What is the best contraceptive pill for me?

How to choose the best birth control pill for your needs

The contraceptive pill was first developed in the 1950s and was licenced for use in the west in the 1960s.  Since then the formulation of the pill has been refined and there are many brands and several options available when it comes to choosing the right pill for you. It must be stressed however that the pill still requires a prescription and so must be taken under the supervision of a health professional. That health professional can also help you make a decision about which pill will suit you best.

 

Types of the contraceptive pill

There are two types of the contraceptive pill, those that contain oestrogen and progesterone known as the combined pill and those that only contain progesterone also known as the progesterone-only or mini pill.

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How does the pill work?

  • The combined pill - in order to prevent the fertilisation of the egg by the sperm which would result in pregnancy, the pill does three things.  It stops or delays the production of the egg by the ovary (ovulation), it causes the lining of the womb to become thinner than usual which in turn prevents the egg from implanting and it causes a physical barrier by making the mucus around the cervix thicker and so making it more difficult for the sperm yo pass-through
  • The progesterone-only pill - these pills deliver a steady dose of progesterone which prevents pregnancy in two ways, firstly by thinning the lining of the uterus again preventing the egg from implanting as well as causing the mucous around the cervix to thicken and so making it more difficult for the sperm to permeate

When used correctly, the pill can be up to 99% effective in the prevention of pregnancy

 

Advantages and disadvantages of the pill

The combined pill

Advantages

  • When taking the combined pill there is more flexibility in terms of when the pill is taken each day. Provided it is less than 24 hours late taking your pill take it immediately and take the next pill when it is due, even if this means taking two pills in one day.  Protection from pregnancy will be maintained and no further action needs to be taken
  • The combined pill can help with premenstrual syndrome by steading the oestrogen fluctuations which can be responsible for PMS; as a result, fewer symptoms like bloating and mood swings may be experienced
  • Lighter and less painful periods may be a welcome side effect of taking the combined pill. This is because having a thinner uterine lining means there is less tissue to shed. This can mean that the period could stop completely or because there is less lining, fewer prostaglandins are produced; these are the hormone type chemicals that cause the cramping and so pain in the uterus. This benefit would be especially welcome for people that experience excruciatingly painful periods, for instance, those who suffer from endometriosis
  • There is another welcome side effect from taking the combined pill and that is it can cause acne to clear up. When the combined pill suppresses ovulation, it calms down the testosterone spikes that may accompany ovulation and cause bad skin and in so doing clearer skin ensues
  • If a person is prone to developing ovarian cysts which can be extremely painful, another welcome side effect of suppressing ovulation
  • With certain combinations of the combined pill, it is possible to manipulate the arrival of your period for the sake of convenience.  This is done by either missing the placebo week of pills to miss a period completely or change the day of the period beginning by changing when the placebo pills are taken
  • Menstrual migraines can be relieved by taking the combined pill. During normal menstrual cycle levels of oestrogen can fluctuate and so trigger these migraines. If the combined pill is taken continuously and not having the withdrawal bleed, these painful headaches can be suppressed
  • There is a reduced risk of developing some cancers whilst taking the combined pill; these include colorectal cancer, ovarian cancer and endometrial cancer
  • If you decide that you wish to have a child then fertility returns almost immediately when a person stops taking the combined pill

 

Disadvantages

  • The estrogen found in the combination pill can cause some unwelcome side effects. These may include sore breasts and loss of libido.  It may be that the side effects diminish with time or you may need to try a pill that has a slightly different formulation. Speak to your doctor and they will be able to advise
  • Whilst taking the combined pill as your only form of contraception you are still vulnerable to contracting sexually transmitted infections. If this is possible or likely then it is advised that condoms are also used for added protection
  • It is crucial that you remember to take a pill every day. If this is likely to be a problem then it may be that the implant, the patch or the IUD would be preferable forms of contraception in your particular case
  • The combined pill is not recommended for people who are breastfeeding as oestrogen may affect the milk supply
  • For some women, the combined pill can actually make migraines worse
  • For some people who have risk factors, the combined pill can increase the risk of cardiovascular issues such as blood clots and stroke.

