The pill *
DESCRIPTION
The pill contains synthetic hormones similar to the natural hormones produced by the female body, i.e. estrogen and progesterone. Each pill pack contains 21 pills composed of these two hormones. There are also 28 pill packs which include 7 placebo pills which do not contain any hormones.
HOW THE PILL WORKS
The pill's main activity is to prevent ovulation. It also works at the level of the uterus by making the cervical mucus less penetrable by sperm and by modifying the uterine lining(endometrium) which becomes incapable of receiving the fertilized egg.
EFFICACY
The pill is 99.5% effective. However,if the conditions of correct use are not respected, this effectiveness can diminish rapidly (e.g.forgotten pills).
COST
A pack of pills costs between $15 and $18. The various insurance programs reimburse this amount either in whole or in part. For adolescents whose parents are covered by the Quebec Medicare Insurance(Régime d'assurance médicaments du Québec),the pills are free up to the age of 18 or to the age of 25 (inclusive) if the adolescents are still students.
BEFORE TAKING THE PILL
A consultation with a health professional is essential before starting the pill. This consultation will determine whether there are any medical conditions present which would prevent taking the pill. The conditions are listed below. There are absolute contraindications which completely prevent taking the pill and there are relative contraindications which require a more extensive evaluation before prescribing the pill. The gynaecological exam may be done at a later visit if there is no particular gynaecological problem.
Absolute contraindications
- Migraines accompanied by visual problems or numbness
- History of blood clots (thrombosis or embolus), previous infarct
- Significant decrease in liver function
- Known or suspected cancer of the breast or genital organs
- Abnormal uterine bleeding of unknown cause
- Known or suspected pregnancy
- Women over 35 years of age who smoke more than 15 cigarettes per day
Relative contraindications
- Simple migraines
- Diabetes
- Arterial hypertension (high blood pressure)
- Epilepsy (depending upon medication used)
- Hyperlipidemia (elevated cholesterol levels)
- Women over 35 years of age who smoke less than 15 cigarettes per day
WHEN TO START THE PILL
It is suggested to begin taking the pill in the first 5 days of the menstrual cycle (day 1 being the first day of bleeding). Protection against pregnancy is then immediate. If the pills are begun at another time of the cycle, a back up method of contraception is then recommended for the first 7 days of the first pack of pills.
HOW TO TAKE THE PILL
You take one pill per day, ideally at the same time of day. For the 21 pill packs, you will have a one week break before beginning a new pack. For the 28 pill packs, there is no break before beginning the next pack. For practical purposes, you will begin each new pack on the same day of the week. The pill will be effective at all times(even during the week break for the 21 day pack) provided you take each pill regularly and restart each new pack on time.
FOLLOW UP VISIT
A follow up visit with your doctor may take place 3 months after starting the pill or earlier if necessary. Following that, an annual doctor's appointment is recommended. There is no advantage in stopping the pill after several years of use in order to give your body a “break”. You may take the pill as long as you require birth control and as long as there aren't any contraindications for its use.
SIDE EFFECTS
The pill's side effects are most frequent during the first 3 months of use and generally disappear after this time. Should they persist, your doctor can change the type of pill. The principal side effects are:
- Menstrual irregularity (bleeding at any time of the cycle) is most common during the first 3 months of pill use. If there were no forgotten pills, diarrhea, or vomiting, the pill remains as effective. Should the bleeding persist, continue taking your pills and contact your doctor.
- Nausea can be decreased by taking the pill at night or while eating. Should these suggestions not be helpful, consult your doctor who could change the type of pill.
- Breast swelling and tenderness: usually a short-lived side effect. Wear a supportive brassiere and decrease use of tobacco, salt, chocolate, coffee, tea and alcohol. If the problem persists, contact your doctor.
- Body weight usually remains unchanged. Balanced nutrition and regular exercise are always recommended, whether you take the pill or not.
ADVANTAGES OF THE PILL
The pill is a very effective and reversible method of contraception.
