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What is
an oral contraceptive pill?
A birth control pill ('The Pill') is taken by mouth with the objective of preventing pregnancy. Currently birth controls are taken by women only.
In 1921 it was suggested that extracts from ovaries could be used as birth controls. Diosgenin was first extracted from the Mexican yam in 1941 and this continues to provide a source for the production of sex steroids including norethisterone (norethindrone in the USA) and progesterone (Progest progesterone and progestogen in PMS; progesterone replacement therapy) and Crinone (progesterone and progestogen in PMS). How popular are birth control pills?A birth control was first used in a clinical trial in 1956. The pill became available in the USA in 1960 and in the UK in 1961. By 1986, 95% of sexually active women in the UK under the age of 30 had used the combined birth control pill at some time and by 1991 almost half the women aged 20 years in the UK were taking it. A survey in 1995 found that 25% of the 13 million women in the UK aged 16-49 were currently using the combined birth control pill. The peak age group was 20-24 with 48% of all women and 70% of contraceptive users choosing this method. The use of the various methods of contraception varies from country to country. In Japan less than 2% of women use the combined birth control pill whereas in Holland 40% of sexually active women do so.
Recommended Books:
The Pill and Other Forms of Hormonal Contraception (Facts) What are the benefits of birth control pills?The combined birth control pill suppresses the natural hormone cycle providing:
The additional benefits include:
The four-weekly bleeds that occur whilst taking the combined birth control pill are not periods (menstruation) but withdrawal bleeds. Menstruation is a bleed that occurs each month spontaneously and not in women who are taking hormonal treatment such as the combined birth control pill. Will the birth pill improve my periods?The majority of patients report reduced flow and less period pain. There are occasional exceptions so that a few ladies with light periods find their menstrual flow increased by the combined
birth control pill. During early pill cycles in particular there may be some breakthrough bleeding. Some women do not have a withdrawal bleed during the combined oral contraceptive pill-free interval. If this happens for two consecutive cycles a pregnancy test should be considered. Absence of the withdrawal bleed is not detrimental to health. When the combined oral contraceptive pill is discontinued, the periods may take a few months to return to normal. Premenstrual syndrome is less common whilst taking the combined oral contraceptive pill although there may still be some symptoms for the last few days of the cycle. Related Medical Abstracts - Click on the paper title:-
Could the birth pill alter my libido?
Relieved of the stress of possible unwanted pregnancy, some women report increased initiation of sexual activity. Others find their libido reduced, perhaps as there is some sub-conscious wish to have a child. If libido is reduced, vaginal discomfort due to infection should be excluded. Otherwise a change to a less progestogenic pill may help.
Related Medical Abstracts - Click on the paper title:-
What are the risks of taking the birth pill?
Thromboembolism (blood clots): The early combined oral contraceptive pills contained 150 mg of the oestrogen mestranol together with norethynodrel which is a progestogen. The first report of thromboembolism (a blood clot forming in a vein within the leg or pelvis and then travelling to the lungs) in association with the combined oral contraceptive pill came soon after the combined oral contraceptive pills were introduced. The pharmaceutical industry has made enormous efforts to reduce the risks associated with the oral contraceptive pills whilst maintaining their contraceptive effectiveness. Essentially there have been two avenues that have been explored. Firstly, the amount of oestrogen in the combined oral contraceptive pill has been reduced and secondly newer progestogens have been developed. The oestrogen in the combined oral contraceptive pill reduces LH and FSH production and therefore suppresses follicular development and ovulation (Q 2.3). There has been concern that reducing the amount of oestrogen in the combined oral contraceptive pills could lead to contraceptive failure. Over the years it has been found that the lowest dose of oestrogen that remains effective is much lower than originally contemplated. The original 150 mg was reduced to 100mg then 50mg. The majority of pills prescribed today have less than 50mg of ethinyl oestradiol and two have just 20mg (Loestrin 20 – Parke Davis; Mercilon – Organon). At this level, the oestrogen content is only a little more than that found in hormone replacement therapy (HRT). HRT does not suppress follicular development or ovulation and it therefore follows that the 20mg oestrogen pills will be the minimum effective dose. Mortality risks are negligible. Related Medical Abstracts - Click on the paper title:-
What side-effects could I have whilst taking the birth pill?
