My Daughter is Going to College This Fall and Was Interested in Starting the Birth Control Pill. I H
1- WHAT ARE THE RISKS OF THE BIRTH CONTROL PILL?
Birth control pills are commonly used in women from the teenage years through perimenopause and are usually very safe and well tolerated. There is no medication that is completely without side effects, and the pill is no exception. There is a small increase risk of blood clots on the pill, but the absolute number is very small. If you are on the pill and develop any shortness of breath or chest pain (could represent a blood clot in the lungs) or if your leg is hot, red, swollen and painful (could represent a blood clot in the leg) you should call your doctor immediately.
Some women experience breast tenderness, nausea (less likely with low dose pills, and this can be ameliorated by taking the pill right before bed instead of in the morning), unscheduled or break through bleeding, especially in the first 3-4 cycles of the pill, and Melasma (dark discoloration of certain areas of facial skin due to the estrogen in the pill)
2- WHAT ROLE DOES THE PILL PLAY IN INCREASING OR DECREASING THE RISK OF CANCER?
The birth control pill decreases the chances of ever getting ovarian or uterine cancer because it prevents ovulation. The longer you are on the pill the more cancer protective benefits you will get. BRCA positive women of reproductive age who are not ready for risk reducing removal of their ovaries and fallopian tubes are at an increased risk of breast and ovarian cancer and are encouraged to take the birth control pill for risk reduction.
The pill will reduce the chance of getting ovarian cancer, and does not increase the risk for breast cancer. The pill does not significantly increase the risk of any cancers. Women who have had breast cancer, however, are not to take the pill.
3- WHAT ARE THE BENEFITS OF THE PILL?
As mentioned above, the pill significantly reduces the risk of ovarian and uterine cancer and also is an excellent contraceptive. There are many other non-contraceptive benefits of the pill such as reduction in acne, facial and body hair growth due to the pill reducing the free testosterone levels, relief of dysmenorrhea (painful periods), and reduction in menorrhagia (heavy menstrual flow)- the pill makes the periods shorter, lighter and more regular. It is very useful in correcting the hormonal imbalances caused by PCOS and reduces symptoms and sequelae of endometriosis. It is an excellent treatment and maintenance medication for endometriosis.
4-HOW EFFECTIVE IS THE PILL IN PREVENTING PREGNANCY?
With perfect use, the pill is about 99 percent effective as a contraceptive for pregnancy protection. A barrier method such as a condom should still be used to protect against sexually transmitted disease, as the pill does not provide this. Perfect use of the combination of the birth control pill and the condom is very close to 100 percent.
5- WHAT IF SHE MISSES PILLS?
If you miss one pill you should take it as soon as you realize that you missed it. If you usually take the pill at night, and realize in the morning that you forgot, you should take the missed pill right away that morning, and take your regularly scheduled pill that evening (that would be two pills in one day). If you miss two consecutive pills you should take 2 pills each day for 2 days to make up for it, and use a backup method like a condom for a week, especially if you did this in the first week of the pill pack, where there is more of a risk of an escape ovulation and a higher risk for pregnancy.
You can avoid missing pills by either putting your pill pack next to your toothbrush (unlikely you will forget to brush your teeth at night, so this is a good reminder), or even better set your phone to alarm at a certain time every evening and keep your pill pack in your pocketbook so that no matter where you are you will be able to take your pill.
6- DOES THE PILL HAVE TO BE TAKEN AT EXACTLY THE SAME TIME?
Combined estrogen and progesterone birth control pills should be taken around the same time every day to be most efficacious and to mimic “perfect use” with regards to protection against pregnancy and to decrease the chances of unscheduled break through bleeding, but there is some lee way, and if you take the pill one night at 6pm and the next night at 8pm there should be no consequence. If you are taking the progesterone only mini pill (micronor or Nor-q-D) you should take this pill at exactly the same time every night, otherwise there is a higher chance of method failure.
7- ARE SOME PILLS BETTER THAN OTHERS?
There is no magic pill, and all pills are good for cycle control- making the periods light, short and regular, and all are beneficial for acne and hair growth and ovarian and uterine cancer protection. If you give the same pill to 3 different women they may all react differently with regards to benefits and side effects, and it is not easy to predict who will react positively and who will react negatively.
