Though referred to as “the pill,” oral contraceptives in pill form come in a variety of different brands and hormone combinations, making “the pill” a misnomer for what can be a very complex assortment of birth control choices.
According to Kids Health, a pediatrician-reviewed website, most birth control pills contain a specific combination of the hormones estrogen and progesterone designed to prevent the release of an egg during a woman’s monthly menstrual cycle.
By preventing this process, called ovulation, there is no egg in the system able to be fertilized by the male’s sperm. This is the primary method of pregnancy prevention facilitated by birth control pills; however, most oral contraceptives also thicken the mucous surrounding the cervix, making it difficult for sperm to enter the uterus in the first place. This way, if an egg does get released (no oral contraceptive is 100 percent effective) the mucus acts as an initial defense mechanism.
But the birth control pill is much more complex than just the chemistry behind pregnancy prevention.
Many women are placed on birth control pills without much discussion regarding the “what ifs,” and some are too embarrassed to ask certain questions.
In an effort to shed some light on the myths and truths associated with the pill, Saludify enlisted the aid of several sexual health professionals in a Q&A session; Karen Shea, MSN, WHNP-BC, Planned Parenthood Federation of America Director of Medical Standards; Dr. Jacqueline Gutman at Reproductive Medical Associates, Philadelphia; and Carrie Roberson, MS, LMFT, Sex Therapy, Awakenings Center.
Q&A with the experts on birth control pills
Q: What are the differences between pills?
A: “The two main types of pills are combination pills and progestin-only pills. Combination pills work best when taken every day,” Shea told Saludify.
“Progestin-only pills must be taken at the same time every day. A combination pill offers many benefits in addition to pregnancy prevention, including some protection against acne, bone thinning, breast growths that are not cancer, ectopic pregnancy, endometrial and ovarian cancers, serious infection in the ovaries, tubes, and uterus, iron deficiency anemia, cysts in the breasts and ovaries, premenstrual symptoms, including headaches and depression, bad cramps, heavy and/or irregular periods.”
Most combination pills come in 28-day or 21-day packs. Both types have 21 “active” pills that contain hormones. The last seven pills in 28-day packs of combination pills are called “reminder” pills. They do not contain hormones.
In 21-day packs, one pill is taken every day for three weeks in a row. No pills are taken for the next week, and then a new pack of pills is started.
Some combination pills contain a few months’ worth of active pills. They are specially packaged to reduce the number of periods a woman has each year. Women can also take the active pills in 21-day or 28-day packs continuously to reduce how often they have periods.
Progestin-only pills come only in 28-day packs. All progestin-only pills are active.
With combination pills, you’ll get your period during the fourth week (this is the withdrawal bleeding) — unless you choose to avoid menstruation by using active combination pills during the fourth week, as well.
With progestin-only pills, you may get your period the fourth week, get no periods, or have bleeding on and off throughout the month.
Q: Can you get pregnant while taking the pill?
A: “Women can get pregnant while taking the pill though the likelihood is extremely small-typically less than 1 percent,” said Gutman.
Shea adds that while less than 1 out of every 100 women run the risk for pregnancy while on oral contraceptives, approximately 9 out of 100 women will become pregnant while on the pill annually due to incorrect use.
Other reasons birth control pills may fail include: obesity, vomiting or diarrhea, and the use of certain supplements/medications. Women on antibiotics, antifungals, HIV medications, anti-seizure medications, and St. John’s Wort supplements should all consult with their doctor about a secondary form of birth control.
“If you’re taking your birth control pills exactly as directed (each day and at the same time of day), they are 98 to 99 percent effective at preventing pregnancy,” Roberson told Saludify. “However, if a dose, or more, is missed during a cycle, you are at higher risk of unintended pregnancy during that cycle. To be safe, use a backup form of contraception, such as a condom.”
Q: What is withdrawal bleeding and what is breakthrough bleeding?
A: “Withdrawal bleeding is bleeding that comes at the end of the hormone pills – usually during the reminder week,” explained Shea. “It’s what women think of as their period when they are taking the pill. Breakthrough bleeding is spotting that occurs between withdrawal bleeds (periods).”
According to the Mayo Clinic, breakthrough bleeding, which is often a cause of concern for most women on the pill, is not a sign the pill isn’t working properly. Breakthrough bleeding is common, especially on extended use pills which allow withdrawal bleeding every 3 or 6 months—sometimes longer.