The hormones present in birth control pills can increase the clotting factors in the blood. This may result in clots forming which can cause heart attacks and strokes

  • If you have high blood pressure (hypertension) that is not controlled as oestrogen can actually cause a rise in blood pressure
  • Whilst the combined pill may reduce your risk of some cancers, it may also increase your risk of others.  Some evidence has indicated that those people who are taking the combined pill are at higher risk of developing breast cancer and cervical cancer
  • The combined pill is not recommended for people who either have or have had breast cancer.

Whilst there are many different brands of the combination pill on the market, just to confuse matters, there are subgroups of the combined pill called monophasic, biphasic, triphasic and quadriphasic pills.

The different names describe how the pills deliver the dosages of oestrogen and progesterone

  • Monophasic pills - these deliver the same quantity of oestrogen and progesterone in each active pill
  • Biphasic pills - these contain two, colour coded, active pills which contain different doses of oestrogen and progesterone
  • Triphasic pills - they contain pills with three different combinations of oestrogen and progesterone
  • Quadriphasic pills - these pills have 4 different combinations of hormones in the active pills

In general, the multiphasic pills are attempting to mimic the rise and fall of oestrogen and progesterone during a normal menstrual cycle and so potentially reducing the side effects of the combined pill 

 

Variations of the combined pill

  • Low hormone variety - They potentially have levels of oestrogen as low as 10 - 35 mcg. In reality, compared with the sort of doses contained in the older type of pills, most modern pills would be considered to be a low dose. The lower dose pills still carry the same level of protection but are less likely to cause side effects
  • Conventional or extended cycle pill - conventional pill packs contain 21 active pills and 7 placebo pills to permit a withdrawal bleed period.  Extended cycle pills come in packs of 84 pills which are taken back to back then 7 inactive pills. This allows for four periods per year which is bound to be the preferred option for people who suffer from painful period-related issues such as period pains, endometriosis and migraines.

The other option to consider if the combined pill is unsuitable is the progesterone-only pill (POP) or mini pill.

Advantages

  • Lighter and less painful periods
  • You can take them when breastfeeding
  • You can take them if you suffer from hypertension (high blood pressure)
  • Fertility will return quickly after stopping the pill
  • You can take them if you can’t take oestrogen

Disadvantages

  • They must be taken in the same three-hour window every day in order for their contraceptive function to remain intact
  • Irregular bleeding or spotting may be suffered as a side effect
  • The POP cannot be manipulated to influence when your period arrives
  • They do not provide protection against sexually transmitted infection
  • Ovulation suppression is not guaranteed with the POP so if you suffer from ovarian cysts or ovarian pain this pill will not help
  • As with the combination pill, if you have or have had cancer, this pill is not recommended
  • If you get pregnant whilst taking the POP then there is an increases risk of having an ectopic pregnancy (a pregnancy that develops in the fallopian tube)

 

Conclusion

At the end of the day, the pill can help not only with preventing unwanted pregnancy it can also help with a number of menstrual cycle-related problems suffered by many women.

It is important that you ask your doctor the right questions when deciding together which pill would be best for you. It is important to discuss any risk factors, possible control over the frequency of the period, any menstrual cycle problems that you suffer from as well as your health and family history in order that the best solution can be reached.

Remember that if one pill does not suit there are many more to choose from and there is almost definitely one out there that will suit you!

 

Sources

  1. Birth Control Pills:  are they right for you? https://www.healthline.com/health/birth-control-pills
  2. Progesterone Only Contraceptive Pills https://patient.info/sexual-health/hormone-pills-patches-and-rings/progestogen-only-contraceptive-pill-pop
  3. Birth Control Pills https://www.webmd.com/sex/birth-control/birth-control-pills

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