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What You Need to Know About Birth Control

Birth control was designed for women to prevent pregnancy, but there are many other uses that include regulating menstruation (your periods), balancing hormone levels, treating acne, and more. There are many different methods of birth control and the most commonly used of these is the birth control pill. Birth control pills are safe, successful, and relatively inexpensive. Today’s oral contraceptive pill (OCP) has a rate of success in the high 90s which makes it a great method of avoiding an unplanned pregnancy.

What You Need to Know About Birth Control

How the Pill Works

Birth control pills use hormones and work by preventing fertilization of the egg. Ovulation (when an egg pops out) is prevented by hormones. The hormones also cause thickening the mucus on the cervix which makes it difficult for a sperm to reach an egg. The pill has created a mucus wall and blocked the egg from developing or popping out.

“Regular” birth control pills contain a synthetic form of two female hormones. — estrogen and progesterone. Synthetic hormones mimic pregnancy and then the pituitary gland does not release other hormones that tell the ovaries to create and release mature eggs.

Birth control pills work on a schedule. It is essential to take the pills at the same time every day. A schedule creates a stable level of hormones in your body.

Forgot to take the Pill for a Couple of Days?

If you forget to take your birth control pill each day, and at the same time each day, or you don’t refill your prescription on time, you are at risk of getting pregnant. If you do miss one pill, take it as soon as you remember. If you don’t remember until the next day, take two pills on that day. If you forget to take your pills for two days, your risk of getting pregnant is still low, but take two pills that day and the next to get back on schedule.

If you miss more than two birth control pills in a row, call your doctor. You may need to take some emergency contraception and use a backup method and/or abstain from sex for the next week or so in order to prevent pregnancy.

During this time it would be beneficial to use an alternative form of contraception, if you are sexually active. Condoms, sponges, or spermicides all have various levels of success but are good for backup use.

What You Need to Know About Birth Control

If you miss your period and you know you have forgotten to take the pill for a few days, take a pregnancy test, to be safe.

Note: You might not have a period on a low-dose birth control pill even if you don’t miss any pills.

When used as prescribed, the pill is 99% effective against unwanted pregnancy. However, many women have a hard time taking the pill at the same time everyday, so its effectiveness in “real life” is about 91%. That means, 9 out of 100 pill users get pregnant every year, which is much lower than 85 out of 100 women getting pregnant using no birth control at all.

What to Know About Birth Control

You can start on the Sunday after your period – then you might need to use a backup method for 7 days or abstain.

You can start on the day you get the medication in your hands, then you need to use a backup method or abstain for 1 week to be extra safe.

You can start within 5 days of the FIRST day of your period, then theoretically the medication is effective immediately.

However, to be absolutely safe, we always recommend a backup/abstain for 1 month. And to always use a condom to prevent diseases and it’s just cleaner for the woman.

At what age to start birth control pills?

The decision to start birth control pills is an immensely personal one. It depends on the medical need – anemia, PCOS, painful periods or pregnancy prevention. In general, we don’t recommend starting birth control before the age of about 14 (2 years after you get your period) to allow the young woman to get maximal height. The estrogen causes the epiphyseal plates to fuse early and you might lose like 1-2 inches off your final height if you started too early. However, if you are missing school, are anemic, have a bleeding disorder, then we might start you as soon as you get your periods. Best to discuss this with your medical provider.

Birth control can be used NOT for birth control but for other Medical Reasons.

Just because someone is on the birth control pill, doesn’t mean that she is having sex. Birth control pills are prescribed to teenagers for period regulation, acne suppression, anemia and more.

Birth control pills can be used to prevent unwanted pregnancies, but hormonal birth control regulates periods, reduces ovulation, reduces the risk of ovarian cancer and endometrial cancer.

Birth Control After Pregnancy

It is possible to get pregnant shortly after giving birth, though less likely if you are exclusively breastfeeding. Thus you may need to begin your birth control within days after delivery. Most doctors recommend not taking the combination pill while breastfeeding because it might decrease your milk supply.