- It regulates the cycle
- It increases bone density (bone strength)
- The pill decreases the frequency of:
- Acne
- Menstrual pain
- Anemia (by decreasing the menstrual flow)
- Symptoms preceding menstruation (premenstrual syndrome)
- Ovarian cancer
- Endometrial cancer (lining of the uterus)
- Colorectal cancer
- Benign breast tumours
- Ovarian cysts
- Salpingitis (infection of Fallopian tubes)
- Ectopic pregnancies (tubal pregnancies)
- Symptoms of endometriosis
FORGOTTEN PILLS
- N.B. If you have questions concerning forgotten pills, you may contact us or call Info Santé (811)
- One pill forgotten by less than 24 hours (no matter which week):
Take the forgotten pill as soon as possible and take the next one at the usual time. This may mean taking 2 pills on the same day. There is no risk of pregnancy. - One pill forgotten by more than 24 hours or more than one forgotten pill during the first week:
Take one pill as soon as you realize the oversight, discard the forgotten pill(s) and take one pill per day until the end of the pack. Use a back up method of contraception (e.g. condoms) if you have sexual relations in the 7 days following the forgotten pills. Emergency contraception (morning after pill) is indicated if you had sexual relations in the preceding 5 days. - One or two consecutive forgotten pills during the second or third week of the pack:
Take one pill as soon as possible, discard the forgotten pills and continue taking one pill per day until the end of the active pills. Do NOT take the placebo pills. Start a new pack of pills. You will not menstruate that month. - Three consecutive forgotten pills or more during the second or third week of the pack:
Take one pill as soon as possible, discard the forgotten pills and continue taking one pill per day until the end of the active pills. Do NOT take the placebo pills. Start a new pack of pills. Use back up contraception (e.g. condoms) if you have sexual relations in the 7 days following the forgotten pills. Emergency contraception (morning after pill) is indicated if you had sexual relations in the preceding 5 days. You will not menstruate that month.
COMPLICATIONS
Complications are very rare but require immediate consultation with a doctor. They occur primarily in women with health problems or in women who smoke. Prompt evaluation by a doctor is essential. These complications include:
- Severe chest pain with difficulty breathing
- Severe headaches
- Significant visual problems (decrease or sudden loss of vision)
- Significant leg or calf pain and/or swelling of the leg
- Numbness and/or weakness of one side of the body
PARTICULAR SITUATIONS
- The Pill and antibiotics: Antibiotics may cause diarrhea and vomiting. These side effects may decrease the pill’s effectiveness. As a precaution, if you must take antibiotics, use a back up contraceptive method (e.g. condoms) during the period of treatment. It is important to continue taking your pill as usual.
- Vomiting: In case of vomiting within two hours of taking the pill, take the next day’s pill and continue your pack taking one pill per day. At the end of your pack you will be one active pill short. You must then contact a Family Planning Clinic, a CLSC, a doctor, or a pharmacist, for advice on what steps to take.
- Diarrhea: May decrease the pill’s effectiveness. One day with diarrhea is equivalent to one forgotten pill, two days of diarrhea is equivalent to 2 forgotten pills etc. (See recommendations for forgotten pills.)
- The pill and pregnancy: Pregnancy becomes possible as soon as the pill is discontinued. There may be a delay of several months before the menstrual cycle returns to normal. The woman’s future fertility remains the same, no matter the number of years of oral contraceptive pill use. The pill will not result in malformation of the baby if the mother took the pill in early pregnancy. The pill may be restarted three weeks after giving birth. For breast-feeding mothers, the pill is not recommended, however, your doctor can propose other birth control options including the mini-pill.
- The pill and peri-menopause: Women in good health and who are non-smokers may use the pill until menopause.
- The pill and surgery: If you expect to have surgery which will require immobilisation (bed-rest), inform your surgeon that you are taking the pill.
- The pill, STIs (STDs) and HIV (AIDS): The pill does not protect against sexually transmitted infections and, moreover, its use is associated with decreased condom use. Your sexual health is important and condom use remains essential if you are at risk of STIs.
- The pill and cigarettes: Tobacco use increases the risk of cardiac diseases in women taking the pill. This risk increases with age and the pill can not be prescribed for women over 35 years of age who smoke more than 15 cigarettes per day. Why not consider quitting smoking right away?