Birth control pills – Missed pills
In general birth control pills are very popular. Often pills called also “birth control pills” and/or “combined pills” and/or “combined oral contraceptives (COC)”. The effectiveness of different brands is fluctuating between 95% – 99% (if correctly used!). Combined pills contain estrogens and progesterone (or similar gestagens). The contraceptive effect of COCs is mainly due to inhibition of ovulation; they also cause thickening of the cervical mucus, making it difficult for sperm to pass into the uterine cavity and move towards the Fallopian tubes. The receptivity of the uterus (endometrium) to the fertilized eggs is also reduced. It is very important to mention that different brands suit different persons.
Birth control pills are available in packets of:
- 21 pills, where 1 pill containing the oestrogen/progestogen combination is taken every day for 21 days, then a break from pill-taking occurs for 7 days before starting a new packet; and
- 28 pills, where 1 pill containing the oestrogen/progestogen combination is taken every day for 21 days then, instead of a break, 7 placebo or iron pills are taken as the other pills in each packet to complete a full 28-day cycle.
Birth control pills – Starting the pill
Birth control pills
You can start the first cycle of pills within the first 5 days of your menstrual period, preferably on the first day. Some girls and women find it convenient to start the pill on a particular day of the week (e.g., Sunday, Monday); if you wish to do so and that day is beyond the fifth day of your menstrual cycle, just be sure that you are not pregnant and use additional contraceptive protection against pregnancy for the next 7 days.
Birth control pills – Taking the pill
You should take 1 pill every day at the same time until the packet is finished; you should not interrupt taking the pills before a packet is finished, even if you does not have sexual intercourse.
Birth control pills – Starting a new packet
If you are using the 28-pill packet, you should start a new packet without a break the day after you finish the previous packet. If you are using the 21-pill packet, you should skip 7 days before starting a new packet. If the pills are taken correctly, you will always start a new packet on the same day of the week.
Birth control pills – MISSED PILLS
I would like to emphasize the importance of not forgetting any pill. If you miss one or more hormonal pills, you may have some spotting or breakthrough bleeding and, more importantly, you will be at a greater risk of becoming pregnant. The greatest risk is when you miss hormonal pills at the beginning or at the end of the cycle, because that is equivalent to prolonging the interval during which you do not take hormonal pills.
Birth control pills – What should be done if pills are missed?
For 30-35 μg ethinyloestradiol pills
- If 1or 2 hormonal pills are missed, you should take that pill as soon as you remembers. You should take the next pill at the usual time; this might mean that you has to take 2 pills on the same day or at the same time. You do not need any additional contraceptive protection.
- If 3 or more consecutive hormonal pills are missed or you start a pack 3 or more days late, you should take the hormonal pill as soon as possible and then continue taking pills daily, one each day. You should also use condoms or abstain from sex until you have taken hormonal pills for 7 days in a row.
- If you missed the pills in the third week you should finish the hormonal pills in your current pack and start a new pack the next day, not taking the 7 inactive pills.
- If you missed the pills in the first week and had unprotected sex, you may wish to consider the use of emergency contraception (so called Plan B or Morning after pills).
For 20 μg or less ethinyloestradiol pills
- If you misses 1 hormonal pill, you should follow the above instructions for missing 1 or 2 30-35 μg ethinyloestradiol pills.
- If you misses 2 or more hormonal pills or if you start the pack 2 or more days late, you should follow the above instructions for missing 3 or more 30-35 μg ethinyloestradiol pills.
For 30-35 μg and 20 μg or less ethinyloestradiol pills
- If 1 or more non-hormonal (placebo) pills are missed, you should discard the missed placebo pill(s) and continue taking the remaining pills once daily. Start the new pack as usual. No additional contraceptive protection is required.
Vomiting and diarrhea
Acute vomiting and/or diarrhea will interfere with the effectiveness of pills. If vomiting occurs within 1 hour after taking an active hormonal pill, you should take another active pill. If symptoms persist for more than 24 hours, it is recommended the use of additional contraceptive protection until you have been without these symptoms for 7 days. If severe vomiting or diarrhea continues for more than 2 or more days, you should follow the procedure for missed pills.
Other medications and Drug interactions
Certain medicines reduce the effectiveness of COCs, so you must always share information on all your medications with your doctor, whatever the reason for consultation. Drugs that induce liver enzymes, particularly those used in long-term treatments, may reduce the efficacy of pills. Such drugs include antibiotics (rifampicin & others), griseofulvin, phenytoin, ethosuximide, carbamazepine, glutethimide, barbiturates, primidone, topiramate, oxcarbazepine and some antiretroviral agents. Interference should be suspected if a client has inter-menstrual bleeding and spotting when using any of the above drugs together with pills. Read about Pills and Antibiotics, Pills and Yeast Infection and Pills and smoking.
Birth control pills – Side effects
The following side-effects (which should not be a reason to discontinue the method) are common during the first 3 cycles of COC use, and then usually disappear: Breakthrough bleeding; Mild nausea and/or dizziness; Breast tenderness; and Mild headaches.
Other side-effects include weight gain, fluid retention and depression. Most side-effects are usually tolerated by clients if they are supported by counseling. Sometimes symptomatic treatment may be required. If the problem is of serious concern, consider whether you should discontinue pills and, if so, use alternative methods of contraception.
Missed periods (irregular periods or amenorrhea) may also occur because of taking pills, which necessitates ruling out pregnancy, especially if pills have been missed or taken late. If missed periods continue in the absence of pregnancy, reassure that this does not mean any health risk. Another type of pill may be tried.
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