Our Bodies, Ourselves (49 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
SAFETY OF NONOXYNOL-9 WHEN USED FOR CONTRACEPTION
6
Many barrier methods of contraception are more effective when used with a spermicide. Unfortunately, Nonoxynol-9, the active ingredient in most spermicides, has been shown to increase the risk of HIV infection when used more than once a day by women at high risk of infection. This may be because women using N-9 have a greater risk of developing small sores on the labia or in the vagina, which can allow the virus to enter the body. Spermicides containing N-9 appear to be safe for women who use them less than once a day.
Some condoms come prelubricated with Nonoxynol-9. Because these condoms are no more effective in preventing pregnancy or infection than condoms lubricated with silicone, they are not recommended.
Because N-9 can be more damaging to the rectal lining than to the vaginal lining, condoms prelubricated with N-9 should not be used for anal sex.
Some women are now opting to use the Pill, patch, or ring continuously for several months in order to skip periods. Some new brands of pills are packaged to be used this way. If you do not have a brand of pills designed for continuous use, you can skip your periods by using regular monophasic pills this way: Take only active pills in one pack, skip the inactive pills, and go directly to the next packet of active pills. After three months, or when you begin to have spotting, take inactive pills for a week. Then begin using the active pills again. If you use the patch or ring, wear it for the recommended time, remove it, and immediately begin the next patch or ring. Studies show that using the pill continuously is as safe as using it with monthly bleeds.
7
The long-term health effects of using continuous hormonal contraception have not been studied.
8
Many women are happy to skip periods, although some miss the monthly reassurance that pregnancy has not occurred.
All hormonal methodsâthe Pill, patch, ring, minipill, and shotâare available by prescription only. You must see a health-care provider. The clinician will discuss your medical history with you, check your blood pressure, and give you any other medical exam that may be needed. If a hormonal contraceptive is right for you, the clinician will give you a prescription and may be able to give you a starter pack. Pelvic exams are not necessary to begin hormonal contraceptives.
Combined pills are the most popular type of birth control used in the United States and among the most commonly used methods worldwide. What is commonly referred to as “the Pill” is actually many different brands and several different regimens that may differ from one another in the dosage and type of hormones. Women can choose a regimen in which they bleed every month, every three months, or less frequently than that. You may need to try more than one type of pill before you find one that works well for you and does not cause unacceptable side effects.
Combined pills come in one-month or three-month packs. One pill is taken every day. Most of the pills have a combination of synthetic estrogen and progestin; the remaining pills have no hormones and are called spacer pills, sugar pills, or inactive pills. Bleeding begins during the time you take the inactive pills. The specific types of hormones and the number of active and inactive pills vary by brand.
The original birth control pills had twenty-one days of active pills and seven days of inactive pills. Some newer pills have twenty-four active pills and four inactive pills; this regimen reduces irregular bleeding. Many brands of these pills now have generic versions, which are less expensive than the new, patented varieties. Since the generic pills have been around for longer and are better studied, the risks associated with using them are better understood.
The Pill works by preventing the ovaries from releasing eggs. It also prevents fertilization by causing the cervical fluid to thicken, making it harder for sperm to enter the uterus. The Pill is a very effective method of birth control, although it does not protect against sexually transmitted infections, including HIV/AIDS.
With perfect use, the Pill is over 99 percent effective. Perfect use means that the woman takes a pill at about the same time every day and never misses a pill. With typical use, the Pill is about 92 percent effective. That means that about one
in thirteen women who use the Pill becomes pregnant in the first year of use.
⢠May cause lighter or more regular bleeding.
⢠May reduce painful periods.
⢠Does not interrupt spontaneity.
⢠May reduce incidence of ovarian cysts and fibrocystic breast changes.
⢠May relieve premenstrual syndrome (PMS).
⢠Protects against uterine and ovarian cancers.
⢠Provides some protection against pelvic inflammatory disease.
⢠Does not require a pelvic exam for use.
⢠May reduce acne.
⢠Certain types can be used for
emergency contraception
.
⢠Does not protect against STIs, including HIV.
⢠Must be taken as directed; can be difficult to remember.
⢠Can have unpleasant side effects on mood or libido.
⢠Raises risk of venous thromboembolism (blood clots in the veins), heart attack, and stroke for some women.
⢠Requires a prescription, which must be regularly filled.
If you begin taking the Pill within five days after your period starts or within five days after an abortion, it is effective immediately. If you begin at any other time, the Pill becomes effective after one week (so use a backup method or avoid intercourse during that week). To lower your risk of STIs, use condoms as well. Combining condom and pill use also increases your protection from pregnancy.
A common way to start taking the Pill is to begin on the first day of your period or the day of an abortion. Some women prefer to start on the first Sunday after they begin their period or the first Sunday after an abortion. Starting pills on Sundays has the advantage of usually having your period begin on a Monday or Tuesday, and thus not having periods on weekends.
Some health-care practitioners now recommend the Quick Start method. Following a negative pregnancy test, you take your first pill in the clinic or office. Use a backup form of birth control for one week.
Take one pill every day until you finish an entire pack. If you take your pill at the same time you brush your teeth, eat a meal, or perform another daily activity, it may be easier to remember. If you have a mobile phone, you can also set an alarm as a reminder to take your pill. Start a new pack immediately after you finish the old one.
Missing pills is the most common reason for becoming pregnant while using birth control pills. Missing the first day(s) of a new pack of pills is the most dangerous in terms of decreasing their effectiveness, so make sure to refill your prescription before you run out. If you forget to start a new pack on the right day or if you miss a pill during the cycle, here's what to do.
⢠If you are one or two days late starting the next package, take two pills as soon as you remember and one pill each day after. Use a backup form of birth control for one week.