The vast majority of patients taking the combined oral contraceptive pill feel very well but, as with any medicine that has benefits, some minor side-effects are occasionally reported. These include:
These side-effects usually settle within two or three months.
What is the effect of birth pills on body
weight?
All of us are intermittently gaining or losing weight. Inevitably some patients find that they gain weight around the time of starting the combined oral contraceptive pill but others observe a weight loss. In a personal computer search of the medical literature from 1966 to date I found exactly fifty papers (articles in medical journals) where weight change in relation to the combined oral contraceptive pill had been studied.
Related Medical Abstracts - Click on the paper title:-
Will the birth pill increase my vaginal discharge?
Cervical ectopy (erosion - cervical erosion) appears to be more common in women taking the combined oral contraceptive pill although the newer lower dose pill seem to cause this less frequently. Cervical ectopy only requires treatment if there are persistent significant symptoms after excluding other problems such as infection. Contrary to popular belief, there is no evidence that the combined oral contraceptive pill increases the incidence of candida (thrush).
Does the birth pill increase my chance of pelvic
infections?
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Figure 15.1
A study by the World Health Organisation (WHO) published in 1995 provided evidence that the newer pills with their lower oestrogen content are associated with lower incidence of thromboembolism than the earlier higher oestrogen dose pills. This study also brought attention to the relationship between the progestogen in the combined oral contraceptive pill and thromboembolism.
There have been three “generations” of progestogens used in oral contraceptives. The WHO study found that the second generation progestogen, levonorgestrel, was only half as likely to be associated with thromboembolism compared to the third generation progestogens desogestrel and gestodene. Essentially, the WHO study demonstrated that the second generation progestogens were associated with a lower incidence of thromboembolism than had been previously believed. The third generation progestogens were not found to be associated with higher risks than anticipated.
In October 1995, the Committee on Safety of Medicines issued an alert to doctors and the media recommending that women taking third generation combined oral contraceptive pills should change to second generation preparations.
- The presentation of the information was such that many women were inappropriately led to believe that the combined oral contraceptive pill was associated with high risk of mortality.
- There was a 10,000 increase in the number of pregnancy terminations in the next nine months. Some Hospitals reported a 25% increase in births in July and August of 1996.
- There are risks of mortality with pregnancy termination and with childbirth. The emotional trauma of pregnancy termination is not easilyQuantified.
Table 15.1 puts the risk of deaths from thromboembolism in perspective.
Table 15. 1 Deaths per million women.
| Risk | Deaths per million women |
| Second generation pill | approximately 2 |
| Third generation pill | approximately 3 |
| Pregnancy and childbirth | 60 |
| Road traffic accidents | 80 |
| Scuba diving | 220 |
| Smoker (aged 35) | 1670 |
A change from a third generation pill to a second generation would be expected to prevent the death of one women
in every million taking the combined oral contraceptive pill. There are risks in most aspects of life. We cannot be complacent but every effort should be made to ensure that when clinical information is presented to the public, it is presented in perspective. One death in a million is a tiny risk but for any family (and doctor) involved it is a disaster of the most enormous proportion. There has been an indication that third generation progestogens may have been safer in relation to heart disease.The latest evaluation of the third generation of the combined oral contraceptive pill has concluded that these pills can be prescribed as a first choice preparation. There are a number of factors to be taken into account when assessing risk and the tiny risks involved probably make it virtually impossible to distinguish risks between second and third generation pills. Related Medical Abstracts - Click on the paper title:-
The combined oral contraceptive pill has slight adverse effects on the lipids (“fat” chemicals) in the blood and these changes are known risk factors for heart disease. Heart attacks before the menopause are rare. Studies of patients on the early high dose preparations of the combined oral contraceptive pill found a five-fold increase in the incidence of heart attacks. Further studies demonstrated that there are usually confounding (additional) factors contributing to the attacks. In particular, smoking increases the risks. With the more modern low dose pills the risks are probably lower. The latest evidence suggests that there is no increased risk of heart attacks for oral contraceptive users.