Starting with low dose pills is usually beneficial to all, and seeing how you do over 3-4 cycles on the pill is the way to go. Most people will do just fine and tolerate the pill well and accrue great benefits. For those who do not and have break through bleeding or other side effects, it is important to try to stay on the same pill for 3-4 cycles unless the side effects are very bothersome, worrisome or severe. If you are having problems with the pill, always contact your doctor to discuss the symptoms to see if they fall under that concerning category where you should discontinue or switch, or if these symptoms are common and expected and you should persevere.
Be very specific about your side effects when you speak with your doctor, and this should help him or her adjust pills accordingly. For example, if after 3-4 months you continue to have breakthrough bleeding your doctor will resolve this by slightly raising the estrogen dose of the pill. This will stabilize the lining of the uterus and decrease break through bleeding. If you have nausea despite taking the pill at night your doctor may decrease the estrogen dose. If acne is your problem and it is not resolving, your doctor may change the pill to one with a different progesterone, usually one with a less androgenic progesterone (less male hormone side effects). Ask your doctor- he or she will know how to alter the pill if needed to address your specific situation.
8- WHAT IF SHE DECIDES NOT TO TAKE THE PILL- WHAT ARE THE OTHER OPTIONS?
Using the condom alone is one alternative (with the backup of the morning after pill if the condom breaks or slips off), but alone, a condom may only be 85% effective against preventing pregnancy. The diaphragm has about that same efficacy, but has to be fit by your gynecologist and you need to be taught how to insert it. Many women find there to be less spontaneity with either condoms or diaphragms, and the diaphragm has to be used with spermicidal jelly and left in for 6 hours and then removed, rinsed and put back into a case.
There may also be more UTIs with use of the diaphragm. We will talk a little bit in the next question about the IUD which is an excellent LARC (long acting reversible contraceptive method), but insertion can be uncomfortable. Another LARC is Nexplanon which is a progesterone releasing device placed on the underside of the upper arm by your gynecologist which lasts 3 years and is over 99.5% effective.
The most important take away point is that it is imperative to schedule a consult with your gynecologist to discuss all of the different methods and options open to you, and which one suits you as an individual best. One size does not fit all.
9- MY DAUGHTER’S FRIEND WAS ON THE PILL AND SHE DIDN’T GET HER PERIOD FOR A WHOLE YEAR WHILE ON THE PILL. IS THAT OK?
The period that you get on a birth control pill is an artificial one, and it is not necessary to have one for health reasons. It is extremely common for women on low dose pills to not get a period for an extended period of time. There is no health deficit associated with this. It is very different than if a woman doesn't get a period when they are not on a pill. Then we worry about pregnancy or PCOS or other hormonal imbalances. The pill is very effective against pregnancy and if you don’t get periods on the pill you don't have to worry about being pregnant if you didn't miss any pills.
Once you go off of the pill your periods should resume as they were before you went on the pill. (Meaning- if you were regular before you went on the pill you should be regular when you come off, and if you were irregular before you went on the pill you will likely resume your prior pattern when you come off). If you are someone who gets very anxious when you don’t get your period regularly, your doctor can change your pill to one with a higher estrogen dose and you will likely resume periods.
10- IF MY DAUGHTER IS ON THE PILL FOR MANY YEARS WILL THAT NEGATIVELY AFFECT HER FERTILITY IN THE FUTURE?
On the contrary, the pill is fertility protective. The pill has been studies for almost 70 years and there is no increase in fertility problems from being on the pill for years or decades. If you were fertile before the pill you should be fertile after you come off of it. There are certain conditions that can negatively affect your fertility that the pill reduces such as endometriosis.
11- I HEARD ABOUT WOMEN TAKING CONTINUOUS OR EXTENDED CYCLE PILLS- IS THAT SAFE, AND HOW DO YOU DO IT?
As we spoke about before, the period we give you on the pill is an artificial one, and is not necessary for health reasons. There are certain conditions such as severe dysmenorrhea (bad pain with periods) and endometriosis, where it is extremely beneficial for women to not get a period. In these women, we often give extended cycle pills like Seasonale where there are 84 active pills and 7 placebo pills, giving a 91 day cycle.
Some women find that they get more break through bleeding when they use the extended cycle pills and prefer to modify the pill themselves by using a regular pill and skipping the placebo week, taking 6 consecutive weeks of active pills and 4-7 days of placebo. Ask your doctor what is best for you and he or she will best be able to present the options you have based on your specific situation
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