Oral Contraception Information

• Preventing the ovaries from releasing eggs.
• Thickening mucus in the lower part of the uterus (cervix). This prevents sperm from entering the uterus.
• Thinning the lining of the uterus (endometrium). This prevents a fertilized egg from attaching to the endometrium.

OCPs are highly effective when taken exactly as prescribed. However, OCPs do not prevent STIs (sexually transmitted infections). Using condoms while on an OCP can help prevent STIs.

What happens before starting OCPs?

• You may have a physical exam, blood test, and Pap test.
• Your health care provider will make sure you are a good candidate for oral contraception. OCPs are not a good option for certain women, such as:
  • Women who smoke and are older than age 35.
  • Women who have or have had certain conditions, such as:
    • A history of high blood pressure.
    • Deep vein thrombosis.
    • Pulmonary embolism.
    • Stroke.
    • Cardiovascular disease.
    • Peripheral vascular disease.

Ask your health care provider about the possible side effects of the OCP you may be prescribed. Be aware that it can take 2–3 months for your body to adjust to changes in hormone levels.

Types of oral contraception

Birth control pills contain the hormones estrogen and progestin (synthetic progesterone) or progestin only.

The combination pill

• Conventional contraception pills come in packs of 21 or 28 pills.
  • Some packs with 28-day pills contain estrogen and progestin for the first 21–24 days. Hormone-free tablets, called placebos, are taken for the final 4–7 days. You should have menstrual bleeding during the time you take the placebos.
  • In packs with 21 tablets, you take no pills for 7 days. Menstrual bleeding occurs during these days. (Some people prefer taking a pill for 28 days to help establish a routine).
• Extended-interval contraception pills come in packs of 91 pills. The first 84 tablets have both estrogen and progestin. The last 7 pills are placebos. Menstrual bleeding occurs during the placebo days. With this schedule, menstrual bleeding happens once every 3 months.
• Continuous contraception pills come in packs of 28 pills. All pills in the pack contain estrogen and progestin. With this schedule, regular menstrual bleeding does not happen, but there may be spotting or irregular bleeding.

Progestin-only pills

This type of pill is often called the mini-pill and contains the progestin hormone only. It comes in packs of 28 pills. In some packs, the last 4 pills are placebos. The pill must be taken at the same time every day. This is very important to prevent pregnancy. Menstrual bleeding may not be regular or predictable.

What are the advantages?

• Menstrual period cramps.
• Irregular menstrual cycle or bleeding.
• Heavy menstrual flow.
• Abnormal uterine bleeding.
• Acne, depending on the type of pill.
• Polycystic ovarian syndrome (POS).
• Endometriosis.
• Iron deficiency anemia.
• Premenstrual symptoms, including severe irritability, depression, or anxiety.

• Reduce the risk of endometrial and ovarian cancer.
• Be used as emergency contraception.
• Prevent ectopic pregnancies and infections of the fallopian tubes.

What can make OCPs less effective?

• You forget to take the pill every day. For progestin-only pills, it is especially important to take the pill at the same time each day. Even taking it 3 hours late can increase the risk of pregnancy.
• You have a stomach or intestinal disease that reduces your body's ability to absorb the pill.
• You take OCPs with other medicines that make OCPs less effective, such as antibiotics, certain HIV medicines, and some seizure medicines.
• You take expired OCPs.
• You forget to restart the pill after 7 days of not taking it. This refers to the packs of 21 pills.

What are the side effects and risks?

• Headache.
• Depression.
• Trouble sleeping.
• Nausea and vomiting.
• Breast tenderness.
• Irregular bleeding or spotting during the first several months.
• Bloating or fluid retention.
• Increase in blood pressure.

• Blood clots.
• Heart attack.
• Stroke.

Follow these instructions at home:

Follow instructions from your health care provider about how to start taking your first cycle of OCPs. Depending on when you start the pill, you may need to use a backup form of birth control, such as condoms, during the first week. Make sure you know what steps to take if you forget to take the pill.

Summary

• Oral contraceptive pills (OCPs) are medicines taken by mouth to prevent pregnancy. They are highly effective when taken exactly as prescribed.
• OCPs contain a combination of the hormones estrogen and progestin (synthetic progesterone) or progestin only.
• Before you start taking the pill, you may have a physical exam, blood test, and Pap test. Your health care provider will make sure you are a good candidate for oral contraception.
• The combination pill may come in a 21-day pack, a 28-day pack, or a 91-day pack. Progestin-only pills come in packs of 28 pills.
• OCPs can sometimes cause side effects, such as headache, nausea, breast tenderness, or irregular bleeding.