Health education: acne

Women’s Health
Birth Control Pills
What are they?
Birth Control Pills are an excellent means of contraception and are the most commonly used method of birth control used
in the United States. Pills are used by 16 million women in the US. and by 60 million women world-wide. Pills are one of
the most extensively studied medications ever taken. Not everyone can take pills, but they are safe for many, many
women.
How do they work?
Most birth control pills use a combination of two types of hormones--estrogen and progesterone. These synthetic
hormones mimic the effects of a woman's natural estrogen and progesterone produced by the ovaries. This constant,
steady level of hormones feeds back to the pituitary gland, inhibiting its normal cyclic production of hormones that
stimulate the ovaries to ovulate. Thus, if a woman does not ovulate, she cannot become pregnant. Secondary mechanisms
of action include:
* less hormonal stimulation of the endometrium (lining of the uterus) resulting in a less than optimal environment for a
fertilized ovum to grow.
* changes in the cervical mucus making it less pervious to sperm transport.
Who can use the pill?
Any healthy woman between the ages of puberty and menopause
How effective is the pill?
When pills are used perfectly --that means taken at the same time every day, and other considerations such as
concomitant antibiotic or other dug use or vomiting and severe diarrhea are taken into account--only about 1 out of 1000
women (0.5%) over the course of a year will actually become pregnant. In actuality, with typical use--taking them
erratically or failure to use a back-up method during a flu-like illness, for example--the failure rate is about 3%.
Are there problems with using the pill? Many pill users experience some nuisance side effects such as nausea, spotting or even bleeding between periods. Mood changes, weight gain, breast fullness or tenderness, headaches, and decreased sex drive may also occur with pill use. Side effects can vary from one woman to another and from one pill to another. Most side effects resolve on their own in a matter of days to a few months. Serious side effects are rare, but they do occur. Some symptoms might be: • severe chest pain, shortness of breath, unusual cough • severe headaches or headache accompanied by visual disturbances Also, birth control pills are expensive. The average price is $30. per cycle pack. Who shouldn't use the pill?
Women who:
• have or have had thrombophlebitis or a thromboembolic disorder • have acute liver disease or impaired liver function • have coronary artery disease or history of coronary artery disease • have/have had a history of malignancy of the breast or reproductive system • have migraine headaches accompanied by visual disturbances How to take the pill
You may begin taking your birth control pills in 1 of 3 ways:
• Sunday Start cycle: Start your first pack of birth control pills on the Sunday during or immediately following
your menstrual period. Thus, if your period starts on a Sunday, you start the birth control pill that day OR
• Day 1 Start cycle: Start your first pack of pills the same day your period starts. Thus if your period starts on a
Tuesday, you start the birth control pills that day. • Day 5 Start cycle: Begin your pills on the 5th day after your period starts, counting the day that the bleeding
starts as day 1 (even if it's 10 p.m. or later). The advantage to the Sunday Start cycle is that you will never have your period on the week-end. If this is important to
you, use the Sunday Start. The advantage to the Day 1 start cycle is that you will be immediately protected from
pregnancy. If maximizing the contraceptive effect of the "pill" is most important to you, use the Day 1 Start. There is no
particular advantage to the Day 5 Start cycle. Many European manufactured pills instruct women to start their pills in
this manner, and sometimes your clinician, for certain medical reasons, will have you use this start as well.
Once you have taken that first pill, take one tablet every day thereafter until you have taken all 21 tablets in the package and there are no tablets left. You will take no pills for the next 7 days. If you have a 28-day package, you will have 7 tablets of a different color to take during these 7 days. These 7 different pills are not medication and serve only as reminder pills. No additional birth control is required during this week. About 3 days after finishing all 21 tablets, most women will have a "period", often much lighter and shorter than you're used to. On the next Sunday (the 8th day) begin a new package, whether or not you are still bleeding. You will now have a regular 28-day cycle: 21 days taking birth control pills and 7 days taking either the reminder pills or no pills, and during which time you will menstruate. Points to Remember
• The best time of day to take your birth control pill(s) is with a meal. It helps to prevent nausea. However, you
may take it at any time that is most convenient for you. The important thing is to take it regularly at about the same • Theoretically, your pills are effective from the seventh day if you start using the Sunday Start or the Day 5 Start
cycle. However, for practical purposes you should not consider yourself safe until the end of the first cycle. If you
take them regularly, you are protected from then on, even during the week of no birth control pills. Using the Day
1 start, you are protected from pregnancy right away, since you are taking the pill at the beginning of your
period, thus interrupting your natural hormonal cycle at the beginning.
• You can usually expect your menstrual period about two to three days after you finish your package of 21 pills, or
on about the 2nd or 3rd reminder tablet if you have a 28-day package. • If you have been taking your pills regularly and you miss a menstrual period, do not panic. It is unlikely that you
are pregnant and you should continue taking your tablets on your regular schedule. However, if you should miss two consecutive periods, you should be seen by your clinician to exclude pregnancy, and possibly to change the pill type. • If you forget, or omit one or more tablets, see the information in your package insert on taking your pills
• If you are taking oral antibiotics of any kind, be sure to use an additional back-up method such as condoms,
spermicidal suppositories, VCF etc. during the entire time you are taking the medication and for a full 7 days
afterward.
• Oral contraceptives may have other side effects, including breast tenderness, nausea, headaches and changes in
menstrual periods. Many of these symptoms will disappear with time. Therefore, if you have symptoms you think may be due to your pills, and they are not too troublesome, it may be best to wait two to three cycles for them to subside. However, if your symptoms are very troublesome, a change in the type of pill might alleviate them. You should arrange to see your clinician to do this. • A common side effect is breakthrough bleeding (BTB)--light bleeding or spotting between periods. It may even be
as heavy or almost as heavy as a regular period. This is not dangerous. If it persists two months in a row, or if it is extremely troublesome, consult your clinician. A change in the brand or dosage of your pills might help. There is no relationship between breakthrough bleeding and contraceptive protection as long as you are taking your pills consistently at the same time every day. You are still protected against pregnancy even though you are having a flow. • If nausea is a real problem, consider taking your birth control pill at bedtime with a DRAMAMINE tablet (motion
sickness pill, no prescription required). If this does not control the nausea, take your birth control pill at supper and DRAMAMINE at bedtime. The nausea is usually short-term, gone by the second or third cycle. • Weight gain has not been a problem on the current low-dosage pills. If you do notice a slight weight gain, try
decreasing your salt intake, decreasing you calories slightly, and increasing your activity, which will counterbalance it. The weight gain should not continue month after month. • If you decide to stop your birth control pills, finish off a cycle (no need to use the reminder pills). This will keep
your menses more regular. Your first spontaneous flow off the pills may be delayed. This is not unusual. Occasionally, your concern over symptoms may warrant stopping your pills in mid-cycle. If so, expect some bleeding and menstrual irregularity for a cycle or two. If you have any symptoms which concern you, do check with your clinician. • You will have a prescription after the first few months of pill use. The pharmacist will keep your prescription.
Your first prescription pack will have a prescription number. The only way you can get a refill is with that prescription number. Therefore, record the number so that if you lose or misplace your pill pack, you can still purchase a refill. Remember to get a new prescription filled before the old one runs out. That way, you will always have a pack on hand. Make this a part of your regular vacation and holiday planning. Keep in mind that the pill does not protect you from the virus that causes AIDS or any other sexually transmitted
diseases such as herpes, chlamydia, or warts. Only lateeferably those lubricated with spermicide,
provide any protection.

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