⢠If you are three or more days late starting the next package, start with the first pill in the package and use a backup method of birth control until you have taken seven active
(hormonal) pills in a row. If you had unprotected intercourse during the time you missed pills, consider using
emergency contraception
. If you have questions, call your health care provider.
SAFETY OF THE PILL
The birth control pill is one of the most intensely researched medications in history. Since its development more than fifty years ago, it has been used by millions of women worldwide.
The early pill formulations raised concerns about blood clots, heart attack, and stroke, spurring exhaustive research on oral contraceptives beginning in the 1960s and '70s. Since then, new formulations of the Pill with low-dose hormones have been introduced, and today's pills contain about one-eighth to one-tenth of the estrogen in early pills. Research has concluded that today's birth control pills are safe for most women, and that healthy, nonsmoking women have little if any greater risk of heart attack or stroke than women who do not use the Pill.
Any woman of any age has a tripling of her risk of blood clots while on the Pill, although this risk is still quite small overall. To put the risk in perspective, the risk of a blood clot during pregnancy is double the risk of getting a blood clot while on the Pill. Women with some cardiovascular conditions or some chronic illnesses and women over age thirty-five who smoke should not take the Pill. In rare cases, women who use birth control pills may develop liver tumors. Some evidence suggests that oral contraceptive use slightly increases the risk of getting cervical cancer or breast cancer among women under thirty-five,
9
but these associations are controversial and have not been fully established.
Long-term use of the Pill provides significant noncontraceptive health benefits. Long-term use protects against ovarian and endometrial (uterine) cancers, and research suggests that these protective effects may last up to fifteen years or more after stopping the Pill. Women who take the Pill have lighter, shorter periods (thus reducing the risk of anemia), are less likely to develop ovarian cysts, and have a decreased incidence of pelvic inflammatory disease (PID).
Though the information listed above is based on research on the Pill only, it is reasonable to infer that the same cautions and side effects apply to all methods that contain both estrogen and progestin, such as the patch and the ring.
⢠If you miss one pill, take the missed pill as soon as you remember and take your next pill at your usual time. This may require taking two pills in one day. If you miss your pill by twenty-four hours, take both the one that is late and the one that is due.
⢠If you miss two pills in a row in the first two weeks of the pack, take two pills on the day you remember and finish the rest of the pack as usual. Use a backup form of birth control for one week.
⢠If you miss two pills in a row in the third week of the pack, keep taking one pill every day until you have finished the active (hormonal) pills. Then set aside the rest of the pack, including the inactive pills, and start taking a new pack of pills. Use a backup form of birth control for one week.
⢠If you miss three or more pills in a row in the first two weeks, take one pill as soon as you remember, then keep taking one pill every day. Use a backup method of birth control until you have taken seven active (hormonal) pills.
⢠If you miss three or more pills in a row in the third week, take one pill as soon as you remember, then keep taking one pill every day until you have finished the active (hormonal) pills. Don't take the inactive pills. Go directly to a new pack and take the whole pack. Use a backup form of birth control for one week.
Missing any of the last, inactive pills of a combined pill package will not raise your risk of pregnancy. Skip the pills you missed and be sure you start your next pack on time. (This is not the case
for the minipill.
) Know what regimen you are taking and which pills are active and which are inactive.
Women taking the pill often have shorter and lighter periods. A drop of blood, even if it is brown, during the week you are taking no hormonal pills is counted as a period when you are on the Pill.
If you miss one period and you took all of your pills correctly, and you don't have any signs of pregnancy, the chances of pregnancy are very low. It is not uncommon to miss a period while on the pill. If you miss two periods in a row, it could be either normal or a sign of pregnancy. Take a pregnancy test either at home or with a health-care provider, but keep taking your pills, in case you are not pregnant. If you become pregnant while on the Pill and continue your pregnancy, there is no evidence that the Pill increases the health risks to your baby.
Contraindications
Women who are over thirty-five and smoke generally should not take the Pill. Women who have any of the following conditions also should not take the Pill.
⢠Severe hypertension (high blood pressure)
⢠History of heart attack or stroke
⢠Clotting disorders or blood clots in the legs or lungs
⢠Migraine headaches with aura
⢠Unexplained vaginal bleeding (until diagnosed; then the Pill may be a treatment)
⢠Current breast cancer
⢠Known or suspected pregnancy
⢠Liver disease
⢠Heart disease
⢠Major surgery with prolonged immobilization
⢠Gastric bypass surgery
The Pill is generally not recommended for women who have a history of breast cancer, diabetes with complications, or certain types of gallbladder disease, or who take certain antiseizure medications or rifampin, a tuberculosis medication.
Women who have given birth should wait three weeks before beginning a birth control method that contains estrogen. Women are at high risk for blood clots for several weeks after a pregnancy, and adding a birth control method that contains estrogen increases that risk. Because estrogen can interfere with the quality or quantity of your milk production, women who
breastfeed may want to use a different method of birth control. (For more information, see
“Suitable Contraceptive Methods to Use While Breastfeeding.”
)
HORMONAL BIRTH CONTROL AND MOOD CHANGES
Studies of women using combined hormonal birth control methods have shown that they experience a variety of moods. For some women, birth control improves mood. Most studies of progestin-only birth control, such as Depo-Provera (the shot), an implant, and the Mirena IUD, show on average little or no difference in mood changes. However, there is enormous variability in any individual woman's response to her own hormones and any synthetic hormones she takes. Some women report feeling depressed when using hormonal birth control. Because Depo-Provera initially puts more progestin into the bloodstream than methods that emit a lower, steady dose of progestin, some women find it to have a greater negative effect on both mood and libido (sex drive) than other hormonal methods. For these reasons, it makes sense to pay attention to your body and emotions when using birth control methods that contain hormones.