Pill 08

What is a pill?

The Combined Oral Contraceptive Pill (COCP) is also known as the birth-control pill, or simply "the Pill". It consists of a combination of two female hormones: estrogen (oestrogen) and progestin (progestogen). These hormones will stop (if used correctly, this goes without saying!) the female user from ovulating (producing an egg each month)and since no egg will be produced, fertilization by the contact of sperm will not happen, and there will be no risk of pregnancy.

Do different sorts of pill exist?

Yes! Three different sorts of pills exist: the Combination Pill, the Progestin-only Pill (POP) and the Emergency Contraceptive Pill (ECP).

Let's begin with the combination pill, which, as it's name indicates, consists of an oral contraceptive containing a combination of two female hormones: estrogen and progestin. The term Birth control pill often refers to this type of pill. The advantages and disadvantages of this type of pill will be spoken of later on.

The second type of pill is the progestin-only pill, or mini-pill. This different sort of pill contains no estrogen. This makes it milder and reduces it's side-effects, but it also makes it less effective. The progestin-only pill is ideal for women who are breastfeeding, because estrogen reduces milk production, and the mini-pill is estrogen-free. This type of pill is also the best choice for women who cannot take estrogen. It is also known that as the years go by, the safest choice for ageing women is to switch to the mini-pill. This is due to the fact that the risk factors increase (ex: thrombosis, we will speak about this situation in the advantages/disadvantages of the Pill) with age, and the regular combination pill can become riskier to take. This pill can also be taken by women smoking, because the cigarette causes a breakdown of estrogen, so it is unuseful to take a combination pill containing estrogen.But smoking is dangerous anyway!

The third type of pill is the emergency contraceptive pill. The important fact to know about this sort of pill is that it is not intended to be used as a regular contraceptive method. They are designed for emergency situations, like the prevention of pregnancy after unprotected sex.

How does the pill function?

Most birth control pills are "combination pills" containing a combination of the hormones estrogen and progesterone to prevent ovulation. When you take the Pill, the artificial hormones contained in it will trick your body into thinking it is already pregnant. Ovulation usually occurs at mid-cycle, but if you are using the Pill as a contraceptive method, nothing will happen. No egg will be released from the ovaries, so no fertilization will be able to occur. No fertilization means no risk of pregnancy. When a woman takes the Pill, her menstrual cycle will not function as it would naturally. The natural menstrual cycle will stop but hormone withdrawl bleeds will still take place. This means that during the week when the woman takes a break from the Pill, the input of artificial hormones will stop, and this resulting in the shedding of the uterine's lining. A shorter and lighter period will then take place. The pill also works by thickening the mucus around the cervix, which makes it difficult for sperm to enter the uterus and reach any eggs that may have been released. The hormones in the Pill can also sometimes affect the lining of the uterus, making it thinner and beacuse of this, it is more difficult for an egg to attach to the wall of the uterus.

When and how do you have to take it?

When you ask for the Pill, you are given pack of 21 or 22 Pills, and one of them must be taken every day for three weeks. At the end of those three weeks, you take a one-week break and stop taking it. It is during those seven days that your period will happen. This is due to the fact that you have stopped taken the Pill. After those seven days, you can start the whole process again with a different pack.

Some packs of pills exist with 28 pills, 21 regular pills containing the two female hormones, and 7 placebo pills. These placebo pills, sometimes containing iron, are useful if you are afraid of forgetting to start taking the Pill again, after the seven-day break. They permit the woman to take a pill everyday, reducing the chances of forgetting pills and skipping days, which is the main reason why the Pill is sometimes not completly effective.

Where can you get it and how much does it cost?

You can find all types of Pills in a pharmacy if you have a doctor's agreement. Seeing a doctor before going on the Pill is safer because he will prescribe you the pill that is the most appropriate to your body/recations. You will also be warned of the different risks etc. The pills are reimbursed by the insurence. If you need to take an emergency pill, you have to be 16 years old, or be accompagnied your parents. You can get a pill without your parents knowing if you go to the familial planning. It costs between 15 and 26 francs.

Advantages?

The Pill is known to have the following health advantages:

- It reduces considerably (even abolishes) period pains.

- It makes periods shorter and lighter.

- These two advantages result in smaller chance of becoming anaemic.

- The Pill also improves acne.

- The pill also permits women to avoid having their periods at inconvinient times. (this is due to the fact that with the Pill, they can plan when they will have their period.)

Disadvantages?

Along with the advantages, several disadvantages, or side-effects also accompagny the use of the Pill as a contraceptive method. The side-effects that are stated below usually occur during the first few packs of pills, and then disappear. If not, an easy solution to get rid of these side effects is to switch to another brand of pills.

- headaches

- nausea

- breast tenderness

- slight weight gain

- light spotting of blood between the periods.

Serious side effects are more rare, but they can occasionally happen, and knowing about them is already a way of preventing them...here is a list of the more serious side-effects:

- Deep Vein Thrombosis (DVT) or clotting. This is a rare condition, and when it occurs, it is usually within more mature women. This is due to the fact that the risk factors that can lead to this problem increase with age.

- heart attacks

- strokes

The good news is that these events are very rare. But a woman is more likely to have one of these problems if she has some of the following risk factors:

- being a smoker

- having a past family history of thrombosis, heart attacks, or similar illnesses

- being diabetic

- having high blood pressure

- having a high cholesterol level

Who should or shouldn't use it?

