FAQs about The Birth Control Pill
How effective is the pill against pregnancy? 91% in the real world, with your best effort, it's easy to make mistakes.
How can I improve on this? By not missing any pills, there are apps to help (such as my pill or ipill, and bedsider.org will text you daily.
Why do I need condoms, too?
Because the birth control pill is not 100% effective, and we want 100% efficacy. In addition, unlike any hormonal options, condoms are very protective against STDs (HIV, syphilis, chlamydia, gonorrhea, hepatitis, trichomonas.) Many of these infections have few to no symptoms (up to 80%!), so unless you only date virgins, condoms are critical.
When do I start?
You have choice. If you'd like to start on the first day of your period: [First-day start], it will become effective immediately. If you forgot to take the pill, or didn't have it available on the first day of your menses you can start the pill on the first Sunday following the beginning of your menses: [Sunday start]. Sunday start patients are not covered via contraception the first month, but should be using condoms anyway. If your periods are irregular and you are not sexually active you can start as soon as you want to, [Quick start.]
Do I need to take the pill the same time every day?
What if I decide to sleep in on Saturday? To get the highest effectiveness from birth control pills, take them around the same time every day. (Either with breakfast, lunch or dinner – if your schedule is irregular, consider taking them with dinner: set your cell phone alarm to remind you.) To help you get in a routine, try to connect taking your pill to something you do every day (like brushing your teeth.)
Can taking the pill make my periods lighter, less painful?
Absolutely, heavy periods will be lighter and less crampy by month 2.
Benefits other than protecting me from pregnancy:
What if I don’t want to take the placebos?
That’s your call, but most of us will make more mistakes if we throw out the placebo and try to count ahead.
I am having breakthrough bleeding, what should I do?
If it’s within the first 3 months of taking the pill or switching brands, this is normal.
On the other hand, if you have been on the pill awhile and you are having new breakthrough bleeding/spotting, and have not missed any pills, it’s time for a visit to rule out other possible causes.
How long will I have breakthrough bleeding?
For the first 3 months, even if you take the pill exactly at the same time each day, 40-50% of young women will spot when they shouldn’t. Persevere and you will be rewarded with very predictable, lighter menses soon.
If I miss a pill, what do I do? What do I do if I miss taking one or more pills?
The effectiveness or side effects of birth control pills can be altered by taking them late or by not taking them at the same time each day. If you miss one of more pills, refer to the manufacturer package insert that came with your pills. In general, for most pills, the following should be followed:
If you had intercourse in the last 5 days, and did not use condoms:
If I left my pills home, and I am on vacation, help?
Call the office with a local pharmacy number, and we will call in an emergency pack.
Will the pill affect my future fertility?
Absolutely not. The long-term data (the pill has been around for 50 years) are very reassuring about your fertility.
My mother/sister/grandma (insert family member) had breast cancer, will taking the birth control pill increase my risk?
No. There is no evidence that the birth control pill increases your breast cancer risk.
My mother/sister/grandma (insert family member) had ovarian cancer, will taking the birth control pill increase my risk?
Absolutely not. In fact, in patients with a hereditary increased risk of ovarian cancer, the birth control pill has been shown to decrease your risk of ovarian cancer, and the longer you take it, the greater the benefit of risk reduction.
Will I gain weight?
Some of us do, (<10%), but in general most do not. If you take care to avoid junk food the first 2 months you are on the pill, you will not gain weight either. However, if you gain weight on one formula of the pill doesn't mean that all pills have this side effect. Let me know if you find this an issue and we can change formulas.
Will my skin/acne get better?
Yes. In general, most young women find that the pill improves your skin, especially if you are prone to worsening acne around your period. The sex-hormone binding globulin found in the pill will bind up free testosterone, and this should improve acne that is driven by stress and your menstrual cycle. It often takes 2 cycles to see this benefit.
Will my breasts grow permanently?
Not permanently, but sensitive patients may notice for the first 1-2 months that they need a larger bra. Once your own ovaries get the message to quiet down, your breast size should go back to normal. Rarely, a patient won’t return to her pre-pill size after a few months on the pill. If this is bothersome, then we recommend that she stop the pill and try a contraceptive without estrogen.
