A hormone-based tool for avoiding pregnancy is the oral contraceptive pill, widely known as “the pill.” This may also help overcome intermittent menstrual syndrome (PMS), painful or extreme cycles, endometriosis, acne and premenstrual syndrome.
“The pill” is used in the United States by about 16 percent of women aged 15 to 44 and has both benefits and disadvantages. Individuals with various risk factors may be recommended to use a particular type of pill.
There are various types of birth control pills. They all contain synthetic forms of estrogen , progesterone or both of the hormones. The word progestin is called synthetic progesterone. Combination pills include the oestrogen and progestin. The “mini pill,” only contains progestin.
The monophasic pills all contain the same hormone balance. Two or three different types of pills are taken each month with phasic pills, each with a different hormone balance.
“Everyday pills” and “21-day pills” are another option. A pack of daily pills lasts 28 days, but seven of the pills are inactive. The daily pill may be easier to use properly, because the routine is the same every day.
Used correctly, the pill is highly successful, but because people make mistakes, it is thought that 6 to 12 pregnancies in every 100 occur each year when using it. The Centers for Disease Control and Prevention ( CDC) has set a failure rate of 9 percent for both pill types.
Common side effects of oral contraceptives include:
- intermenstrual spotting
- breast tenderness
- headaches and migraine
- weight gain
- mood changes
- missed periods
- decreased libido
- vaginal discharge
- changes to eyesight for those using contact lenses
We will look at each of these side effects in detail below.
1. Intermenstrual spotting
Breakthrough vaginal bleeding between expected periods is normal. It typically fixes within 3 months of taking the drug.
The drug is still safe during spotting, as long as it has been administered properly and there are no missing doses. Anyone experiencing 5 or more days of bleeding while on active drugs, or 3 or more days of heavy bleeding should contact a health care provider for advice.
This bleeding can occur because the uterus adjusts to having a thinner endometrial lining or because the body adjusts to varying hormone levels.
Many people get slight nausea while taking the pill first, but symptoms generally subside after a while. It can help to take the pill with food or at bedtime. If you experience extreme nausea or continue for more than 3 months, you should seek medical advice.
3. Breast tenderness
Birth control pills can cause an enlargement or tenderness of the breast. It usually fixes a couple of weeks after the pill begins. Anyone who discovers a lump in the breast or has constant discomfort or tenderness or serious discomfort in the breast should seek medical assistance.
Tips for breast tenderness relief include reducing the consumption of caffeine and salt, and wearing a supportive bra.
4. Headaches and migraine
The hormones in the birth control pills will make headaches and migraine more likely.
Pills with different hormone types and concentrations can cause different symptoms.
Using a low dose pill can reduce headache incidence.
Symptoms usually improve over time but you should seek medical help if serious headaches start when you start taking the drug.
5. Weight gain
Clinical trials have not found a clear correlation between the use of birth control pills and changes in weight. Fluid retention, however, may occur especially around the breasts and hips.
According to one study , the majority of research of progestin-only birth control showed an average weight gain of under 4.4 pounds (2 kilograms) at 6 or 12 months. Research of other forms of birth control have shown the same benefit.
Many types of hormonal contraception have been linked with a reduction in lean body mass.
6. Mood changes
Research show that oral contraceptives can influence the mood of the patient and increase the likelihood of depression or other changes in the emotions. Someone who reports changes in mood during use of the drug should contact their health care provider.
7. Missed periods
A duration can often be skipped even with good use of the pills. This can be affected by factors such as stress, sickness, travel and hormonal or thyroid abnormalities.
If a period is missed or is very light while using the pill, a pregnancy test is recommended before starting the next pack. It is not uncommon for an occasional flow to be either very light or skipped entirely. When the need arises, seek professional advice.
8. Decreased libido
For some people the hormone or hormones in the contraceptive pill can affect sex drive or libido. When reduced libido continues and is embarrassing, this should be discussed with a health care provider.
For certain cases , for example, the birth control pill will raise libido by eliminating pregnancy issues and reducing the debilitating effects of menstrual cramping, premenstrual syndrome, endometriosis and uterine fibroids.
9. Vaginal discharge
After taking the pill, changes in vaginal discharge can occur. There may be an rise or decrease in vaginal lubrication, or a change in the discharge character. If this results in vaginal dryness, added lubrication can help make sex more comfortable.
These variations are typically not harmful but color or odor alternations may indicate an infection. Those worried about these changes should speak to their healthcare provider.
10. Eye changes
Hormonal changes caused by the birth control pill are related to corneal thickening in the eyes. A greater risk of eye disease has not been linked with oral contraceptive use, but it could mean that contact lenses no longer fit comfortably.
Wearers of contact lenses should check with their ophthalmologist if they notice any changes in vision or lens resistance during use of pills.
The pill should not be taken by:
- women who are pregnant
- smokers over the age of 35 years, or anyone who stopped smoking within the last year and is over 35 years old
- anyone with obesity
- those who are taking certain medications
- anyone who has or has had thrombosis, a stroke, or a heart problem
- anyone with a close relative who had a blood clot before the age of 45 years
- people who have severe migraines, especially with an aura as the warning sign
- anyone who has or had had breast cancer or disease of the liver or gallbladder
- anyone who has had diabetes for at least 20 years or diabetes with complications
If any of the following occur, the user should see a doctor.
