Beginner's guide to birth control pills
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Beginner's guide to birth control pills

What are birth control pills? Are there a variety of them? If yes, which one should you use? What about all the side-effects you have heard about? To help you get answers to all your questions, we spoke to Maj (Dr) Sameena Parikh (retd), MS, PGDMLS, about birth control pills at length.

What are birth control pills?

As the name suggests, these are pills that you need to swallow to prevent an unwanted pregnancy. Broadly, the pills, with the help of hormones,  help stop the production of eggs inside a female’s body and prevent sperms from getting through to the egg. They do this by making the mucus around your cervix thicker. By stopping the production of an egg or the sperm reaching the egg, the pill prevents the pregnancy.

What are the different types of birth control pills? 

There are two types of birth control pills. The first variety is called combined oral contraceptives (COC), as it contains two hormones - estrogen and progesterone (for example, Mala D, Mala N, Ovral, and Loette).

The second variety contains only progesterone (for example Cerazette).

Combined birth control pills, with two hormones, stop production of an egg. At the same time, they make the mucus around your cervix thicker so the sperm can’t get through.

Pills with only one hormone, work just because of this thickening of the mucus. But they also stop production of an egg some of the time too, depending on the dose.

There are many versions of both available in the market today. 

Most COCs are low-dose pills in which the dosage of estrogen is the bare minimum to reduce the side effects on your body.

Which variety should one take?

COCs are the most commonly prescribed contraceptive pills, owing to the fact they’re the most effective non-intrusive method (not requiring insertion of a foreign device or administering by a medical professional) of birth control pills. However, there may be specific conditions in which the estrogen component may not be suitable for you. Your doctor will ask you specific questions to ascertain whether or not COCs will be the right fit for you.

Where do I get birth control pills?

Birth control pills are available in almost all pharmacies. However, purchasing them over-the-counter without a doctor’s prescription is not recommended, as not all birth control pills are suitable for all women. For instance, as mentioned before, COCs, which comprise estrogen, may be unsuitable for women with certain underlying medical conditions. 

Once you’ve been prescribed a pill, you may continue to replenish your monthly supply of birth control pills without  follow-up consultation with your doctor, unless otherwise specified.

How to take birth control pills? 

To understand how to take birth control pills, it’s important to get to know your pill pack. There are typically two kinds – 21 pills or 28 pills. In a 28-pill pack, the last 7 pills are of a different colour. These do not contain hormones. 

The packs, both with 21 and 28 pills, have markings starting from the first pill of the pack. Just follow the direction of the arrows on the pack to take the rest of the pills. 

Here are few other things to remember: 

• Take one pill each day until the pack is empty. 

• To avoid missing a pill, link pill-taking to a daily activity such as cleaning your teeth. 

In the case of a 28-pill pack, start a new pack the very next day after finishing the previous one. 

In the case of a 21-pill pack, you should wait for 7 days – no more – before starting the next pack. 

When to start on birth control pills? 

According to Dr Parikh, when a woman can start on birth control pills depends on her lifestyle, medical conditions, and current circumstances. 

When starting on a contraception for the very first time or switching from a non-hormonal method (such as condoms):

You can start the pill any time of the month 

• If starting within 5 days after the start of the period, no need for a backup method (such as also using a condom).

 • If it is more than 5 days, a woman can start COCS but a backup method is recommended for the first 7 days of taking pills. 

• If switching from an IUD, COC can be started immediately.

When switching from a hormonal method (such as injections): 

• Immediately, if you have been using the hormonal method consistently and correctly or if it is reasonably certain you’re not pregnant. 

• If switching from injectables, you can begin taking COCs at the time when repeat injection would have been given. 

When breastfeeding: 

• A breastfeeding mother can start taking contraceptive pills six weeks after childbirth if she is partially feeding the baby. In case the period hasn’t resumed post-delivery by that time, the use of a backup method like condoms is recommended for the first 7 days. 

• In case a woman is fully breastfeeding, she can start taking contraceptive pills after 6 months or when breast milk is no longer the baby’s primary food – whichever comes first. 

• If a mother isn’t breastfeeding at all, she can start taking contraceptive pills 21 to 28 days after childbirth. 