What to Know About Birth Control

Instead of birth control by pill, doctors suggest the progestin-only pill (POP) soon after childbirth and until you stop breastfeeding. However, know that with the POP, if you are late by 3 hrs, you need to abstain/use backup for the next 48 hrs and you may need some emergency contraception if you had sex within the past 48 hrs. You might want to get some emergency contraception to have in case of emergencies but especially if you are on POPs.

After an abortion or a miscarriage, you can start any birth control method of your choice immediately.

What to Know About Birth Control

How long do birth control pills take to work?

Birth control pills need to be started within 5 days after your period starts. Once you begin taking the pill, you will be protected from unwanted pregnancy right away. For example, if your period arrives on a Monday morning, start the pill anytime until early Saturday and your protection will start right away.

If you start combination pills any other time, you will be protected from unwanted pregnancy seven days after you have taken the pill.  Use another method of birth control for those seven days before the pill becomes effective.

Progestin only pills, also known as “mini-pills” or POPs  can be started at any time. You will be protected after 48 hours or two days from when you start the mini-pill.

However, to be absolutely safe, we always recommend a backup/abstain for 1 month. And to always use a condom to prevent diseases and it’s just cleaner for the woman.

Side Effects and Risks when Taking Birth Control Pills

Birth control pills are safe for most women, but all medications have side effects and risks. Your doctor will help you figure out if the regular birth control pill is safe for you. Most people can take the regular combined birth control pill with no problems. It has been around for more than 50 years, and millions of women have taken it safely.

Birth control pills aren’t for everyone. There are times when a doctor will not prescribe the pill for you. For example:

  • If you are over 35 and smoke, don’t take the pill or other types of birth control that contain estrogen. You can use the progestin only pill instead, if you’re a smoker.
  • If you have a history of blood clots or an inherited blood-clotting disorder or a vein inflammation condition, don’t take the birth control pill.
  • Women with breast cancer are not recommended to take birth control pills.
  • If you have had a heart attack, stroke, angina, or other serious heart problems, avoid the pill.
  • Sufferers of migraine headaches with aura or seeing lines and lights, will not be prescribed the pill.
  • Uncontrolled high blood pressure or a history of high blood pressure makes you at risk if you take birth control pills.
  • Diabetes with complications or liver disease can also be a problem, and you may not be prescribed combined birth control pills (with estrogen and progesterone).

Birth control pills are safe but the combination pill can increase your risk of particular health problems. Complications are not common especially in those under the age of 35 and Non-smokers, but they can be severe in those with risks or unknown blood problems. Some risks include heart attacks, stroke, blood clots, and liver tumors. In very rare cases, birth control pills can lead to death.

Make sure you always tell your doctor about what medications you are taking and any health problems you have or have had before asking for the birth control pill.

There is always the chance you could get pregnant while taking the pill during early pregnancy. However, taking the birth control pill while pregnant will not increase the risk of congenital mutations.

Will Birth Control Make Me Gain Weight?

Contrary to some myths out there, it is very unusual for women to gain weight when they take birth control pills. It can be a temporary side effect, but it is usually due to fluid retention and not extra fat.

In a review of 44 studies, there was no evidence that birth control pills cause weight gain. There are other possible side effects of the pill, but weight gain is minimal and goes away with a proper diet and regular exercise.

If you do pack on a few pounds after you begin using birth control pills, talk to your doctor. You may need to use a different type of BC pill. All pills are not the same. Most birth control pills use the same type of estrogen in different doses, but each brand may include a different type of the hormone progestin. Pills are made differently and thus have different side effects.

Pills sold in the early 1960s were high in estrogen and progesterone. Estrogen in high doses does cause weight gain due to increased appetite and fluid retention. Fifty years ago, birth control pills might have created weight gain, but today’s pills have lower amounts of hormones. Weight gain is not likely to be a side effect.

If your birth control pills do cause some side effects, keep in mind that when starting the pill most side effects do go away in about 2-3 months.

You may experience headaches, sore breasts, nausea, spotting (light bleeding) between periods when you use the pill. These side effects will also clear up after a couple of months. If you are still having problems after taking the pill for a few months, talk with your doctor. You may be prescribed another birth control pill with different hormones. About 10% of women need to try a few different types of pills before finding the right one for you.

