the contraceptive pill

Is the Pill popular?

If you’re thinking of going on the Pill, you’ll be joining a band of about 100 million women worldwide who use this method.

Did you know?

More than 100 million women worldwide use the contraceptive pill.

How many women take it in the UK?

In the UK alone, there are 3.5 million women who take the Pill. This is roughly one in three of all females of reproductive age.
The Pill has always been a bit controversial. Although it is now well over 50 years since it was first used (in Puerto Rico in 1956), there are still occasional ‘Pill scares’ – when newspaper headlines trumpet the dangers of Pill taking.
However, the fact that it remains so staggeringly popular does indicate that for huge numbers of women, the slight risks are outweighed by the benefits.

So is the Pill safe?

Basically, yes. But very occasionally, it can have serious side-effects.
However, recent news about Pill safety has been remarkably good.
The Royal College of General Practitioners has produced an important report that revealed the remarkable fact that Pill-users have a 12 per cent reduction in their risk of developing cancer.
The report also found that breast cancer rates were the same in women who have used the Pill, and women who haven’t.

Warning!

A very tiny number of women should not take the Pill, because they have serious medical conditions.

Nevertheless, most doctors don’t think that the Pill should be ‘dished out’ to absolutely everyone, without any need for a preliminary chat.
So when you want to start on the Pill, you should see a doctor (or family planning nurse) and have a short check-up.
The this is to see if you have any ‘risk factors’ – especially smoking – that would make you more liable to deep vein thrombosis (DVT), heart attacks or strokes.

Once you're on the Pill, what then?

You should return to the surgery or clinic for occasional ‘Pill checks’. In Britain, they are usually done at six-monthly intervals.
These visits are very brief, and generally all the nurse or doctor does is ask you whether you’re having any problems with the Pill, ensure that you haven’t developed any ‘risk factors’ in the last six months and check your blood pressure (and possibly weigh you).
A lot of people still think that you have to have a vaginal examination and a smear test before going on the Pill but this is no longer true.

What is the Pill?

The Pill is a tablet containing two female hormones – an oestrogen and a progestogen.
Various oestrogens and progestogens are used in the many different types of Pill which are available. There are currently 28 brands on the market in Britain. Six new ones have just been introduced.
These two hormones stop you from ovulating (producing an egg) each month. And if you don’t ovulate, you won’t get pregnant.
In addition, the hormones thicken the secretions round your cervix, making it more difficult for sperm to get through. Also, they make the lining of your womb thinner, so that it’s less receptive to an egg.

Is the Pill the same as the mini-Pill?

Pill versus mini-Pill

The two are not at all the same. The Pill contains two hormones; the mini-Pill only one. The mini-Pill has fewer side effects but is also less effective.

The mini-Pill is not a low-strength version of the ordinary Pill. It’s a completely different product, because it contains only one hormone instead of two. This makes it ‘milder’ and freer of side-effects, but also less effective.
Adverse effects of the mini-Pill can include breast discomfort, headache, dizziness, weight changes and spots on the skin. For a full list, read the package leaflet, or talk to your nurse or doctor.

How effective is the Pill?

It’s very effective indeed, which is why so many millions of women rely on it.
If you take it exactly as prescribed, then its effectiveness is likely to be almost 100 per cent.
Put it another way: let’s say that 100 women use the Pill for a year, and that all of them never forget to take a tablet. It’s likely that not a single one of them will get pregnant.
In contrast, if they were all relying on the condom instead, then probably about two to five of them would become pregnant. And if they used no contraception at all, then at least 20 of them would fall pregnant!
So the Pill is just about the most effective method of contraception there is, apart from sterilisation.

How do you take it?

In the UK, you’re given a pack which usually contains 21 pills and you take one every day for three weeks. At the end of those three weeks, you ‘break’ for a week. During those seven days, you’ll have your period.
If you wish, you can take seven ‘dummy’ tablets during the week’s break.
It’s stopping the Pill at the end of the 21-day pack that brings on the period.
After the week’s break, you start on your next packet. So it’s ‘three weeks on and one week off’ throughout the year.
If you want to, you can set your mobile phone so that it beeps at the same time every day, to remind you to take your Pill.
Note: one newly-introduced Pill, called Qlaira is different from all the rest, because the makers have decided that you should have hormones on 26 out the 28 days of your cycle.