When there is no menstruation: 

• In case you don’t get your period for reasons other than pregnancy, childbirth or breastfeeding, you can start using contraceptive pills at any time as long as you’re reasonably certain that you’re not pregnant 

In case of an abortion or miscarriage: 

• You can start within 7 days after first- or second-trimester miscarriage or abortion, without needing a backup contraception method. 

• If it is more than 7 days after first- or second-trimester miscarriage or abortion, it’s advisable to wait until you’re certain that you’re not pregnant anymore to start COCs. 

After taking an emergency contraceptive: 

• You can start or restart COCs immediately after you take the ECPs. There’s no need to wait for your next monthly bleeding. A continuing user who needed ECPs due to pill-taking errors can continue where she left off with her current pack. Using a backup method is recommended for the first 7 days. 

Common side-effects

When you start on COCs, here are the common side-effects that you may experience: 

• In the first few months, irregular bleeding at unexpected times. This may be followed by lighter, shorter, and more regular monthly bleeding. 

• Headaches

• Breast tenderness

• Weight change 

• Mood swings

What to do in case you experience these side effects? 

Dr Parikh reiterates that side effects are not signs of illness. Most of these usually subside or lessen within the first few months. And not all women on birth control pills experience these. 

The best course of action is to keep taking COCs. Skipping pills risks pregnancy and can make some side effects worse. Taking the pill at the same time every day helps reduce irregular bleeding and also reduces the risk of missing doses. 

Besides, taking pills with food or at bedtime helps avoid nausea. In case the side-effects bother you or interfere with your ability to function normally, talk to a doctor. 

When to avoid taking birth control pills? 

There are certain lifestyle habits and medical conditions in which COCs are not recommended. These include: 

  • If you’re 35 years of age or older and smoke, do not take COCs. You can consider other methods of contraception such as a patch or a ring if you smoke fewer than 15 cigarettes a day.
  • COCs or hormone-based contraceptive methods are not recommended in case of conditions such as liver disease (severe cirrhosis or liver tumour, viral hepatitis or history of jaundice), high blood pressure, being diabetic for over 20 years (or in case of having suffered damage to the vision, kidneys, arteries or nervous system due to diabetes), gallbladder disease. 

When should one stop taking these pills?

Birth control pills can be a safe long-term contraception method and you can keep taking them for as long as you’re in your fertile years and sexually active. Here are a few circumstances where you may want to go off the pill: 

  • You want to get pregnant: Of course, if you want to get pregnant, going off the pill becomes essential. The right way to wean yourself off the pill depends on the kind of pill you are on - is it a COCs or progesterone-only pill? Irrespective of the nature of the pill, it’s not advisable to stop mid-way as it can alter your cycle. The best recourse is to finish the current pack and then let your body go through one menstrual cycle before you stop. 
  • You’re no longer sexually active: In case you’re no longer sexually active, the use of contraceptive pills becomes redundant. In this case, you can go off the pill. Once again, the right way is to finish the pack you’re on and then stop, so that your menstrual cycle isn’t thrown out of whack. In the event that you decide on being sexually active again, you can resume taking the pill like you did the first time around. It’s advisable to use a back-up method of contraception like a condom for the first seven days of going back on the pill.
  • You’ve reached menopause: Once you’ve hit menopause, you can say goodbye to the pill for good. It’s advisable to discuss the right time and approach for stopping the pill with your ob-gyn, as this is a time when hormones in the female body run amok. Going off the pill hastily might aggravate it even more. 

In essence, unless there is an underlying medical condition at play, the pill isn’t the ominous choice of contraception it’s often made out to be. We hope this lowdown on everything you need to know about birth control pills will empower you to make informed decisions about your sex life and sexual health.

Have questions? Join our discussion forum to have your questions answered or connect to us via Facebook.  We are also on Instagram, YouTube and Twitter. 

Arushi Chaudhary is a freelance journalist and writer with 5 years of experience in print publications such as the Pune Mirror and Hindustan Times, and has spent close to a decade writing for digital platforms and print publications – The Tribune, BR International magazine, Make My Trip, Killer Features, The Money Times, and Home Review, to name a few. Of the many things she's written about over the years, exploring the space of love and relationships through the prism of psychology excites her the most. Writing is her first and forever love. You can find her on Twitter here.

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