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Birth Control Pills

Congratulations! You have chosen one of the most effective reversible birth control methods available today. But, as it is a medication, there is the potential for side effects. The purpose of this handout is to provide information about the pills, minimize the side effects and maximize the effectiveness of the pills.

In addition to contraception, birth control pills (BCPs) also have many other health benefits. This includes regulating periods, decreasing the amount of bleeding with periods and therefore, decreasing anemia, and decreasing the cramping associated with periods. BCPs also decrease the occurrence of ovarian cysts and decrease the incidence of ectopic (tubal) pregnancies. BCPs also decrease fibrocystic breast changes and fibroadenomas (non-cancerous tumors in the breast). BCPs decrease the occurrence of Pelvic Inflammatory Disease (PID) but not sexually transmitted diseases. BCPs also protect against cancer of the uterus and ovary and prevent endometriosis and the development of fibroids.

First, there are two types of pills - Combination (estrogen & progestin) and Progestin-only pills. Most pills are combination. The progestin-only pills are typically reserved for those women that cannot tolerate estrogen- containing pills or those that shouldn’t be taking estrogen. There tends to be more irregular bleeding with this type of pill and it is less effective because it MUST BE TAKEN AT EXACTLY THE SAME TIME EVERY DAY (which is very difficult for most women).

With combination pills, there are two ways to start taking the pill - either the first day of bleeding or the Sunday after you start your period. There is no difference in effectiveness between the two types. You will be told whether you are taking a first day or a Sunday-after pill. If it is a Sunday-after pill, you take the pill the Sunday after you start your period. If you start bleeding in a Sunday, you take the pill THAT SAME DAY.

When you are taking the pill, please take the pill about the same time every day - morning, noon or night - but ABOUT THE SAME TIME every day. Taking the pill irregularly can lead to pregnancy and/or irregular bleeding. If the pill seems to bother your stomach (e.g. nausea), then try taking it before you go to bed or after a meal.

Any birth control pill you start can give you irregular bleeding for the first several months. This can be anything from occasional spotting to a heavy flow. Please keep taking the pill. Most irregular bleeding will straighten out by the third month. If you continue to bleed irregularly, please call the office (and have a pharmacy number available). We will be happy to phone in a different type of pill for you if the irregular bleeding persists after the first 3 months.

You may occasionally develop irregular bleeding on the pill after months or years. Again, continue taking the pill regularly and it usually corrects itself. Again, make sure you are taking the pill the same time. Some women are very sensitive to even a few hours difference.

Please remember - the pill DOES NOT PROVIDE EFFECTIVE CONTRACEPTION FOR THE FIRST MONTH. Please make sure you are using a back-up method (like condoms) for the ENTIRE first month.

In addition, the pill does not protect against sexually transmitted diseases or HIV infection. If you are with a new partner or think that your partner has had sex with someone else, insist he wear a condom. Once you have established a committed relationship and you and your partner have been tested for sexually transmitted diseases, then use the pill as your only method of contraception.

Once you have been on the pill for a while, you will find that your periods generally get much lighter in flow, shorter in duration and darker in color (sometimes almost black). THIS IS NORMAL. In many instances, you may only have a little spotting or no flow at all, even though you may still experience bloating and cramping . If you have not missed any pills, don’t worry. THIS IS NORMAL. The pills have thinned the lining of the uterus, making your periods very light or absent. Later periods may occasionally be heavier. DON’T WORRY.

Another frequently asked question is what to do if you have missed a pill (or two or three). If you miss just one pill, take it as soon as you remember. If it’s the following day (and time to take your next pill), you can take both at once (but that could make your stomach upset) or take one and the second one a few hours later.

If you miss two pills in a row, take one or two together, then the other one or two several hours later but please use another method of contraception for the rest of the pack of pills. The ability of the pill to prevent pregnancy is lost when more than one pill is forgotten. SO, make sure he wears a condom!

Women often worry about headaches and BCPs. It is very uncommon for pills to cause headaches. Menstrual headaches (those you get with your period) can be due to hormone withdrawal (remember, the last week of pills are sugar and are only there to remind you to keep taking them). Usually, ibuprofen or tylenol relieves the headaches. If you have been on the pills for several months and develop headaches, look for other causes (such as stress, the need for eye glasses, etc.). Headaches associated with BCPs occur within a few days of starting the pill, persist for the three weeks of hormonal pills and stop during the last week. If this is occurring, you may need to stop taking the pill or switch to the progestin-only pill.

Finally, please do not call the office the day your pills run out and expect us to call in a prescription. Please check the number of refills left EVERY TIME you get a new pack of pills. When you have two refills left, call the office for an appointment (if it’s time for your 6 month check up or annual exam). If you are just trying out the pills for a few months, call several weeks before the last day of the pill. Please have your pharmacy number and the type of pills you are on easily available and we will be happy to call in a prescription for you. If you need an appointment but can’t get one in time, we will call in a one or two month prescription of pills (enough to last until your appointment).

We hope this handout helps answer some of your questions and alleviates any concerns you may have.  If you have any more questions, please call us.

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