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Contraception - the contraceptive pill
Written by Dr David Delvin, GP and family planning specialist
What are the good points about the Pill?
The Pill has now been shown to have certain major health advantages:
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:
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:
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.
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
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?
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?
Be 'breast aware'
Does anything make the Pill less likely to work?
Although the effect of such common antibiotics as Amoxil (amoxicillin) on the Pill may be slight, it's better to be safe than sorry.
In general, take extra precautions if you're put on an antibiotic. If a doctor wants to prescribe something for you, always tell your doctor that you're on the Pill. Also, avoid the popular herbal remedy St John's wort while you are taking the Pill.
Please read the full list of possible drug interactions on your package leaflet.
What if I miss a Pill?
If you miss only one Pill, you'll probably be OK; take it as soon as you remember – and then take the next one on time (even if that means you're taking the two of them at the same time).
If you want to be super-careful, you could avoid sex for the next seven days – or take extra precautions.
However, if you're more than 12 hours late in taking the Pill, avoid sex for the next seven days – or take extra precautions.
But missing more than one Pill is quite risky – particularly near the beginning or end of a packet. To avoid pregnancy, follow the advice on the pack leaflet strictly.
To be frank, the 'missed Pill advice' in these leaflets is pretty complicated – and keeps being changed! If you're in doubt:
So which Pill should I choose?
And unfortunately, a lot of doctors who don't know much about contraception do tend to pick Pills more or less at random from the 22 currently (2007) available. If you want a more informed choice, go to a doctor who has training in Family Planning.
My advice to you is to ask for:
The reason for preferring a 'second generation' Pill is that the ones which came after them in the late 1980s (the 'third generation Pills') carry a minutely increased risk of thrombosis.
Admittedly, this increase in risk is very, very tiny indeed.
I strongly advise you not to pay any attention to newspaper stories or broadcasts which suggest that any particular brand of Pill is 'wonderful' or 'better than all the rest'. These tales usually originate from the PR companies employed by the manufacturers!
It is believed that a continuous Pill will be available in late 2007 or in 2008. You take this every single day without breaks – which means that you don't have to be bothered with periods at all. It's provisionally titled 'Lybrel'.
Finally, you may be interested to know that in the UK, 6 out of 10 women are on the formulation contained in the low-dose, second generation Pills called Ovranette and Microgynon, which have been around for many years.
Useful numbers for Pill information
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.
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.
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.
Yes. These things make it less effective:
Try not to! Of course people do inevitably miss Pills; it's only human nature.
Regrettably, very few women do actually choose their own brand of Pill. The choosing is mainly done by doctors or nurses. (The main exception to this occurs when a woman asks to go 'on the same Pill as my friend' – or 'the same as my Mum!')
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