Oral contraceptive pill is the most common type of hormonal birth control in the United States. It was introduced in the U.S. sometime in the 1960s and has been very effective in its purpose, when used properly. However, it is a reality that the “perfect” use of this method is rarely attained by women and or with their partners (Hall, White, Reame & Westhoff, 2010). In the United States, 30% of women verbalized missing one or more of these pills every month and in addition to that, an estimated more than 50% of new hormonal pill users discontinue their use before one year of starting. It was reported, also, that 9% of the usual users fail the method and this eventually lead them to an untimely, or unwanted pregnancies.
The following are the different types of contraceptive pills:
Progestin-only Pills: By the name itself, this pill only contains progestin and are also known as minipills. These pills are taken by women when estrogen is contraindicated to them because of medical and health reasons. The woman may or may not have any menstrual bleedings while taking this pill. In addition to that, this kind of pill is ideal for women who are breastfeeding because production of breastmilk in the presence of estrogen is reduced. Women who also have migraines, cardiovascular illnesses, and thromboembolism may also benefit from this kind of pill. Symptoms when starting the pill like nausea, and headaches may not happen unlike the combination pills, however menstruation between periods may be higher than the other type of pills and there are also higher chances of getting pregnant when doses are missed.
Combination pills: This kind of pill contains both estrogen and progestin. The remaining pills in one pad are inactive and do not contain hormones. Combination pills are the following:
- Monophasic pills: These are for a month’s cycle and each pill contains the same amount of estrogen and progestin hormones. In the last week of cycle, the inactive pills are taken, and the woman will have her period.
- Multiphasic pills: In a one-month utilization of these pills, each pill has different levels of hormones. In the last week of the cycle, inactive pills are also taken and the woman will bleed. These pills are developed to decrease side effects or hormonal pills such as bleeding, spotting and absence of menstruation (amenorrhea).
- Extended-cycle pills: This is for a 13-week cycle. Active pills are taken and still the same, in the last week, inactive pills are taken and there will be bleeding. In a year’s time, a woman will only have three to four times bleeding.
Emergency contraceptive pills (ECP). This kind of pill is not intended to be used on a regular basis. This will only be taken if there is unprotected sex and should be taken within 120 hours. It contains the progestin levonorgestrel.
How do oral contraceptives work?
In the normal cycle of women, follicle stimulating hormones (FSH) and luteinizing hormones (LH) come into play to promote growth and release the mature egg cell of the woman. However, oral contraceptives prevent a certain hormone, the gonadotropin releasing hormone, to be released from the pituitary gland thus inhibiting the gland to produce FSH and LH which, again, are two hormones that are important in the maturation and releasing of egg cell. This allows the ovaries to be somewhat dormant.
Everyday intake of oral contraceptives imitates pregnancy status associated with increased estrogen and progesterone levels in the system and inhibiting ovulation from occurring. Both types of hormonal pills work this way, but they have specific differences. For the combination pills, it causes the body to increase and thickens cervical secretions thus sperm is prevented from entering the uterus. On the other hand, the progestin only pills also thickens the mucus, but at the same time thins the inner part of the uterus (endometrium) thus making it difficult for the fertilized egg to be implanted.
Those side effects may be bothering at some point!
Because of how it works and play with a woman’s hormones (just like any other medications) and ovulation cycles, oral contraceptives bring along its list of uncomfortable side effects, and understandably these are side effects brought about by hormonal levels. In a study done by (Ehsanpour, Mohammadifar, Shahidi, & Nekouyi, 2010), in their comparative study on the attitude of users towards contraceptive methods, they found out that although many users believed that the use of low-dose (LD) pills was an effective contraceptive method, frequency of attitude scores was lower compared to the other methods. It can be considered that the hesitation among women to use the pill was brought about by the side effects of the pills. Here are the common side effects of taking oral contraceptives.
- Increase in weight
- Breasts tenderness
- Irregular menstrual cycles
- Changes in the mood
- Disinterest in sexual desires
Other physical effects of oral contraceptives, and are considered serious, are increased incidence of clot or thrombus formation in the vein (thromboembolism), myocardial infarction, and ischemic stroke. In addition to that, although it might not suggest direct link, but there are associations related to oral contraceptives use and the development of migraines, increased blood pressure, cervical cancer, breast cancer and abnormalities of the fetus.
Psycho-emotional effects of oral contraceptives are not excluded in the list of side effects. In several researches, it was found out that women who were using the birth control method presented more symptoms of borderline personality disorder, a kind of mood disorder that affects emotion, control, self -perception and relationships with other people. Higher rates of depression were also expressed by women who take oral contraception. Social behavior is also said to be affected when using the hormonal pill. In experimental studies done on macaques and cynomolgus monkeys, it was observed that these primates develop either aggression towards other monkeys or complex interactions with social hierarchies thus suggesting that hormonal pills do have effects on social interaction.
How do I manage the side effects?
Uncomfortable side effects of these pills can be managed and controlled within 3 to 5 months of continued use. Among different oral contraceptive use, there are no reported evidence of changes with regards to sore breast, changes in mood, and nausea. Bleeding in the first month is expected, but if there is persistent and increasing bleeding then medical attention is needed. If acne develops when using hormonal pills that are mainly progestin in content, the woman is usually advised to change to a combined method if possible. Most of the time side effects are alleviated by switching methods per doctor’s advice.
However, even with the mentioned risks and side effects brought about by these pills, it is still acceptable that oral contraceptives are safe for effectively preventing untimely and unwanted pregnancies. It only needs visit to the doctor so that a woman can properly choose the right pill for her.
Author: Sarah Catina RN
Ehasapour, S., Mohammadifard, M., Shahidi, S. & Nekouyi, N. (2010). A comparative study on attitude of
contraceptive methods users towards common contraceptive methods. Iran J Nurs Midwifery Res. 15(Suppl1): 363-370 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208930/
Hall, K., White, K., Reame, N. & Westhoff, C. (2010). Studying the use of oral contraception: A review of
measurement approaches. J Womens Health. 19(12):2203-2210 DOI: 10.1089/jwh.2010.1963
Welling, L. (2013). Psychobehavioral effects of hormonal contraceptive use. Sage Publishing. 11(3)