Contraception

THE PILL (ORAL CONTRACEPTIVE)

Description

The pill contains synthetic hormones similar to those naturally produced by a woman’s ovaries, estrogen and progestin. Each pack contains 21 pills, which are made of two hormones. There are also packs of 28 pills, from which the last seven are "reminder pills" (placebos) that do not contain hormones.

Mechanism of action

Essentially, the pill inhibits ovulation. It also acts on the uterine cervix, making cervical mucus (or phlegm) less permeable to spermatozoids and it modifies the inner lining of the uterus (endometrium), preventing a fertilized egg to attach itself.

Effectiveness

Its effectiveness is rated at 99.5%. However, when it is not used as directed, this rate can decrease quite rapidly.

Cost

A pack of pills can cost between $15 and $17. Various insurance schemes refund part or the total price. For teenagers whose parents are covered by the Quebec Prescription Drug Insurance Plan, pills are free of charge until the age of 18 or until the age of 25 (included) if they still attend school.

Before taking the pill

Before starting the pill, you will need to schedule a medical appointment. This visit will allow for the identification of medical conditions that may prohibit you from using the pill. These conditions are listed below. Absolute contraindications mean that the pill is totally out of the question, whereas relative contraindications refer to conditions that require further evaluation before the pill is prescribed. At that time, a genealogical examination may be done; it can also be conducted on a subsequent visit.

Absolute contraindications

• History of blood clot (thrombosis or embolism), infarctus
• Severe liver dysfunction

• Known or suspected breast or genitalia cancer

• Unexplained abnormal bleeding of the uterus

• Known or suspected pregnancy

• Smoker aged 35 or over

Relative contraindications

• Migraine, with sight disorder or numbness
• Diabetes
• Arterial hypertension (high blood pressure)
• Epilepsy (depending on medication taken)
• Hyperlipidemia (high cholesterol)

When to start taking the pill

Some doctors recommend starting the first pack on the first day of periods. Protection against pregnancy is then immediate if the pill is used properly. On the other hand, some doctors suggest beginning on the first Sunday following the day on which the periods started. An additional birth control method is then suggested for the first seven days of the first pack of pills. Starting on a Sunday prevents menstruation over the weekend.

How to start taking the pill

You take one pill per day, ideally at the same time every day. For packs of 21 pills, you will have a pause of one week before starting a new pack. For boxes of 28 pills, there is not stoppage time. To be practical, you will always start a new pack on the same day of the week. The pill will remain effective at all times (even during the "pause" week for packs of 21 pills) provided you take all the pills regularly and start a new pack on time.

Monitoring appointment

Usually, a monitoring appointment is made with your doctor three months after starting the pill or earlier when needed. After this visit, a yearly appointment is recommended. There is no benefit in stopping the pill after a few years to provide "a break" for your body. You can rely on the pill for as long as you wish if you need contraceptive protection and if there is not contraindication to its use.

Side effects

Side effects are more frequent during the first three months of use and generally disappear after that. If side effects persist, your doctor can change the pill’s brand. Main side effects are:

• Irregular periods (frequent bleeding at any moment of your cycle) mostly occur during the first three months. If no pill was forgotten or there was no vomiting or taking of antibiotics, the pill remains effective. If bleeding persists, keep taking the pill and contact your doctor;
   
• Nausea that can be reduced by taking the pill at night or with food. If that does not seem to be efficient, consult with your doctor before stopping the pill; he may choose to change the brand;
   
• Pain or swelling of the breasts: these symptoms are often temporary. Wear a brassiere providing adequate support and reduce the use of tobacco, salt, coffee and alcohol. If the problem persists, talk to your doctor;
   
• Weight usually remains unchanged. A balanced diet and exercises are always recommended, whether or not you are taking the pill.

Benefits of the pill

It is an effective and reversible contraceptive method.

It regularizes the cycle.

It protects against arteriosclerosis (hardening of the arteries).

