Birth Control Hormonal Methods (cont.)

Birth control pills, also known as oral contraceptives, have been marketed in the United States since 1962. Over the past 40 years, the type of estrogen and progestin (hormones) used in the pills has changed and the amounts of those hormones has been lowered.

Birth control pills today are designed to improve safety and reduce side effects. Lower doses of estrogen are associated with a decrease in side effects, such as weight gain, breast tenderness, and nausea.

Birth control pills are taken by mouth and swallowed with a liquid. In late 2003, the US Food and Drug Administration (FDA) approved a spearmint-flavored chewable birth control pill called Ovcon 35. These pills contain the same hormones, progestin and estrogen, that are present in standard birth control pills. Packages contain 21 active pills and 7 inactive pills to be taken throughout one menstrual cycle. You may chew the pills or swallow them whole. If you chew the pill, you should drink eight ounces of water afterward to make sure the full dose reaches your stomach. The chewable version has similar side effects to other birth control pills, such as an increased risk for blood clots, heart attacks, and strokes.

Over 30 different combinations of birth control pills are available in the United States. Most of the combinations of these pills have 21 hormonally active pills followed by seven pills containing no hormones. A woman begins taking a pill on the first day of her period or the first Sunday after her period has begun. By taking a pill a day, a woman can usually take pills consistently throughout her cycle.

• Monophasic pills:These have a constant dose of both estrogen and progestin in each of the hormonally active pills.
  
  
• Phasic pills:These combinations can alter either or both hormonal components to try to mimic the natural menstrual cycle.

If a woman misses 1 or 2 pills, she should take 1 tablet as soon as she remembers. She then takes 1 tablet twice daily until each of the missed pills has been accounted for. Women who have missed more than 2 consecutive pills should be advised to use a backup method of birth control at the same time, finishing up the packet of pills until her next period.

The pills prevent ovulation (release of an egg) and thus prevent pregnancy.

• How effective: Pregnancy rates range from 0.1% with perfect use to 5% with typical use.
  
  
• Advantages: Birth control pills are used to treat irregular menstrual periods. Women can manipulate the cycle to avoid a period during certain events, such as vacations or weekends by extending the number of intake days of hormonally active pills or by skipping the nonactive pill week. Birth control pills prevent certain conditions, such as benign breast disease, pelvic inflammatory disease (PID), and functional cysts. Functional cysts are reduced by the suppression of stimulation of the ovaries. Ectopic pregnancies are prevented by the cessation of ovulation. Birth control pills have been known to prevent certain ovarian and endometrial cancers.
  
  
• Disadvantages: Problems in taking birth control pills include nausea, breast tenderness, breakthrough bleeding, no periods, headaches, depression, anxiety, and lower sexual desire. Birth control pills do not provide protection from sexually transmitted diseases (STDs). Taking the pills daily and consistently (same time every day) is important. If a woman stops taking birth control pills, she may need a few months to get her normal ovulatory cycle back. After 6 months, her health care provider may need to examine her.
  
  
• Additional risks:Some women may be at risk for blood clots (venous thrombosis). At particular risk are heavy smokers (especially those older than 35 years), women with high or abnormal blood lipids (cholesterol levels), and women with severe diabetes, high blood pressure, and obesity.

The association of birth control pill use and breast cancer in young women has been controversial, although more recent studies show that birth control pills will not increase one's risk to develop breast cancer.

The relationship between birth control pill use and cervical cancer is also quite controversial. Important risk factors include early sexual intercourse and exposure to the human papillomavirus. The thinking now is that if birth control pills increase the risk of cervical cancer, the risk is small and related to sexual behavior. Thus, women who use birth control pills should have a periodic Pap test.