“The birth control pill is one of my patients’ most requested blog topics.”
This article summarizes my in-office consultation when prescribing the pill to first-time users.
10 FAQs will be answered.
Contraceptive pill rules are covered in a different article.
Firstly, let me clarify which pill we will be discussing.
The birth control pill is a broad term for two types of contraceptives:
- ‘The Pill’ or Combined Oral Contraceptive (COC) contains a combination of hormones, estrogen and progesterone. For excellent reasons, this is the most commonly requested and prescribed birth control option.
- The Progesterone Only Pill (POP) or ‘mini-pill’, which we will not be discussing in this blog.
The COC is the focus of this article.
Why are Combined Oral Contraceptives (COCs) so popular?
They are:
- fantastic for preventing pregnancy, >99.7% safe if taken correctly,
- ensuring cycle predictability,
- allowing you to skip your period,
- eliminating PMS (premenstrual symptoms),
- reducing heavy or prolonged bleeds,
- stopping period pains and
- treating acne.
Despite all these positives, the COC might not be your preferred contraceptive option.
Also read: 8 Reliable Birth Control Methods For Females – Free Advice
The 10 quick-start questions I’ll be answering today:
- Which pill should I take?
- Who can’t take the pill?
- When should I stop the pill immediately?
- What side effects can I expect?
- Will all brands give me side effects?
- Are there rules I should know?
- Can I skip my period?
- Will the pill make me infertile?
- Low-dose pills – Are they less effective?
- Should I take a break now and then?
1. Which pill should I take?
Your doctor will help you to make this decision.
Questions they might ask you:
- Have you taken a COC before?
- Did a COC give you side effects in the past?
- Do you have acne?
- Do you have PMS, irregular or heavy periods?
2. Who can’t take the pill?
The medical term for this is contraindications.
Estrogen increases your risk for clotting, which can be life-threatening.
Certain groups of women with an increased risk for blood clots should not be prescribed COC.
Reasons not to take the pill:
- Older than 35 and a smoker
- Family or personal history of blood clots
- History of heart attacks or strokes
- Overweight with a BMI > 30
- Uncontrolled diabetes or high blood pressure
- Personal history of breast cancer
- Breastfeeding
- Migraines with auras
- Liver problems
3. When should I stop taking the pill immediately?
As mentioned above, combined oral contraceptives increase your risk for blood clotting.
Your doctor will screen you for contraindications before prescribing the pill. However, even if you are healthy, your risk increases compared to a lady not taking a COC birth control pill.
The risk of clots is highest in the 12 months after starting for the first time, but especially in the initial three.
You can, however, develop clots at any stage, and your risk naturally increases as you get older.
“I recommend memorizing the signs and symptoms (S&S) of clotting.”
Stop the birth control pill, and contact a doctor immediately if you develop any of the following.
Stop if you develop any S & S of blood clots:
- a swollen, painful leg or legs,
- chest pain, especially with breathing, or
- shortness of breath.
Stop if you develop S & S of a stroke:
- weakness of your arms or legs,
- slurred speech,
- confusion, or
- a brief loss of consciousness.
Photo by Lucas Oliver: https://www.pexels.com
4. What side effects can I expect?
If you read any medication’s package insert, you will see many other side effects. Most of these are rare or insignificant.
“We are all different. If you feel something new is happening after starting a new medication, always contact your doctor.”
Dangerous side effects
These were already discussed in ‘When should I stop taking the pill immediately?‘
Temporary side effects
Nausea
This is very common in the first month. For most women, this is temporary, thank goodness.
To minimize this, take the birth control pill after food during this time.
Irregular bleeds
Some spotting may occur during the first 3 months of taking the pill.
This is more likely if:
- your baseline cycles are not regular or are very heavy
- you do not start the pill on the first day of your period
Bloating And Fluid Retention
This usually resolves after the first month.
Vaginal dryness and yeast infections
This may resolve after a few months or persist in some unlucky individuals. There are some COC that are less likely to cause these effects.
Unacceptable Side Effects
“Changes in sex drive and mood are reasons to change or stop immediately.”
Decreased libido (sex drive)
Not healthy for relationships! Try a different COC, or consider a non-hormonal IUD.
Mood changes
Watch yourself for a dip in mood, personality change, or increased anxiety.
This must-see TED talk, ‘The surprising link between women’s brains and the birth control pill,’ discusses the importance of having thoughtful conversations about the birth control pill.
Sarah Hill’s message is not to stop the pill but to be aware of its effects.
5. Will all brands give me side effects?
No, various brands contain different estrogens and progesterone types and doses.
“Don’t give up after trying one hormone combination; try another.”
6. Are there rules I should follow?
Yes, there are many rules.
They are very important to ensure efficacy and cycle control.
I cover these extensively in an article dedicated to contraceptive pill rules.
7. Can I skip my period?
“Yes, after 3 months of well-controlled pill cycles, you can skip your period.”
This is very useful if you are going on a hike, getting married, or swimming in a gala when your period is due.
How to do this is covered in my contraceptive pill rules article.
8. Will the pill make me infertile?
No, the birth control pill will not affect your fertility.
“The truth is that skipping even one pill can result in pregnancy.”
The fertility issue may predate starting the pill, and the birth control pill is falsely blamed.
Patients may start the COC because of irregular cycles, acne, or severe period pains.
Underlying conditions causing these symptoms often cause infertility—for example, Polycystic Ovarian Syndrome (PCOS) or endometriosis.
“Acne is one symptom of PCOS.
The underlying reason for starting the pill is most likely the reason for fertility issues when stopping.”
Image by Alexander Grey from Pixabay
9. Low-dose pills – Are they less effective?
No, low-dose COCs are as effective as their higher-dose counterparts as long as you follow the rules.
10. Should I take a break every now and then?
No, giving yourself a break from the COC is not good. It can be a danger to your health.
This comes back to the blood clotting risk.
If you stop the pill for more than a month, this resets to the baseline high. You are effectively starting from scratch.
“The risk of clots is highest in the first 12 months after starting for the first time—especially the first three months.”
I hope this has answered all of your questions. If not, feel free to message me on my contact page.