Will I be more or less moody? Less. You’re welcome.
Is it normal to miss my period when using “The Pill”?
When taking birth control pills, it is common to miss a period every once in a while, or have a period that is very light (just a brown stain on your underwear). If you haven’t missed taking any pills and you miss one period without any symptoms of pregnancy, it is unlikely you are pregnant. If you have missed more than 1 pill during your last pack, have missed two periods in a row, or have symptoms of pregnancy, keep taking your pills as usual but also get a urine pregnancy test.
Do antibiotics make “The Pill” less effective?
Only one antibiotic – rifampin - is known to make the Pill less effective. Rifampin is used to treat tuberculosis.
Other routine antibiotics do not make the pill less effective.
Certain other medicines, which are not antibiotics, may make the Pill less effective. These include:
Is there any reason to get my period once a month on the pill, or should I consider the once every 3 mos pill?
Traditional birth control pills mimic a regular 28-day monthly cycle. For the first 21 days, you take active pills containing reproductive hormones. For the last seven days, you take placebos. While you're taking the placebo pills, you bleed vaginally, as if you were having a regular menstrual period. By contrast, extended-cycle birth control pills contain active hormones for every day of the month.
The first extended-cycle pill regimens introduced provide active hormone pills every day for three months, then one week of placebo pills (Seasonale) or low-dose estrogen pills (Seasonique, LoSeasonique). You'll experience menstrual bleeding during that week. A newer extended-cycle regimen is designed to be taken continuously for one year (Lybrel). It's meant to suppress all menstrual bleeding.
Some evidence suggests an advantage to this type of regimen. By continuously taking the pill, you prevent hormonal fluctuations that are responsible for bleeding, cramping, headaches and other discomforts associated with getting your period. Unscheduled bleeding and spotting often occur during the first few months. It typically goes away with continued use, but some women do continue to have unscheduled bleeding with continuous use of pills.
Can you use ordinary birth control pills continuously to prevent having a period?
It's possible to prevent your period with continuous use of any birth control pill. This means skipping the placebo pills and starting right away on a new pack. Continuous use of your birth control pills works best if you're taking a monophasic pill — with the same hormone dose in the three weeks of active pills.
You may find continuous use of birth control pills a convenient way to avoid having your period during an important occasion or trip. Taking a monthly regimen birth control pill continuously is fine, but with continuous use of the pill you may develop breakthrough bleeding and then you should take the placebo pills so that you'll have a menstrual cycle.
If you plan to have a baby, how soon after stopping the birth control pill can you conceive?
After you stop taking the pill, you may have only a two-week delay before you ovulate again. Your period would follow about four to six weeks after you take the last pill. Once ovulation resumes, you can become pregnant. If this happens during your first cycle off the pill, you may not have a period at all.
What happens if you stop taking the birth control pill but your period doesn't resume?
If don't get a period for several months, you may have what's known as post-pill amenorrhea. The pill prevents your body from making hormones involved in ovulation and menstruation. When you stop taking the pill, it can take some time for your body to return to normal production of these hormones.
Typically, your period should start again within three months after you stop taking the pill. But some women, especially those who took the pill to regulate their menstrual cycles, may not have a period for many months. If this happens, make an appointment to see us by 3 months.
How effective is the pill against pregnancy? 91% in the real world, with your best effort, it's easy to make mistakes.
How can I improve on this? By not missing any pills, there are apps to help (such as my pill or ipill, and bedsider.org will text you daily.
Why do I need condoms, too?
Because the birth control pill is not 100% effective, and we want 100% efficacy. In addition, unlike any hormonal options, condoms are very protective against STDs (HIV, syphilis, chlamydia, gonorrhea, hepatitis, trichomonas.) Many of these infections have few to no symptoms (up to 80%!), so unless you only date virgins, condoms are critical.
When do I start?
You have choice. If you'd like to start on the first day of your period: [First-day start], it will become effective immediately. If you forgot to take the pill, or didn't have it available on the first day of your menses you can start the pill on the first Sunday following the beginning of your menses: [Sunday start]. Sunday start patients are not covered via contraception the first month, but should be using condoms anyway. If your periods are irregular and you are not sexually active you can start as soon as you want to, [Quick start.]