But how do I get started?

Go to a GP or a family planning clinic to see the doctor or nurse, discuss risk factors and possible side effects, and get a prescription.
In Britain, it is now the practice to take your first-ever Pill on the first day of your period.
If you do this, you should be protected immediately – so you can have sex whenever you like.
Practices vary in other countries, and their Pill packs may contain more than 21. In the USA, it is extremely common for women to be given packs containing 28 tablets – but seven of which are ‘dummies'.

What are the good points about the Pill?

The Pill has now been shown to have certain major health advantages:

• it abolishes period pains
• it makes periods shorter
• it makes them lighter.

Because of this, you are less likely to become anaemic.
If you have acne, the Pill should improve it.
The Pill is very useful if you want to delay having a period for a special occasion, such as a holiday. By taking two packets back-to-back without a week's break you can avoid having your period at an inconvenient time.
In addition, it decreases your chances of getting certain cancers (though it increases the risk of others).

But can’t it give you a lot of side effects when you start?

Yes. During the first few packs of the Pill, many women get minor, passing side-effects, such as:

• headaches
• nausea
• breast tenderness
• slight weight gain
• slight ‘spotting’ of blood between the periods.

These side-effects usually go away after the first few packs. If they don’t, it’s very easy to get rid of them by simply switching to another brand.

What about serious side-effects?

There is no doubt at all that the Pill can occasionally cause serious problems like:

• deep vein thrombosis (DVT) or clotting (this is now thought to be slightly more common in women who are taking Pills containing the progestogens desogestrel and gestodene)
• heart attacks
• strokes.

Fortunately, these events are rare, but ... they are much more likely to happen if you have certain ‘risk factors,’ which include:

• being a smoker
• having a family history of thrombosis or some similar illness (say, if your mother had a heart attack or a deep vein thrombosis at 40)
• being severely overweight
• being diabetic (though quite a few non-smoking diabetics do use the Pill, under careful supervision)
• having high blood pressure
• having a high cholesterol level (hypercholesterolaemia)
• a past history of phlebitis (vein inflammation) or thrombophlebitis
• being immobile for a while (especially when having a surgical operation).

There are other risk factors, for instance making a very long journey in a plane or a cramped car seat. Your doctor or family planning nurse can give you more details.
The risk is now known to be greater in the first year of taking the Pill. But it also increases a little as you get older.

Varicose veins

Many people have the idea that ‘you can’t take the Pill if you have varicose veins'. This isn’t true.
However, in recent years it has become clear that severe problems with varicose veins are a contraindication to the Pill.
But if you just have mild and superficial varicose veins, it’s quite likely that your doctor will be willing to prescribe a low-dose Pill for you – provided that you have no other risk factors.

Familial blood factors

It’s now clear that certain blood-clotting abnormalities that run in many families make you more liable to clotting.
The best-known of these is Factor V Leiden. If you have this, we suggest you go for another form of contraception.

Hughes' syndrome

In the last few years, it’s become clear that a lot of women have something called Hughes’ syndrome (anti-phospholipid syndrome, or APLS).
This blood disorder predisposes them to serious blood clotting. If you have Hughes’ syndrome, you should definitely not go on the Pill.

Migraine

In the early part of this century, new research showed that women who have severe migraine and use the Pill run an unacceptable risk of having a stroke.
Official advice in the 2010 edition of the British National Formulary (BNF) is that women who have any increase of headache frequency on the Pill should tell their doctors.
The BNF also now says that women who have severe migraine with eye disturbances – or migraine with odd symptoms in other parts of the body – shouldn’t take the Pill.
If you develop these symptoms while on the Pill, you should STOP taking it immediately, and ask your doctor to refer you to a neurology expert.
The Pill is also not suitable for females experiencing migraines lasting 72 hours or more, and those needing treatment with ergot derivatives, such as ergotamine.

Does age make a difference?

Yes. The Pill is extraordinarily safe for young women in their teens or 20s who have no risk factors (such as smoking). But when you get to the age of 35 or 40, the chances of having a thrombosis (clot) are starting to increase.
In practice, there are some women of 40 who take the Pill. But as the years go by, there is more and more reason to switch to the mini-Pill, or to some other method of contraception, such as sterilisation and vasectomy for men.