The pill is for the women who want an excellent protection from pregnancy or who experience painful vaginal bleeding . Unfortunately, not every women can — or should — use the Pill. In some cases, medical or other conditions make the use of the Pill less effective or more risky. For example, it is not recommended for women who have certain types of cancers, or certain types of migraine headaches. This is why it is important to have a medical check-up before starting to use the Pill. This way you can be prescribed to the Pill that suits you the best. (ex: a smoker may not be prescribed to the same pill as a non-smoker or a woman with diabetes etc..)

Does age influence the means of contraception?

It has been shown that women use different means of contraception according to their age. Women aged under 30 years are more likely to use the Pill or use the male condom as a method of contraception. The percent of women using the Pill in their late teens (18-19 years old) goes up to 55%. 38% of women in the same age rely on the use of the male condom. Statistics also show that only one third of women use the contraceptive pill in their early thirties (30-34 years old). And a mere one fifth of the women use the male condom. It has been shown that sterilisation becomes a popular means of contraception in women aged 30 and more.

The Pill and STD's

The pill only prevents women from pregnancy, but it doesn't have any effect against Sexually Transmitted Diseases! This is why this method of contraception is best used for women who are in a monogamous relationship. And for the women who are into polygamous relationships, it is important to consider a second method of contraception in addition to the Pill. (ex: the male condom, which is very effective against STD's)

See STDs_08

Pill ethics

A growing number of doctors and pharmacists are considering pills as a new form of abortion, "It's called a chemical abortion" says Dr Cynthia Jones-Nosacek. As the pill is not 100% efficient, then there still exists possibilities to release eggs,and if an egg is fertilized, it couldn`t be implanted or survive. Even this isn`t defined as a real pregnancy in medecine, but those who are strictly against abortion take it very seriously and protest against use of pills.

link with Contraception_Ethics_08

Contraceptive patches

Using a contraceptive Pill as a contraceptive method is very similar to using a contraceptive patch. Let us say a few words on contraceptive patches and make a quick comparaison between the two means of contraception.

what is a contraceptive patch?

As the name indicates it, it is a contraceptive method in the form of a patch, that is stuck on to the female user's skin.

How does it work?

The patch, once stuck correctly on the woman's skin, will start releasing a daily dose of hormones through the skin, into the bloodstream. (this is why we say it is called a transdermal method of contraception.)Then, it works the same way as the contraceptive combined Pill. It's main function is to stop the ovaries from releasing an egg each month, this process is also known as ovulation. It will also, like the Pill, thicken the mucus from the cervix (this will make it tougher for the sperm to travel across it and reach an egg)and make the lining from the uterus thinner so it is less propice to accept a fertilized egg.

Advantages

- unlike the Pill, you do not have to remember to take it every day. You must just remember to replace the patch once a week. - It is easy to use and doesn't interupt sexual intercourse. - Since the Pill is absorbed by stomach, it can be a problem if it is rejected. This can not occur with the contraceptive patch, since the hormones reach the bloodstream by the skin. - Same as with the contraceptive pill, it makes, in most cases, your periods lighter, more regular and less painful. It also helps with PMS (prementrual syndrome)

Disadvantages

- It can be seen. - It can cause skin irritations in some women. - It may cause an increase in blood pressure. - Then a few temporaryside effects can appear when you first start using the contraceptive patch. THey include headaches, nausea, breast tenderness, and mood changes. - Breakthrough bleeding and spotting. - An important disadvantage, is that as the Pil, it does not protect against STD's! (so user's of the contraceptive patch can consider using a male condom as well.)

How do I use the contraceptive patch?

The idea is to apply a new patch once a week, during three weeks(21 days). Then there is a 7 day break where you do not apply the patch ( patch-free week). The patch cycle starts again after the seven day break.

It is very important to keep the patch stuck on, and to remember to replace it immediatly on change day, which is the the day you change your patch after seven day's use. If it falls off, or if you forget to change it, you can follow the detailed advice found in the contraceptive patch reference link. Detailed information is given for the different cases, ex: you had it off during 48 hours, or more etc.

Is the Contraceptive Patch effective?

The patch is as effcetive as the contraceptive Pill if used correctly and accordingly to instructions. This means for example not forgetting to re-apply a patch on change day and to keep it stuck on during the week. But the effectivness of the patch also depends on the user's personnal reaction to it. This is why it is again, like with the Pill, useful and safer to have a doctor prescribe it.

References

If you want more information on the Contraceptive Pill:
http://www.thewomens.org.au/ThePill
http://www.netdoctor.co.uk/sex_relationships/facts/contraceptivepills.htm
http://www.healthywomen.org/healthtopics/birthcontrolpills
http://www.birth-control-comparison.info/thepill.htm
http://www.patient.co.uk/showdoc/23068708/ - 47k

And for further information on Contraceptive Patches:
http://www.fpa.org.uk/information/leaflets/documents_and_pdfs/detail.cfm?contentid=137
http://kidshealth.org/teen/sexual_health/contraception/contraception_patch.html

Information about pill ethics refers to:
http://news.bbc.co.uk/2/hi/americas/3652462.stm

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