What is Oral Contraceptive Pill (OCP)?
Birth control methods to prevent pregnancy include barrier methods (condoms, cervical cap), birth control pills,spermicide, intrauterine device and sterilization. Oral contraceptive pills is one effective method of contraception whereby you ingest the pills orally. The OCP which contains hormones (usually progestins and estrogens) works by preventing ovulating (preventing the egg release from from ovary), thins the lining of the the womb to reduce chance of implantation and thicken the cervical mucus which prevent fertilisation of egg by the sperm in the uterus (womb).
When taken correctly, it's effectiveness if about 99.9%. This means that fewer than one woman in 100 who use the combined contraceptive pill will get pregnant in one year. Certain medications like Rifampicin, ampicillin, tetracyclines, HIV drugs, Anti-seizure medications (carbamazepine, phenytoin, barbiturates topiramate) and St John's wort may make contraceptive pills less effective as they affect the liver enzymes. The pill may also be less effective if you have diarrhea or vomiting.
Types of Combination contraceptive pills
The pills contain synthetic hormones (estrogens and progestins). Most of the pills are active containing the hormones whereas the remaining pills are inactive (do not contain hormones). The types of combination ocp are:
Progestin-only pills
Progestin-only pills contain progestin without estrogen. They are also called the minipill. Progestin-only pills are suitable for women who can’t take estrogen due to certain health conditions for example those with history of strokes, deep vein thrombosis, cervical and breast cancer patients. With these progestin-only pills, all pills in the cycle are active. As there are no inactive pills, so you may or may not have a period while taking these pills.
Medical indications for taking OCP
OCP not only is used for preventing pregnancy. It can also be used to treat and help certain medical conditions below:
Taking the pill
If you start the OCP on day one of your menstrual cycle you will be protected from pregnancy straight away. You do not requie additional contraception.
If you start the pill on the fifth day of your menses or before, you will still be protected from pregnancy straight away, unless you have a shorter menstrual cycle for example if your period cycle is every 23 days or less. If so, you will need additional contraception, such as condoms, until you have taken the pill for 7 days.
If you start the pill on any other day of your menstrual cycle, you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days.
Once you start the pill, it is best not to skip any pill and to take the pill at roughly the same times daily.
Missed pills
If you miss a pill or pills (> 24 hours since last pill ), or you if you start a new pack of OCP late (forgotten to take at usual time), this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:
BUT missing 2 or more pills, or starting the pack 2 or more days late (> 48 hours late) may affect the effectiveness of contraception. So if you have missed two or more pills or if you are taking your pill > 48 hours late anywhere in the pack: take the last pill you missed now (taking two pills in that day is fine), leave alone any earlier missed pills then continue to finish the rest of the pack as usual and use an extra method of contraception for the next seven days. You may need to start the next pack of pills without a break for extra precaution.
You may need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (or if you are taking your pill > 48 hours late) in the first week of a pack. Emergency contraception is often called the morning after pill (e.g. Postinor).
If there are seven or more pills left in the pack after the last missed pill: You have to finish the pack and take the usual seven-day break.
If there are fewer than seven pills left in the pack after the last missed pill: You have to finish the pack and start the new second pack the next day, without having a break.
How to take the pill post-delivery
If you have just delivered and are not breastfeeding, you can start the pill on day 21 after delivery. By doing so, you will be protected against pregnancy straight away. If you start the pill later than 21 days after delivery, you will need additional contraception (such as condoms) for the next 7 days.
If you are breastfeeding a baby less than six months old, taking the pill will reduce the milk flow. If you are lactating then you must consider another method of contraception until you stop breastfeeding.
Taking the pill after miscarriage or abortion
If you have had an abortion or miscarriage, you can start the pill up to five days after this and then you will be protected from pregnancy straight away. But should you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception (e.g. condoms) until you have taken the pill for seven days.
Contraindications to taking OCP
You should not take OCP if you have the following medical conditions/ criteria:
Advantages of OCP
Side effects of OCP
The first generation contraceptive pill had a higher concentration of the both oestrogen and progestin. The first generation pill was linked to some health scares issues which resulted in a change in the amount of hormones used leading to the development of second generation contraceptive pill.