The current recommended advice is that smokers should discontinue the combined oral contraceptive pill at the age of 35years. The best advice is that smokers should stop smoking. Related Medical Abstracts - Click on the paper title:-
What is the relationship between the combined oral contraceptive
pill and heart attacks?
What is the relationship between the birth pill and strokes?
Strokes are uncommon in young women but there is a marginal statistical increase in those who have taken the combined oral contraceptive pill. Strokes may involve haemorrhage (bleeding) within the brain or reduced blood supply (ischaemia) to part of the brain. In young women it is the bleed variety of stroke that is the more common. One study in Europe found no significant increase in the chance of the bleed variety of stroke in association with the combined oral contraceptive pill. Smoking and high blood pressure are more important risk factors and these confuse any analysis of the risks of the combined oral contraceptive pill.
Related Medical Abstracts - Click on the paper title:-
Many women find that their breasts are slightly larger when taking the combined oral contraceptive pill. Breast discomfort (mastalgia) may respond to vitamin B 6 (pyridoxine) 50 mg once or twice daily. Otherwise a change of pill should be considered. Should milk production occur (galactorrhoea) investigation of the prolactin hormone level is indicated (hyperprolactinaemia). Benign breast disease (Q 27.16) tends to improve when the combined oral contraceptive pill is taken.
Could I feel depressed as a result of taking the birth pill?
A few women describe a little depression when taking the combined oral contraceptive pill. The pill does not cause severe depression. If a change of pill does not solve the problem, pyridoxine (Vitamin B6) 50mg daily may be beneficial but it can take up to two months to be effective. Related Medical Abstracts - Click on the paper title:- Several studies have provided convincing evidence that ovarian cancer is less likely to occur in women who have taken the combined oral contraceptive pill. Your risk of ovarian cancer is reduced by about 50% if you have taken the combined oral contraceptive pill for at least five years. The protection continues for about 15 to 20 years after you stop taking the combined oral contraceptive pill. This protection appears to be independent of the brand of pill used. It is likely that the combined oral contraceptive pill needs to have been taken for a minimum of two years to achieve this protection. The incidence of ovarian cancer seems to be falling and this is likely to be related to this benefit of the combined oral contraceptive pill. Related Medical Abstracts - Click on the paper title:- Progesterone and progestogens protect against endometrial (lining of the womb) cancer. The combined oral contraceptive pill provides progestogen for 21 days each month. Studies indicate a 40% reduction in the incidence of endometrial cancer when the combined oral contraceptive pill has been taken for more than five years. Protection continues for more than fifteen years after the combined oral contraceptive pill is discontinued. Related Medical Abstracts - Click on the paper title:- Sexual activity and number of partners are the factors that have large
impacts on the incidence of pre-malignant and malignant conditions of the
cervix (neck of the womb -
Q32.16). The sheath (condom) provides mechanical protection not only against pregnancy but also against sexually transmitted disease. It prevents transmission of the human papilloma virus believed to be responsible for cervical cancer. It may be that the early studies suggesting that the combined oral contraceptive pill increased the risk were only reflecting the prevention of transmission of the virus with the barrier method. There has been a suggestion that the combined oral contraceptive pill may increase the chance of pre-malignant conditions of the cervix developing in women at risk but this remains an area of debate requiring more data. There is no reason to stop the combined oral contraceptive pill if you have been found to have an abnormal smear test provided appropriate investigations and treatment are undertaken (Pap Test). Related Medical Abstracts - Click on the paper title:-
This question is discussed in
Q32.43.
Support Groups
Members of a support group, provide each other with various types of help and information for a particular shared difficulty.
The support may take the form of providing relevant information,
A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.
Support groups maintain interpersonal contact among their members in a variety of ways.
Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists. This page was updated 30th January 2007
Evra is the first contraceptive patch. It contains 150microg norgestromin + 20 microg. Ethinyl Oestradiol. This patch is applied once-weekly for three weeks with one week with no patch applied. Evra is just as effective as the combined oral contraceptive pills. As 80% of the hormone is still present after 7days it is advised that the patch should not be flushed as there is a risk of water contamination. Symptoms associated with the combined pill such as mastalgia dysmenorrhoea and breakthrough bleeding may be more common in early cycles than with COP. This patch should be applied to the back of the shoulder, low down on the abdomen, upper arm or buttock. Once applied pressure should be applied for ten seconds. There is no need to remove it when bathing. At each change of patch a different site should be used.
When first used an Evra patch should be applied on the first day of your period and it will provide immediate protection. If you forget to change the patch after seven days in the middle of a course but you remember within 48 hours then you may change the patch and no further action is required. If there is more than a 48 hour delay then you should apply a new patch and use a barrier method for the next seven days.
The arrival of a new mode of administration in contraception should be welcomed although it will take a while before we learn how well it will be received. It provides an option for those who have had problems with a variety of oral preparations. Its success will be measured by the number of women who wish to try it on recommendation of their friends and relatives.
The pharmaceutical company has a Web site that provides further information that might interest you:-
www.orthoevra.com
In one study,
ring
users preferred the ring to the oral contraceptive (P<.001), and
patch users preferred the oral contraceptive to the patch.0801 Related Medical Abstracts - Click on the paper title:-
What is the relationship between the birth pill
and cancer of the breast?
Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.
Evaluation of the quality of Web sites is discussed in (internet information). You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:-
What is the contraceptive patch - Evra?
All combined oral contraceptive pills contain oestrogen and progestogen (Tables 16.1 & 16.2). Pills may be either fixed dose or phasic. All phasic pills have varying amounts of progestogen and the oestrogen content may also change during the course. With the exception of two pills, which have mestranol as the oestrogens, all combined pills in the UK contain ethinyl oestradiol as the oestrogen. There are a variety of progestogens that have been developed and we have three “generations” of the combined oral contraceptive pill. In 2002 a new pill called Yasmin® has been launched in the UK. This is the first combined pill to contain a new progestin called drospirenone that affects the salt and water balance in your body. It has been claimed that this new pill is even less likely to affect your weight than its predecessors.
The pill is generally taken for twenty-one days with a seven day gap between courses. Some “every day pills” are marketed with seven placebo (blank) pills. These packages are not popular in the UK as the placebo may be taken at the incorrect time occasionally resulting in pill failure but in some countries the majority of packages are of the every day variety.
Yasmin: Drospirenone 3mg with ethinylestradiol 20microg (Yasmin) is a low-dose combined oral contraceptive (COC) administered in a regimen of 24 days of active tablets followed by a short hormone-free interval (4 days; 24/4 regimen).
Drospirenone, unlike other synthetic progestogens used in COCs, is a 17alpha-spirolactone derivative and a 17alpha-spironolactone analogue with antimineralocorticoid and antiandrogenic properties.
This means that it is not associated with water retention and it counters male hormone (testosterone) effects.
Yasmin is approved in the US for:
- prevention of pregnancy in women,
- treatment of the symptoms of premenstrual dysphoric disorder (PMDD)
- treatment of moderate acne vulgaris in women who wish to use an oral contraceptive for contraception.
The same treatment regimen over three treatment cycles also significantly improved the emotional and physical symptoms associated with PMDD,0701, 0801 and improved moderate acne vulgaris over six treatment cycles in double-blind trials. It was generally well tolerated, with adverse events generally typical of those experienced with other COCs and which were most likely to occur in the first few cycles. Clinical trials indicate that drospirenone/ethinylestradiol 3mg/20microg (24/4) is a good long-term contraceptive option, and additionally offers relief of symptoms that characterise PMDD and has a favourable effect on moderate acne vulgaris.0802