- abdominal or stomach pain
- chest pain, shortness of breath, or both
- severe headaches
- eye problems such as blurred vision or loss of vision
- swelling or aching in the legs and thighs
- redness, swelling or pain in the calf or thighs
They may indicate a more serious condition.
Birth control pills may be used to raise the risk of long-term health issues.
Combination pills will increase the risk of cardiovascular side effects, such as heart attack , stroke and clots of blood, slightly. Any of those can be deadly.
For certain drugs the risk is greater. A doctor will advise you on the correct choices.
Those with uncontrolled high blood pressure or a personal or family history of blood clots, heart attack, or stroke should seek alternative approaches from their medical provider.
Normally occurring female hormones, such as oestrogen, are believed to affect a woman’s risk of developing those forms of cancer. Therefore it is likely that the use of a birth control method based on hormone may have a similar effect.
Ovarian and endometrial cancer: Clearly both are less common in women who use the medication.
Breast cancer: There seems to be a slightly higher risk of developing breast cancer in women who have been taking the contraceptive pill lately, and particularly if they began taking it during their teen years. Nonetheless, after 10 years of not taking the drug, the risk appears to be the same as with those who never used it.
Cervical cancer: Long-term use of the drug was associated with an increased risk of cervical cancer relative to those who never used it. Some forms of cervical cancer are therefore caused by the human papilloma virus ( HPV). It is yet to be verified that HPV is related to the use of oral birth control pills.
Liver cancer: Oral contraceptives have been linked with a greater risk of developing benign tumors in the liver, but these rarely become cancer. Several reports have shown that, after using oral contraceptives for at least 5 years, the risk of liver cancer is higher but other reports have not had the same findings.
There are other choices available for those who can’t use the birth control pill or don’t want it.
This is a birth control barrier method which prevents sperm from getting into contact with egg cells. Male condoms are sheaths placed over the penis. A female condom, at either end, is a pouch with a ring. This is placed inside the vagina.
Condoms are commonly available but are mostly made from latex, but in certain individuals can cause an allergy. Alternatives are polyurethane or lambskin.
The chance of it not working with all forms of condoms is 18 percent or more in a year.
It is a dome-shaped, shallow rimmed cup that is positioned in the vagina to protect the cervix. Using with spermicide, it prevents meeting of the sperm and egg.
Disadvantages involve possible urinary tract infections and vaginal irritation. The discomfort may be due to a reaction to the material from which the diaphragm or the spermicide is made.
In every 100 women who use it, between 6 and 12 pregnancies occur annually, because of human error.
NuvaRing (vaginal ring)
A plastic ring is inserted into the vagina, and hormones are released to prevent ovulation. It is inserted for 3 weeks per month, and removed for 1 week, during which menstruation takes place. These hormones are somewhat similar to the pill and there could be similar side effects.
In every 100 women who use it, between 6 and 12 pregnancies occur each year because of use errors.
The vaginal ring may have similar side effects to the pill as a hormonal birth control device, including intermenstrual bleeding, headache and diminished libido.
Intrauterine devices (IUDs)
In the doctor’s office a small tool made of plastic and copper is inserted into the uterus. IUDs can be hormonal or non-hormonal in nature.
Hormonal IUDs thicken the cervical mucus and suppress ovulation. Non-hormonal IUDs produce an inflammatory response that is harmful to sperm in the uterus.
This lasts up to 10 years and is effective at avoiding pregnancy by almost 100 per cent.
Adverse effects include intermenstrual bleeding and menstrual irregularity. With exacerbated cramps some IUDs can lead to heavier periods.
Surgery is performed in the man, blocking or cutting the tubes that carry sperm from the testicles to the penis. Surgery blocks the Falopian tubes inside the woman.
Possible men’s complications include cancer, hematoma, swelling, and the development of sperm granulomas, lumps that grow in the tissue around the vas deferens where sperm leaks.
This is normally permanent.
The shot versus the pill
Taking a shot of contraceptive hormones can be a more effective way to avoid pregnancy than using a pill as the patient doesn’t have to recall taking it every day at the same time.
Nevertheless, these may also have adverse effects, being hormonal birth control methods.
Injections like Depo-Provera suppress ovulation and thicken cervical mucus to reduce sperm chances of entering egg cells, much as the birth control pill does. This is a solely contraceptive progestin (POC).
The downside of the shot is that you don’t have to take it every day, but you need to consider taking another shot every 3 months, and that’s what the doctor’s office wants to do.
When used correctly, it is more than 99 per cent successful. And, as women often fail to take another shot, by doing it, about 6 out of every 100 women will become pregnant each year. This makes it reliable in contrast with oral contraceptives.
Some side effects from the shot are similar to those of the birth control pill.
Oral contraceptives are related to cardiovascular issues. Some research related the shot to thrombosis, or blood coagulation, but others did not.
The Mayo Clinic states that in people with a history of heart disease, diabetes, or stroke, some providers may discourage use.
Possible side effects that should be reported to a physician include:
- vaginal bleeding that is heavier or lasts longer than usual
- jaundice, or yellowing of the skin and eyes
- Pus and pain around the injection site
Other effects that tend to pass within a few months include:
- abdominal pain and bloating
- decrease libido
- weakness and fatigue
- weight gain
Depo-Provera was also related to a loss of bone mineral density, which in later life raised the likelihood of osteoporosis and bone fractures.
And when used correctly, the shot will trigger pregnancy. It can take up to 10 months to conceive after it has been stopped.