The second generation of contraceptive pills came into market in the 1970s, and contain much lower amount of hormones. They contain progestins such as levonorgestrel and norethisterone. Brand include microgynon.
Then in the 1980s come third generation of contraceptive pills. This group of pills uses progestins such as norgestimate, desogestrel, gestodene and cyproterone acetate. Brands include Yasmin, Diane, gynera and Marvelon.
The most recent 4th generation contraceptive pills contain the progestin called drospirenone. Brands include yaz , zoely and qlaira.
Lately there have been some studies that suggest that newer generations of contraceptive pill have higher risk of thrombosis compared to the second generation pills.
Birth control methods to prevent pregnancy include barrier methods (condoms, cervical cap), birth control pills,spermicide, intrauterine device and sterilization. Oral contraceptive pills is one effective method of contraception whereby you ingest the pills orally. The OCP which contains hormones (usually progestins and estrogens) works by preventing ovulating (preventing the egg release from from ovary), thins the lining of the the womb to reduce chance of implantation and thicken the cervical mucus which prevent fertilisation of egg by the sperm in the uterus (womb).
When taken correctly, it's effectiveness if about 99.9%. This means that fewer than one woman in 100 who use the combined contraceptive pill will get pregnant in one year. Certain medications like Rifampicin, ampicillin, tetracyclines, HIV drugs, Anti-seizure medications (carbamazepine, phenytoin, barbiturates topiramate) and St John's wort may make contraceptive pills less effective as they affect the liver enzymes. The pill may also be less effective if you have diarrhea or vomiting.
Types of Combination contraceptive pills
The pills contain synthetic hormones (estrogens and progestins). Most of the pills are active containing the hormones whereas the remaining pills are inactive (do not contain hormones). The types of combination ocp are:
- Monophasic 21-days pill: Each pill has the same amount of hormone in it. For 21 days, one pill is taken daily and then no pills are taken for the next 7 days . Brands available include Microgynon, Brevinor and Cilest. If its the monophasic 28 days pack: you will be taking 21 days active pills and for the last week you will be taking the inactive pills for example Mircette.
- Multiphasic pills: These are used in one-month cycles and provide different levels of hormones during the cycle. During the last week of the cycle, you take inactive pills.
- Extended-cycle pills: These are typically used in for 13-week cycles. You will take active pills for 12 weeks continuously, and then on the last week of the cycle (13th week), you take inactive pills and have your menses. As a result, you have your period only 3-4 times per year (every quarterly).
Progestin-only pills
Progestin-only pills contain progestin without estrogen. They are also called the minipill. Progestin-only pills are suitable for women who can’t take estrogen due to certain health conditions for example those with history of strokes, deep vein thrombosis, cervical and breast cancer patients. With these progestin-only pills, all pills in the cycle are active. As there are no inactive pills, so you may or may not have a period while taking these pills.
Medical indications for taking OCP
OCP not only is used for preventing pregnancy. It can also be used to treat and help certain medical conditions below:
- Abnormal uterine bleeding
- Acne related to excessive male hormones
- Dysmenorrhea (painful menses)
- Emergency contraception within 72 hours of unprotected intercourse
- Endometriosis
- Hirsutism in females (male-like hair growth on face and body)
- Hyperandrogenism (excessive production of male hormones)
- Menorrhagia (excessive menses bleeding)
- Polycystic ovary syndrome (symptoms that include amenorrhea, hirsutism, infertility, and many ovarian cysts)
- Stop continuous abnormal uterine bleeding
Taking the pill
If you start the OCP on day one of your menstrual cycle you will be protected from pregnancy straight away. You do not requie additional contraception.
If you start the pill on the fifth day of your menses or before, you will still be protected from pregnancy straight away, unless you have a shorter menstrual cycle for example if your period cycle is every 23 days or less. If so, you will need additional contraception, such as condoms, until you have taken the pill for 7 days.
If you start the pill on any other day of your menstrual cycle, you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days.
Once you start the pill, it is best not to skip any pill and to take the pill at roughly the same times daily.