It increases bone density (bone resistance).

It reduces the risk of, or incidence of:

• acne
• menstrual pain
• anaemia (by reducing menstrual flow)
• symptoms preceding periods (premenstrual syndrome)
• ovarian cancer
• endometrial cancer (inner lining of the uterus)
• benign breast tumours
• ovarian cysts
• salpingitis (infection of the fallopian tubes)
• ectopic pregnancy (pregnancy in the fallopian tubes)
• symptoms of endometriosis

Forgetting the pill

Forgetting one pill: If you miss one pill, you should take it as soon as you remember (this may mean taking two pills in one day or two at a time). Use a back-up birth control method if you have sexual intercourse within seven days of forgetting the pill. 

Forgetting two pills in a row: If this happens during the first two weeks of the pack, take two pills on the day you remember and two pills the next day. After that, take one pill per day until you finish the pack. Use a back-up birth control method if you have sexual intercourse within seven days of forgetting the pills.

If you forget during the third week of the pack, keep on taking one pill until the following Sunday (or until the weekday when you usually begin your pack). At that time, throw out the remainder of the pack and immediately start a new one. Use a back-up birth control method if you have sexual intercourse within seven days of missing the pill. You may not have a period on that particular month. If you do not have periods for two months in a row, contact your doctor.

Forgetting three pills or more in a row: Wherever you are in your cycle, follow the same recommendations as suggested above after forgetting two pills in a row during the third week.

NOTE
If you had unprotected sexual intercourse at the time when you forgot two or more pills in a row, or within three days preceding the day where you forgot, you should use an emergency contraceptive pill (or emergency intrauterine (IUD) contraceptive) to reduce the risk of pregnancy.

Complications

Although these are quite rare, they require an immediate appointment with your doctor. Complications mainly occur in women who smoke or those who have health problems.

These complications are:

• severe thoracic pain and difficulty breathing
• severe headaches
• severe vision disorder (decrease or sudden loss of sight)
• significant pain to thigh or calf and/or swelling of leg
• continued numbness and/or weakness on one side of the body

You must promptly consult with your doctor.

Special circumstances

Pill and antibiotics: Some medications can reduce the effectiveness of the pill. Among others, if you must take antibiotics, rely on another type of contraceptive method (e.g. condoms) during the treatment time and for seven days following the use of antibiotics. It is important that you continue taking the pill as usual.

Vomiting: If vomiting occurs less than two hours after taking a pill, take the pill scheduled for the next day and continue your pack, taking one pill per day. At the end of your pack, one active pill will be missing. You will have to contact a family planning clinic, a social services agency (CLSC) a doctor or a pharmacist to get the missing pill.

Pill and pregnancy: Pregnancy is possible as soon as you stop taking the pill. However, a delay of a few months may occur before periods become regular and ovulation comes about. A woman’s future fertility is unaffected, regardless of the number of years during which she has taken the pill. The pill does not result in malformation for a baby whose mother has taken the pill at the beginning of her pregnancy. The pill can be restarted two weeks after giving birth. The pill is not recommended for a mother who is breastfeeding, but your doctor may suggest other methods such as the minipill.

Pill and pre-menopause: Healthy women who do not smoke can use the pill until menopause.

Pill and surgery: If you have to undergo surgery requiring immobilisation, inform your surgeon.

Pill and tobacco: Tobacco increases the risk of heart disease for women who take the pill. Risks increase with age and the pill cannot be prescribed to a smoking woman who is 35 or over. Why not take this opportunity to quit smoking right now?

Pill, STDs and HIV (AIDS): The pill provides no protection against sexually transmitted diseases (STDs).  Furthermore, its use results in many people dismissing the use of condoms. Your sexual health is important and the use of condoms is still recommended if you are at risk of contracting STDs.

The above is translated from an excellent text produced by the family planning team at the Centre hospitalier régional de Rimouski.
http://www.planningchrr.com/