Do I need to take the pill the same time every day?
What if I decide to sleep in on Saturday? To get the highest effectiveness from birth control pills, take them around the same time every day. (Either with breakfast, lunch or dinner – if your schedule is irregular, consider taking them with dinner: set your cell phone alarm to remind you.) To help you get in a routine, try to connect taking your pill to something you do every day (like brushing your teeth.)
Can taking the pill make my periods lighter, less painful?
Absolutely, heavy periods will be lighter and less crampy by month 2.
Benefits other than protecting me from pregnancy:
- Fewer cramps
- Lighter, shorter menses
- Improved acne
- Fewer ovarian cysts
- Ovarian cancer protection
- Regular estrogen dose to protect your bones and endometrium in PCOS
What if I don’t want to take the placebos?
That’s your call, but most of us will make more mistakes if we throw out the placebo and try to count ahead.
I am having breakthrough bleeding, what should I do?
If it’s within the first 3 months of taking the pill or switching brands, this is normal.
On the other hand, if you have been on the pill awhile and you are having new breakthrough bleeding/spotting, and have not missed any pills, it’s time for a visit to rule out other possible causes.
How long will I have breakthrough bleeding?
For the first 3 months, even if you take the pill exactly at the same time each day, 40-50% of young women will spot when they shouldn’t. Persevere and you will be rewarded with very predictable, lighter menses soon.
If I miss a pill, what do I do? What do I do if I miss taking one or more pills?
The effectiveness or side effects of birth control pills can be altered by taking them late or by not taking them at the same time each day. If you miss one of more pills, refer to the manufacturer package insert that came with your pills. In general, for most pills, the following should be followed:
- If you have a 28-day pack and you missed any of the last 7 pills in the pack - don’t worry about it (except Mircette, where the last 7 pills do matter).
- In a 28-day pack, the last 7 pills are placebo or “sugar” pills. These have no active ingredients; the pills are just there to help you know when to start your new pack. But make sure you start your new pack on time.
- If you miss taking one or more pills (except the last 7 pills in the pack), you may not be protected from pregnancy.
If you had intercourse in the last 5 days, and did not use condoms:
- Emergency Contraception: should be considered to prevent pregnancy. To see if you may need EC, call our office to discuss. Missed Pills
- Take one birth control pill as soon as you notice you have missed one or more. Use a backup method of birth control for the next 7 days.
- If you missed one, take 2 birth control pills together as soon as you notice you have missed one or more. Use a backup method of birth
control for the next 7 days. - If you missed 4 or less pills in a row: Continue taking one pill each day as usual until you finish the pack.
- If you missed 5 or more pills: continue taking one pill each day as usual until you reach the placebo (“sugar”) pills, or reach the end of your 21-day pack. Do not take the placebo pills; instead start a new pack of pills. Your bleeding may be unpredictable throughout this next cycle. Keep taking your pills on-time each day regardless of whether you are bleeding or not.
If I left my pills home, and I am on vacation, help?
Call the office with a local pharmacy number, and we will call in an emergency pack.
Will the pill affect my future fertility?
Absolutely not. The long-term data (the pill has been around for 50 years) are very reassuring about your fertility.
My mother/sister/grandma (insert family member) had breast cancer, will taking the birth control pill increase my risk?
No. There is no evidence that the birth control pill increases your breast cancer risk.
My mother/sister/grandma (insert family member) had ovarian cancer, will taking the birth control pill increase my risk?
Absolutely not. In fact, in patients with a hereditary increased risk of ovarian cancer, the birth control pill has been shown to decrease your risk of ovarian cancer, and the longer you take it, the greater the benefit of risk reduction.
Will I gain weight?
Some of us do, (<10%), but in general most do not. If you take care to avoid junk food the first 2 months you are on the pill, you will not gain weight either. However, if you gain weight on one formula of the pill doesn't mean that all pills have this side effect. Let me know if you find this an issue and we can change formulas.
Will my skin/acne get better?
Yes. In general, most young women find that the pill improves your skin, especially if you are prone to worsening acne around your period. The sex-hormone binding globulin found in the pill will bind up free testosterone, and this should improve acne that is driven by stress and your menstrual cycle. It often takes 2 cycles to see this benefit.