Birth control pills can cause emotional upheavals or mood swings. Some people experience feeling overwhelmed or stressed, anxious, and depressed.

If you suffer from mood swings on birth control pills, talk to your doctor about making a change. Doctors also suggest you increase your exercise levels, make dietary changes, and get the right amounts of sleep to help with mood.

Taking a birth control pill might change your period. It could be lighter, and there are times when you might not get a period at all. More and more users take the pill continuously to skip periods. The chance of pregnancy is very low if you’ve been taking your pill as prescribed and even lower if you skip the sugar/placebo pills. If you think you might be pregnant, check a pregnancy test.

Warning Signs of Problems with the Pill

You should not have any problems at all, but just in case, it is good to know what the signs of a problem might be. Check with your doctor right away if:

  • You have chest pain or discomfort
  • There is pain in one of your legs that lasts >20 minutes
  • You have trouble breathing
  • You experience severe pain in your stomach
  • You have a sudden and nasty headache that lasts >20 minutes
  • If you have yellowing of your skin or eyes.
What to Know About Birth Control

Emergency Contraception (EC) Is Last Chance Birth Control

Emergency contraception pills or the “morning after pill” are a form of birth control that can be used by women who have had a contraceptive failure – e.g. condom popped, forgot to take pills 3 days in a row, late for your depot shot, left NuvaRing out for longer than 3 days on non placebo week, sexual assault. EC should be reserved for emergencies and should not be used as a regular method of birth control, because it is only effective 75-95% of the time depending where a woman is in her cycle and how soon after the contraceptive failure/accident/emergency they take the medication and which medication you use.

The most effective form of emergency contraception is the copper IUD. However, this requires a doctor or nurse practitioner put one your uterus.

There are two different types of emergency contraception pills.

The second most effective EC is Ella® or ulipristal acetate. It is more effective than Plan B/Levonorgestrel but you need to get a doctor’s prescription. However, under the Affordable Care Act, it should be “Free” (no co-pay, no deductible). It is also better for women who have a Body Mass Index of >26.

The third most effective EC is Levonorgestrel aka Plan B and its generics. Levonorgestrel temporarily blocks releasing of eggs and prevents fertilization.

When Levonorgestrel EC  is used within 72 hours of a contraceptive accident, it reduces the chance of pregnancy by close to 90%.

Research has shown, however, that Levonorgestrel EC loses its effectiveness in women weighing more than 165 pounds. Doctors do not recommend Levonorgestrel EC for anyone weighing over 165 lbs.

Levonorgestrel EC is available over the counter to anyone (male or female) of any age in the United States at the time of this writing (July 2018).

Emergency Contraception Pill Side Effects

The common side effects of the emergency contraception pills are:

  • Nausea
  • Menstrual changes
At Pandia Health, we offer all our telemedicine customers a prescription for Ella just in case of emergencies. If you do not use Pandia Health’s telemedicine services, you can ask your doctor to prescribe you some Ella emergency contraception “in advance of need” aka for an emergency. 
All methods of Emergency Contraception from copper IUD to Ella (ulipristal acetate) to Levonorgestrel emergency contraception (aka Plan B and its generics) can be used for up to 5 days after a contraceptive failure/accident. However, they work better if you take it ASAP. Dr. Yen likes all her patients to know “If the condom pops at 3am, I want the medicine in the person with the uterus at 3:10am. No cuddling, huddling, etc aka “waiting until the morning after.” Take the medicine ASAP. Get the medicine in advance of your need/emergency. Have it ready like a fire extinguisher.”
What to Know About Birth Control

Birth control pills are currently being used by over 60 million women worldwide. They are very effective against unwanted pregnancies if taken at the same time every day and are one of the safest and best methods of birth control. Just make sure you remember to take the pill every day and at the same time every day. Staying on a schedule is the best way to ensure optimal protection. If you have any questions or concerns about your birth control and health, you can always reach out to your medical provider.