varicose veins'. This isn't true.
However, in recent years it has become clear that severe problems with varicose veins are a contraindication to the Pill.
But if you just have mild and superficial varicose veins, it is quite likely that your doctor will be willing to prescribe a low-dose Pill for you – provided that you have no other risk factors.
Migraine
In 2004, new research showed that women who have severe migraine and who also use the Pill run an unacceptable risk of having a stroke.
I'm not talking about people who have an occasional slight headache, as we all do. But if you have genuine migraine attacks – particularly migraines with 'aura' affecting your eyesight – then in my opinion you shouldn't be on the Pill.
Does age make a difference?
Yes. The Pill is extraordinarily safe for young women in their teens or 20s who have no 'risk factors' (such as smoking). But when you get to the age of 35 or 40, the chances of having a thrombosis (clot) are starting to increase.
In practice, there are some women of 40 who take the Pill. But as the years go by, there is more and more reason to switch to the mini-Pill, or to some other method of contraception, such as sterilisation and vasectomy for men.
What about cancer?
Did you know?
The Pill can increase the risk of some cancers and reduce the risk of others. Ask your doctor for advice.
Be 'breast aware'
Check your breasts regularly for lumps or anything odd, particularly as you approach middle age, which is when this type of cancer starts becoming common.
Does anything make the Pill less likely to work?
Yes.
© Copyright 1998 - 2009 NetDoctor.co.uk - All rights reserved 