Will my breasts grow permanently?
Not permanently, but sensitive patients may notice for the first 1-2 months that they need a larger bra. Once your own ovaries get the message to quiet down, your breast size should go back to normal. Rarely, a patient won’t return to her pre-pill size after a few months on the pill. If this is bothersome, then we recommend that she stop the pill and try a contraceptive without estrogen.
Will I be more or less moody? Less. You’re welcome.
Is it normal to miss my period when using “The Pill”?
When taking birth control pills, it is common to miss a period every once in a while, or have a period that is very light (just a brown stain on your underwear). If you haven’t missed taking any pills and you miss one period without any symptoms of pregnancy, it is unlikely you are pregnant. If you have missed more than 1 pill during your last pack, have missed two periods in a row, or have symptoms of pregnancy, keep taking your pills as usual but also get a urine pregnancy test.
Do antibiotics make “The Pill” less effective?
Only one antibiotic – rifampin - is known to make the Pill less effective. Rifampin is used to treat tuberculosis.
Other routine antibiotics do not make the pill less effective.
Certain other medicines, which are not antibiotics, may make the Pill less effective. These include:
- Certain anti-HIV protease inhibitors
- Certain anti-seizure medications
- A particular anti-fungal medication - griseofulvin - which is used to treat severe, often life-threatening fungal infections.
Is there any reason to get my period once a month on the pill, or should I consider the once every 3 mos pill?
Traditional birth control pills mimic a regular 28-day monthly cycle. For the first 21 days, you take active pills containing reproductive hormones. For the last seven days, you take placebos. While you're taking the placebo pills, you bleed vaginally, as if you were having a regular menstrual period. By contrast, extended-cycle birth control pills contain active hormones for every day of the month.
The first extended-cycle pill regimens introduced provide active hormone pills every day for three months, then one week of placebo pills (Seasonale) or low-dose estrogen pills (Seasonique, LoSeasonique). You'll experience menstrual bleeding during that week. A newer extended-cycle regimen is designed to be taken continuously for one year (Lybrel). It's meant to suppress all menstrual bleeding.
Some evidence suggests an advantage to this type of regimen. By continuously taking the pill, you prevent hormonal fluctuations that are responsible for bleeding, cramping, headaches and other discomforts associated with getting your period. Unscheduled bleeding and spotting often occur during the first few months. It typically goes away with continued use, but some women do continue to have unscheduled bleeding with continuous use of pills.
Can you use ordinary birth control pills continuously to prevent having a period?
It's possible to prevent your period with continuous use of any birth control pill. This means skipping the placebo pills and starting right away on a new pack. Continuous use of your birth control pills works best if you're taking a monophasic pill — with the same hormone dose in the three weeks of active pills.
You may find continuous use of birth control pills a convenient way to avoid having your period during an important occasion or trip. Taking a monthly regimen birth control pill continuously is fine, but with continuous use of the pill you may develop breakthrough bleeding and then you should take the placebo pills so that you'll have a menstrual cycle.
If you plan to have a baby, how soon after stopping the birth control pill can you conceive?
After you stop taking the pill, you may have only a two-week delay before you ovulate again. Your period would follow about four to six weeks after you take the last pill. Once ovulation resumes, you can become pregnant. If this happens during your first cycle off the pill, you may not have a period at all.
What happens if you stop taking the birth control pill but your period doesn't resume?
If don't get a period for several months, you may have what's known as post-pill amenorrhea. The pill prevents your body from making hormones involved in ovulation and menstruation. When you stop taking the pill, it can take some time for your body to return to normal production of these hormones.
Typically, your period should start again within three months after you stop taking the pill. But some women, especially those who took the pill to regulate their menstrual cycles, may not have a period for many months. If this happens, make an appointment to see us by 3 months.
|
Susan Malley, MD
Pediatric, Adolescent & Adult Gynecology |
Summit Health
3030 Westchester Avenue Purchase, NY 914.848.8800 |
Summit Health
1 Theall Road Rye, NY 914.848.8800 |
"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow." MA Radmacher