The new Century have us all in a rush. Women, more starringly involved every day on social life, politics, family management or several duties, have still to undergo natural issues inherent to our gender such as maternity, our care at childbearing ages and menstrual period.
Some of us have a really hard time during premenstrual and periodical lost stages. Headache, mood changes, heavy bleeding, cramps, sickness and vomiting are some of those things.
Oral Contraceptive Pills are one of the many choices we have for contraception and even if there are different types in the market, the most popular are Combined Oral Contraceptive pills (COC).
What is the combined pill and how does it work?
The combined pill is usually just called “the pill”. It contains two female hormones, oestrogen and progestogen. There are many different types and brands.
- It stops the ovaries from producing an egg (ovulation) every month.
- It decreases the movement of the Fallopian Tubes altering the movement of sperm.
- It thickens the mucus in your cervix, which will stop sperm reaching your egg.
- It thins the lining of the womb so the egg can not be implanted.
Who should not take these pills?
There must always be a medical examination and check up before you start taking these contraceptive because some women can not have them, for example:
Women above 35 years old who smoke or who stopped smoking less than a year ago.
Taking certain medicines: The antibiotics rifampicin and rifabutin (others are ok). Epilepsy drugs (carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate). St John’s wort (a herbal remedy). Antiretroviral therapy for HIV…
Whoever had thrombosis (a blood clot) or have a close relative who had a blood clot when they were younger than 45
Being immobile for a long time – for example, in a wheelchair or with a leg in plaster.
Heart abnormality or heart disease, including High Blood P)ressure.
Severe migraines, especially with aura (warning symptoms).
Disease of the gallbladder or liver.
Diabetes with complications or Diabetes for the past 20 years.
Even after you were advised to use these pills, you should see a doctor straightaway if you have any of the following:
- Severe chest pains, breathlessness or coughing up blood.
- Painful swelling in the leg.
- Severe migraine.
- Sudden weakness or numbness in an arm or leg.
- Sudden problems with speech or eyesight.
- Jaundice ( marked yellowing of skin or eyes).
- Fainting attack.
How to take the pills?
Conceptually the pills were made for an standard use of 21 days and then stop 7 days for bleeding. That bleeding is no more than a result of the withdrawal of the pills, not a natural menstruation, and for some people it works as a reassurance for women that they are not pregnant, but it has no real use or need. At the matter of fact, history link this way of taking the pill with pleasing the ruling Pope.
Proven safe tendencies, even though still controversial after more than 4 years, have given women that can take these tablets their freedom from the monthly bleeding slavery, which is way more up to our times!
These are the tailored plans:
1. Shortening the breaks: take pills for 21 days then stop for 4 days only instead of 7 days (you might bleed or not) and back to take the pills.
2. Extended use (Tricycling): you take the pills for 9 weeks (three packages of 21) then you stop 4 days, then back to the intake. You may have a withdrawal bleed which will probably start at the end of your pill free break and may last for the first few days of the new pack.
3. Flexible extended: run packs of pills without stopping to avoid the monthly bleedings and related symptoms untill there is a breakthrough bleeding; then you stop for 4 days and back to tablets intake.
4. Continuous, no hormones free days, no stop.
Doctors still prefer the schemes where you rest for 4 days after 9 weeks, but is a personal choice.
How to start it?
You can start the pill anytime in your menstrual cycle if you are sure you are not pregnant.
If you start on the first day of your period you are protected from pregnancy straightaway.
If you start your pill at any other time you will need to use condoms for the first 7 days.
You can start taking the pill 21 days after you gave birth and will be protected from pregnancy straightaway. If you are breastfeeding a baby it may be better to use another method of contraception as the
combined pill may reduce the flow of milk.
You can start the pill immediately after a miscarriage or abortion up to 5 days. If you start the pill more than five days after the miscarriage or abortion, you’ll need to use additional contraception like condoms until you have taken the pill for seven days.
Answers to common questions.
You are protected from pregnancy during the 4 days that you do not take the pill as long as you start taking it again on the 5th day.
It is common to get breakthrough bleeding in the first few packs of pills but the incidence of this decreases over time and most patients will obtain amenorrhea after 1 year of treatment. If this continues it may be better for you to have a break after every 2 packs rather than take 3 packs in a row. Talk to your clinic doctor or nurse if this continues as you may also need screening for sexually transmitted infections and re-examination for suitability and risk factors.
If you miss any pill by more than 12 hours, continue taking the pill as usual and use condoms for the next 7 days.
If you miss more than 2 pills and you have had unprotected sex in the last 7 days then you may need emergency contraception, please seek advice.
If you vomit within 2 hours of taking a pill it will not be absorbed and you should take another one.
If you have severe sickness and diarrhoea
and cannot take your pill then start taking the pill again when you feel well enough but you will need to use condoms for the next 7 days.
Pills don’t make you increase weight as long as you have a healthy diet and are fairly active.
• It usually makes periods lighter, shorter and less painful.
• It may improve acne in some women.
• It reduces the risk of cancer of the ovary, uterus and colon.
• It may reduce menopausal symptoms.
• It may help with premenstrual symptoms, pelvic pain, dysmenorrhea, menstrual migraine, menorrhagia.
• It may reduce the risk of fibroids, endometriosis, ovarian cysts and non-cancerous breast disease.
• It doesn’t interfere with sex.
All contraceptives may fail in a minimal percentage. The effectiveness of the pill depends on the woman taking it. At best it is over 99% effective (when no pills are missed). However failure rates can be much higher (9-15%) if women do not remember to take their pill properly.
Not knowing if not having a bleeding is a result of the hormones intake or of a failure and a consequent pregnancy, brings some uncertainty sensation.
It doesn’t protect against Sexually transmitted diseases. The advice is to use condoms alongside the pill.
Routine medical care for women taking th oral contraceptive pill includes annual check-ups with a doctor. During these check-ups there is a general interrogatory and examination, blood pressure and weight are normally measured and a cervical smear will be carried out, if it is due.
Enquiries will be made to see if the pill being taken is still the best contraception option, and whether changes need to be made, because of side effects, symptoms or new onset of risk factors or simply because of increasing age.
A matter of choices.
This is related to Combined pills. Progesterone-only ( one hormone only) pills were always taken without interruption so there is no change about it.
Studies indicate that regularly cycling women are interested in reducing the frequency of menstruation and for some careers, the cessation of menses is advantageous. Not having to deal with the associated symptoms is a panacea and as long as we don’t have any condition that disapprove it, extended use of combined contraceptive pills is another choice.
Either way, it’s a great advance having options and freedom of decision regarding these matters of dealing with bleeding and painful cycles or not during the current era. It is a victory for women health.