Missed pills
If you miss a pill or pills (> 24 hours since last pill ), or you if you start a new pack of OCP late (forgotten to take at usual time), this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:
- when the pills are missed
- how many pills are missed
BUT missing 2 or more pills, or starting the pack 2 or more days late (> 48 hours late) may affect the effectiveness of contraception. So if you have missed two or more pills or if you are taking your pill > 48 hours late anywhere in the pack: take the last pill you missed now (taking two pills in that day is fine), leave alone any earlier missed pills then continue to finish the rest of the pack as usual and use an extra method of contraception for the next seven days. You may need to start the next pack of pills without a break for extra precaution.
You may need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (or if you are taking your pill > 48 hours late) in the first week of a pack. Emergency contraception is often called the morning after pill (e.g. Postinor).
If there are seven or more pills left in the pack after the last missed pill: You have to finish the pack and take the usual seven-day break.
If there are fewer than seven pills left in the pack after the last missed pill: You have to finish the pack and start the new second pack the next day, without having a break.
How to take the pill post-delivery
If you have just delivered and are not breastfeeding, you can start the pill on day 21 after delivery. By doing so, you will be protected against pregnancy straight away. If you start the pill later than 21 days after delivery, you will need additional contraception (such as condoms) for the next 7 days.
If you are breastfeeding a baby less than six months old, taking the pill will reduce the milk flow. If you are lactating then you must consider another method of contraception until you stop breastfeeding.
Taking the pill after miscarriage or abortion
If you have had an abortion or miscarriage, you can start the pill up to five days after this and then you will be protected from pregnancy straight away. But should you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception (e.g. condoms) until you have taken the pill for seven days.
Contraindications to taking OCP
You should not take OCP if you have the following medical conditions/ criteria:
- Depression
- Diabetes
- Epilepsy
- Hypertension and other heart diseases
- History of stroke, pulmonary embolism, breast cancer, liver disease, gall bladder disease
- Overweight ( increased risk for metabolic syndrome and cardiovascular disease)
- Pregnancy
- Prolonged bed rest (increase risk of pulmonary embolism)
- Severe migraines
- Smoker who is above 35 years old (increase risk of thrombosis)
- Stopped smoking < 1 year and above 35 years old
Advantages of OCP
- Regulates menstrual cycle and reduce flow and pain during menses
- Does not affect sex drive
- Reduces risk of colon cancer, ovarian cancer and endometrial cancer
- Helps in acne related to over-driven male hormones
- Reduces symptoms of pre-menstrual symptoms (PMS)
Side effects of OCP
- Headaches
- Nausea, vomiting
- Breast tenderness
- Increase blood pressure
- Does not protect you against sexually transmitted disease
- May have spotting and breakthrough bleeding during the first few months of medicine, thereafter should normalize
- Swelling of ankles (water retention)
- No evidence to show weight gain, any weight gain probably is multi-factorial due to water retention. Usually normalize after a few months
- increased risk of cardiovascular diseases especially in those who have history of heart diseases, hypertension, smokers
- increased risk of thrombosis (blood clot) hence increased risk of stroke, heart attack and pulmonary thrombosis
- might increase risk of breast cancer, cervical cancer and a rare form of liver cancer. Regular breast screening and pap smear is recommended.
- May worsen depression in patients who have history of major depression
The first generation contraceptive pill had a higher concentration of the both oestrogen and progestin. The first generation pill was linked to some health scares issues which resulted in a change in the amount of hormones used leading to the development of second generation contraceptive pill.
The second generation of contraceptive pills came into market in the 1970s, and contain much lower amount of hormones. They contain progestins such as levonorgestrel and norethisterone. Brand include microgynon.
Then in the 1980s come third generation of contraceptive pills. This group of pills uses progestins such as norgestimate, desogestrel, gestodene and cyproterone acetate. Brands include Yasmin, Diane, gynera and Marvelon.
The most recent 4th generation contraceptive pills contain the progestin called drospirenone. Brands include yaz , zoely and qlaira.
Lately there have been some studies that suggest that newer generations of contraceptive pill have higher risk of thrombosis compared to the second generation pills.
