Advantages of Birth Control Pills
One of the most important advantages of oral contraceptives (birth control pills) is the simple fact that it is a spontaneous form of contraception. The others “spontaneous” methods of contraception include birth control patches, birth control rings, intrauterine devices (IUD), Depo-Provera, Implanon, and permanent sterilization. Unfortunately, while the barrier methods of contraception – condoms and diaphragms –offer excellent protection against pregnancy and many STDs they often go unused unless couples are diligent in their efforts. In addition, there are many “non-contraceptive benefits” that are listed below.
Today’s pills are about 97-98% effective. About 2-3 women out of a hundred will become pregnant each year despite proper use of the pill. Pill failures are seen disproportionately in greater numbers in very young women (ages 15 – 25). For that reason it may be worthwhile avoiding ultra-low-dose pills in this age group.
Women who take the pill often report lighter menses, associated with less cramping. The decreased bleeding helps to prevent or improve iron deficiency anemia. Many women report an improvement in overall moods, though some women clearly experience depression and agitation while taking OCPs. Women who experience painful ovarian cysts often find that these symptoms also improve on the birth control pill. Long term studies also suggest that women who take OCPs have a lower incidence of ovarian cancer later in life. Some other non-contraceptive benefits include a decrease in uterine (endometrial) cancer and a decrease in postmenopausal hip fractures. Many women report significant improvement of facial acne and even the pain associated with endometriosis. Lastly, the pill is often used to control migraine headaches and appears quite effective in selected women. Nonetheless, there are also women whose headaches worsen while taking OCPs.
The oral contraceptive as a “morning after pill”
One of the lesser known yet important effects of the birth control pill is that it can be taken in a special “off-label” use – not approved by the FDA – in order to prevent a pregnancy if taken within 72 hour of unprotected sex. If you plan on using the pill for this purpose you definitely need to discuss it with your health care provider.
Women often attribute weight gain to the pill. In fact, many studies have shown that modern birth control pills are responsible for minimal (1-2 pounds), if any, weight gain. Many women discontinue their oral contraceptives and switch to another non-hormonal method of contraception only to discover that they continue to gain weight—clearly the result of something other than the pill.
Some women experience mild-nausea in the first few weeks of taking oral contraceptives. Other women have scant or absent periods (amenorrhea) and find this troubling as it raises a concern about whether or not they’re pregnant. Still others have inter-menstrual spotting or bleeding.
Although the incidence of major pill-related side effects is small it is worthwhile mentioning that the pill can, rarely, cause blood clots in the veins of the lower extremities, pelvic veins and even the brain. Women who have known disorders that increase the likelihood of a clot should not take the pill. This includes women with:
- a history of a deep vein thrombosis or pulmonary embolus
- Protein S deficiency
- Protein C deficiency
- antithrombin deficiency
- Factor V (Leiden) mutation
- a smoking history who are over 35 years of age.
Is it okay to take a pill in such a manner that I only get 3 or 4 periods a year?
Although only two contraceptive pills—Seasonale and Seasonique have been approved for use in this manner, the same can be achieved with most contraceptive pills. Seasonale contains 91 pills—84 pink pills that contain 30 mcg of ethinyl estradiol and 0.15 mg of levonorgestrel each; the remaining 7 white pills are inert. Seasonique also contains 91 pills—84 light blue-green tablets that contain 30 mcg of ethinyl estradiol and 0.15 mg of levonorgestrel each; the remaining 7 pills contain 10 mcg of ethinyl estradiol. If you check the table below you’ll see that Seasonale is nothing more than a re-packaging of the exact same hormones in the exact quantities found in Levora, Levlite and Nordettes—all of which are available as a generic!
These pills work well. The only concern is that if you only have a period 4 times a year you could potentially be pregnant and be entirely unaware of it for an additional 2 months compared to a pill that allows you 13 menstrual periods a year.
History & Background on Birth Control Pills / Contraception
In 1960, after more than a decade of research, the US Food and Drug Administration (USFDA) approved the first birth control pill (BCP) marketed by G.D. Searle and Company– Enovid-10. That pill contained 9.85 milligrams (mg) of the progestational hormone norethynodrel and 150 micrograms (µg) of the estrogenic hormone mestranol—about 10 times the progestin and 5-6 times the estrogen contained in most of today’s pills. The “pill” of almost half a century ago was very different from today’s oral contraceptive.
The original oral contraceptives caused tremendous bloatedness, breast swelling, nausea, vomiting and was associated with a small incidence of dangerous and life threatening blood clots. The early pills required high doses of estrogen because they worked primarily by suppressing a woman’s ability to ovulate. Today’s pills, by contrast, work by a variety of means that are quite effective while allowing much lower doses.
Throughout the 1960s and 70s the dose of pills diminished dramatically—from 150 mcg to 80 mcg, to 50 mcg and then to 35 micrograms. Today, many pills contain 20 micrograms of estrogen. Scientists discovered that while the lower dose pills did not necessarily prevent ovulation they were still effective because of their ability to inhibit fallopian tube motility, cause thinning of the uterine lining and make cervical mucous impenetrable by sperm..
Many, many formulations of pills have occurred since then–among them:
- Pills that contain a fixed amount of estrogen for half the cycle and another fixed amount for the other half of the cycle (biphasic pills).
- Pills that divide the cycle into 3 parts with differing amounts of estrogen in each of the 3 parts (triphasic pills)
- Progestin only birth control pills (mini-pills)
- Ultra-low dose pills (20 micrograms of estrogen)
- Pills that offer a menstrual period only 4 times a year.