What about cancer?

Did you know?

The Pill can increase the risk of some cancers and reduce the risk of others. Ask your doctor for advice.

The Pill does affect your risk of certain types of cancer, and when you first decide to go on it, you should be told about this.
But it’s important for you to realise that the Pill actually reduces your chances of getting some cancers – while it increases the risk of others.
As far as we know, the Pill reduces your chance of getting:

• cancer of the ovary
• cancer of the womb (endometrium)
• possibly bowel cancer – a 60 per cent reduction in risk has been claimed, though this is still not proven.

The Pill increases your risk of getting:

Be 'breast aware'

Check your breasts regularly for lumps or anything odd, particularly as you approach middle age, which is when breast cancer starts becoming common.

• breast cancer – though recent research suggests there’s no overall increase in Pill users
• cervical cancer – though this is almost entirely preventable by regular smear tests or (in the near future) by vaccination against the virus that usually causes this cancer
• liver cancer – though this is very rare.

Does anything make the Pill less likely to work?

Yes. These things make it less effective:

• forgetting Pills – especially at the beginning or end of a pack
• having diarrhoea and/or vomiting (a common holiday risk)
• taking certain antiepilepsy drugs, including Epanutin (phenytoin) and Tegretol (carbamazepine)
• taking antibiotics – notably those used for fungus infections and tuberculosis (TB), but also commonly prescribed antibiotics like tetracyclines and Amoxil (amoxicillin).

Although the effect of such common antibiotics on the Pill may be slight, it’s better to be safe than sorry.
In general, take extra precautions for two weeks if you’re put on an antibiotic.
If a doctor wants to prescribe something for you, always tell them you’re on the Pill.
Also, avoid the popular herbal remedy St John's wort while you are taking the Pill. It reduces the effectiveness of the oral contraceptive, and you may get ‘spotting’ of blood.

What if I miss a Pill?

Try not to! Of course people do inevitably miss Pills; it’s only human nature.
If you miss only one Pill, you’ll probably be OK; take it as soon as you remember – and then take the next one on time (even if that means you’re taking the two of them at the same time). If you want to be super careful, you could avoid sex for the next seven days – or take extra precautions.
However, if you’re more than 12 hours late in taking the Pill, avoid sex for the next seven days – or take extra precautions.
Missing more than one Pill is quite risky – particularly near the beginning or end of a packet. To avoid pregnancy, follow the advice on the pack leaflet strictly.
To be frank, the ‘missed Pill advice’ in these leaflets is pretty complicated – and keeps being changed! If you’re in doubt:

• ring a family planning centre for personal advice
• consider using emergency contraception (the morning-after pill)
• don’t have sex until you’re sure you’re fully protected.

Does the Pill reduce sexual desire?

Many experts believe that any reduction of desire is much more likely to be attributable to the woman being with the wrong partner – or at least a partner who does not make proper efforts to romance her and to give her adequate foreplay – than being on the Pill.
At The Congress of The European Society of Contraception in Prague (May 2008) Professor van Lunsen of the Netherlands said that in his view: ‘partner switching is better than Pill switching’.
However, it does seem that a few women may have a reduction of desire because of their reaction to the hormones in the Pill.
Indeed, scientific research presented at the conference seems to point to the Pill somehow being responsible for reducing the amount of androgens in some women.
Androgens are hormones we all have in our bodies which enhance sexual motivation and the frequency of sexual functioning.

So which Pill should I choose?

Regrettably, very few women do actually choose their own brand of Pill. The choosing is mainly done by doctors or nurses. (The main exception to this occurs when a woman asks to go ‘on the same Pill as my friend’ – or ‘the same as my Mum!’)
Unfortunately, some doctors who don’t know much about contraception do tend to pick Pills more or less at random. If you want a more informed choice, go to a doctor who has training in family planning.
You should ask for:

• a low-dose Pill
• a second-generation Pill.

The reason for preferring a second-generation Pill is that the ones that came after them in the late 1980s ( third-generation Pills) carry a minutely increased risk of thrombosis.
I strongly advise you not to pay any attention to newspaper stories or broadcasts that suggest any particular brand of Pill is ‘wonderful’ or ‘better than all the rest'. These tales usually originate from the PR companies employed by the manufacturers!