What is it?
Combined oral contraceptive pills, also known as “the female pill,” are medications that contain estrogen and progestin. These pills prevent the ovaries from releasing an egg (ovulation). They also alter cervical mucus and the endometrium, making it harder for sperm to reach the egg and for a fertilized egg to implant in the uterine lining.
There are different types of combined oral contraceptive pills, which vary in their doses of estrogen and progestin. Continuous-dose or extended-cycle pills allow you to reduce the number of menstrual periods you have each year. If you are considering using combined oral contraceptive pills, your gynecologist can help you decide which type is most suitable for you.
Why take combined oral contraceptive pills?
Combined oral contraceptive pills are a reliable form of birth control that can be easily reversed at any time you choose. Your fertility can return to normal almost immediately after stopping the pills.
Additional benefits of these contraceptive pills include:
- Reduced risk of ovarian and endometrial cancer
- Prevention of ectopic pregnancy
- Improvement in acne
- Less severe menstrual crampsdysmenorrhea).
- Reduction of androgen production caused by polycystic ovary syndrome (PCOS).
- Decreased heavy menstrual bleeding due to uterine fibroids or other causes, and lower risk of iron-deficiency anemia
- Relief from premenstrual syndromePMS).
- Shorter, lighter, and more predictable periods
- Better cycle control and reduced hot flashes in women approaching menopause with your gynecologist (perimenopause)
Combined oral contraceptive pills are available in different combinations of active and inactive tablets, such as:
Conventional pack
The most common type contains 21 active pills and seven inactive pills. There are also formulations with 24 active pills and four inactive pills. You take one pill every day and start a new pack when you finish the previous one (every 28 days). Bleeding occurs each month during the week when you take the last four to seven inactive pills.
Continuous dosage or extended-cycle pack
These usually contain 84 active pills and seven inactive pills. Bleeding typically occurs only four times a year, during the seven days when you take the inactive pills.
There is also a 365-day pill available. You take this pill at the same time every day. For some women, menstrual periods stop completely, while for others, they become significantly lighter.
Continuous-dose and extended-cycle pills may offer additional benefits from menstrual suppression, such as:
- Prevention and treatment of excessive bleeding associated with Uterine fibroids.
- Prevention of menstrual migraines
- Reduction in the worsening of certain neurological conditions linked to menstruation, including seizures
- Relief from pain associated with endometriosis.
However, combined oral contraceptives are not suitable for all women. Ο gynecologist may recommend another form of contraception if you:
- Are in the first month of breastfeeding
- Are over 35 years old and smoke
- Have poorly controlled high blood pressure
- Have a history or current condition of deep vein thrombosis (DVT) or pulmonary embolism
- Have a history of stroke or heart disease
- Have a history of breast cancer.
- Experience migraines with aura
- Have diabetes with complications, such as nephropathy, retinopathy, or neuropathy
- Have liver disease
- Have unexplained uterine bleeding (metrorrhagia)
- Must remain immobilized for a prolonged period due to major surgery
Risks
It is estimated that 9 out of 100 women who use combined oral contraceptive pills will become pregnant during the first year of use. With perfect use, according to instructions, the pregnancy rate is less than 1 in 100 women per year. Although taking combined oral contraceptive pills during early pregnancy does not increase the risk of birth defects, it is best to stop taking them immediately if you suspect that you are pregnant. Combined oral contraceptive pills do not protect against sexually transmitted infections (STIs). Combined oral contraceptive pills may cause side effects such as:
- Breakthrough bleeding or spotting — more common with continuous-dose or extended-cycle pills
- Breast tenderness
- Increased blood pressure
- Headaches
- Nausea
- Bloating
Some side effects — including nausea, headaches, breast tenderness, and bleeding — may decrease with continued use. Combined oral contraceptive pills, however, increase the risk of certain conditions, which can be serious. Some of these include:
- Blood clots in the legs
- Heart attack and stroke, especially if you smoke
- Liver disorders
- Gallbladder disease
Contact your gynecologist as soon as possible if you are taking combined oral contraceptive pills and experience:
- Abdominal pain
- Breast lump
- Chest pain
- Depression
- Difficulty speaking
- Eye problems, such as blurred or double vision or loss of vision, fainting
- Jaundice — yellowing of the skin
- New or worsening headaches
- Seizures
- Severe allergic skin rash
- Severe leg pain or swelling
- Severe mood changes
- Two missed periods or signs of pregnancy
How to prepare for the proper use of contraceptive pills
You will need to obtain a prescription for combined oral contraceptive pills from your gynecologist. The gynecologist will check your blood pressure, weight, and medical history, including any medications you are currently taking. They will also discuss your concerns and preferences to help determine which type of combined oral contraceptive pill is most suitable for you. Gynecologists generally recommend pills with the lowest effective hormone dose that can help prevent pregnancy, provide additional non-contraceptive benefits, and minimize side effects. While the estrogen content in combination pills can be as low as 10 micrograms (mcg) of ethinyl estradiol, most pills contain around 35 mcg.
Low-dose pills may lead to more breakthrough bleeding compared to pills with higher estrogen levels. Combined pills are classified based on whether the hormone doses remain constant or vary throughout the cycle:
- Monophasic: Each active pill contains the same amount of estrogen and progestin.
- Biphasic: The active pills contain two combinations of estrogen and progestin.
- Triphasic: The active pills contain three combinations of estrogen and progestin.
In some types, the progestin content increases over the cycle. In others, the progestin dose remains constant, while the estrogen content increases.
What to expect and what to watch for:
To use combined oral contraceptive pills correctly:
Consult your gynecologist about a suitable start date.
If you are using the quick-start method, you can take the first pill immediately from your pack.
If you are using the Sunday-start method, take your first pill on the first Sunday after your period begins.
With either method, use a backup form of contraception for the first seven days of taking the pills.
If you are using the first-day-start method, take your first pill on the first day of your next period — in this case, no backup contraception is needed. Choose a consistent time each day to take your pill. Establishing a routine helps prevent missed doses and ensures you take it at the same time daily. For example, consider taking your pill when you brush your teeth in the morning. Follow your gynecologist’s instructions carefully. Birth control pills are effective only when used correctly, so make sure you understand the directions.
If you are using conventional combined oral contraceptive pills and want to have regular periods, take all pills in your pack — both active and inactive — and start a new pack the day after finishing the current one.
If you wish to avoid monthly periods, ask your gynecologist how to take the pills and how many packs of active pills you can use in a row.
Be careful with missed pills:
If you miss one active pill, take it as soon as you remember — even if that means taking two active pills in one day.
Continue the rest of the pack as usual and use a backup method for seven days if the pill was missed for more than 12 hours.
Εάν χάσετε περισσότερα από ένα ενεργά χάπια, πάρτε αμέσως το τελευταίο χάπι που χάσατε.
If you miss more than one active pill, take the last missed pill immediately, then continue the rest of the pack as normal and use backup contraception for seven days.
If you had unprotected sex, consult your gynecologist about emergency contraception.
Do not take breaks between packs.
Always have your next pack ready before finishing the current one.
If you vomit within two hours after taking a combined oral contraceptive pill, or experience severe vomiting or diarrhea for two or more days, treat it as if you missed a pill.