If you experience breakthrough bleeding, do not stop taking the pill, but do seek advice from your doctor as soon as possible. Stopping the pill may put you at risk for unplanned pregnancy.
Q: Can the pill increase fertility in a woman by balancing hormones?
A: “The pill doesn’t really balance your own hormones,” Gutman told Saludify. “It just causes the uterine lining to develop and the shed (your period) in a controlled fashion. This mimics the natural (and regular) menstrual cycle. Once you stop the pills, your cycle will typically go back to the way it was; it will be regular if you were regular and irregular if you were not regular prior to starting the pill.”
Experts agree the pill can help regulate menstrual cycles, but does not increase fertility.
Q: What are the effects on the body from taking the pill only 1 or 2 months as opposed to long term use?
A: Some women may have undesirable side effects while taking birth control pills, indicates Shea, most presenting within the first few months of use. Many women adjust to the pill with few or no problems.
During those first months, however, the body may go through an adjustment period, and women may experience:
- Breakthrough bleeding
- Breast tenderness
“Nausea and vomiting may be helped by taking the pill in the evening or at bedtime. But do not stop taking the pill because you feel sick to your stomach — you will be at risk of pregnancy if you do,” cautions Shea. “It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after taking the pill for three months, talk with your health care provider about changing your prescription.”
Q: How long after you start taking the pill for the first time ever are you protected? Do you have to wait a whole month or are you protected by taking the pill just a few days?
A: The initial protection period for first-time pill users depends on the type of pill being used. Shea points out combination pills, which combine estrogen and progesterone, tend to provide immediate protection if started within 5 days post-period. If started at any other time during the month, combination pills take 7 days to reach full pregnancy protection capacity.
Progestin-only pills take 48 hours to provide complete protection; however, it is important to take a progestin-only pill at the same time every day.
Taking it as little as 3 hours later than usual can result in a lapse of protection and another 48-hour time frame will need to pass before the user is protected fully again.
Q: If you get pregnant while taking the pill, what symptoms will you have?
A: Women who become pregnant while on the pill experience the same symptoms as women who are not on the pill. These symptoms, according to the American Pregnancy Association, include:
- Delayed or missed period
- Breast tenderness
- Lower back aches
- Morning sickness
- Frequent urination
- Darkening of the nipples
- Food cravings/aversions
Q: Is it bad to take the pill while being pregnant?
A: It is unlikely that taking the pill during early pregnancy will increase the risk of birth defects.
“If you continued taking a birth control pill because you didn’t realize you were pregnant, don’t panic,” explained Roberson.
“Although years of this experience has been rumored to cause birth defects, there’s very little evidence that exposure to the hormones found in birth control pills will harm a baby. With that being said, once you learn that you are pregnant, stop taking the birth control pill. If you don’t wish to be pregnant, continuing to take the birth control pill will not end the current pregnancy. Contact you health provider to determine your health options.”
Q: Can stopping or missing the pill make you ovulate sooner?
A: You will ovulate if you stop the pill altogether.
“And may very well ovulate if you miss pills,” added Shea.
Q: Do you ovulate during the 7 days you take the placebo pills or bleeding means you don’t ovulate at all during those days either?
A: “You don’t ovulate during the reminder week,” said Shea. “The bleeding that occurs during the reminder week is a withdrawal bleed —that happens because the hormones are taken away. If you take all pills as directed, it’s unlikely you will ovulate during the hormone pills.”
You stay protected during the placebo or reminder week.
Q: If a woman is taking the pill only for acne or regulating her period, but still wants to get pregnant, what can she do?
A: The only way to achieve pregnancy will be stop taking the pill and forfeit acne and period regulation.
“Unfortunately, though the pill helps control your cycle and reduces acne it will (and should) prevent pregnancy,” Gutman told Saludify. “Skipping a couple of pills may reduce how effective it is preventing pregnancy, but doesn’t increase fertility! Once you decide that you want to get pregnant it is time to stop the pill-and if you have irregular periods, see a fertility specialist.”
Roberson added, “If pregnancy is the goal, no form of birth control should be used. There are other medications available if a woman who wants to get pregnant is trying to regulate her cycle. Consult your OB/GYN for more information about what medications might be a good fit. There are also a wide variety of acne treatments for women who are wanting to conceive.”
Q: Can the pill make you infertile?
A: Taking birth control pills for an extended period of time will not make a woman infertile, indicates Baby Center.
In reality, the pill can protect a woman from certain diseases and cancers which can lead to infertility.