Most oral contraceptives, also referred to as “the pill,” contain a combination of female hormones, estrogen and progestin.
Several non-contraceptive benefits of the pill include a reduction in:
- Menstrual cramps or pain (dysmenorrhea)
- Iron-deficiency anemia (a low blood count due to low iron levels)
- Ovarian cancer
- Uterine cancer
Other non-contraceptive benefits are treatment of:
- PMS (in many women)
- Perimenopausal problems
Possible side effects of the pill may include:
- Nausea, breast tenderness, bloating, and mood changes, which typically improve within two to three months without treatment.
- Breakthrough bleeding or spotting. This is particularly common during the first few months of taking oral contraceptives and almost always resolves itself without any treatment within two to three months. Missed or late pills can also cause breakthrough bleeding.
If you experience continuing side effects from taking birth control pills, talk with your Women First Care Team. The pill comes in many brands and formulations, and your Care Team can help you find the pill that’s best for you.
When taking the pill, you should notify your Women First Care Team for severe symptoms such as shortness of breath, chest pain, or severe leg pain.
The effectiveness of the pill may be reduced if you take certain medications.
Anticonvulsants: Some anticonvulsants, including phenytoin (Dilantin®), carbamazepine (Tegretol®), barbiturates, primidone (Mysoline®), topiramate (Topamax®) and oxcarbazepine (Trileptal®) can decrease the effectiveness of hormonal birth control methods (pill, patch, ring). These medications should be discussed with your doctor. Depo-medroxyprogesterone acetate [Depo-Provera®]) is NOT affected by any of these medications, and it actually reduces seizures in patients who have them, making it a good choice for women with seizures.
Other anticonvulsants DO NOT appear to reduce contraceptive efficacy, including gabapentin (Neurontin®), lamotrigine (Lamictal®), levetiracetam (Keppra®), and tiagabine (Gabitril®). However, there is some concern that oral contraceptives may reduce the effectiveness of lamotrigine, potentially increasing the risk of seizures.
Antibiotics: Rifampin, which is sometimes used to treat tuberculosis, can decrease the efficacy of hormonal birth control.
Other antibiotics (e.g., penicillin, cephalexin) DO NOT affect the efficacy of hormonal birth control methods.
St. John’s Wort: St. John’s wort, an herbal supplement sometimes taken to treat depression, may reduce the effectiveness of birth control pills.
Starting the Pill
When to expect a period: When the pill is taken on a 28-day cycle with 21 days of hormone pills followed by 7 days of placebo pills (“sugar pills”), your period usually occurs during the fourth week of the pill pack, i.e., the “placebo week.” However, some women have irregular breakthrough bleeding or spotting in the first few months. It is not necessary to take the placebo pills, but some women find it easier to remember to start their next pill pack if they have taken the placebos.
Shorter pill-free interval: Several pill formulations are available with 24 days of hormone pills (rather than 21) and only four days of placebo pills. This approach is designed to shorten and lighten periods, and minimize pill failures and side effects.
Continuous dosing: Some women prefer to take birth control pills continuously, which allows you to have fewer days of menstrual bleeding per year. This regimen is a particularly good treatment if you experience painful periods or endometriosis, as well as if you want to avoid a monthly bleed.
Some pills are designed and packaged for extended continuous dosing to have a period only every 3 months. Taking an oral contraceptive for an extended time results in fewer periods per year, although you may experience breakthrough bleeding when starting this regimen. Breakthrough bleeding is inconvenient, but does not indicate an increased risk of pill failure (unless you’ve forgotten to take any pills).
Traditional birth control pill packs can also be used in continuous dosing. In this regimen, you take the first three weeks of a pill pack (all the active pills), then immediately start a new pack (without a break); the last week of (placebo) pills is not used. This can be continued for as long as desired. This works best when all the active pills are the same pills (mono phasic not triphasic).