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Contraception and the pill: let's talk about it. - (Contraceptive options part 1)

Contraception is a huge area and covers a vast array of different methods, of which I will focus on the combined oral contraceptive pill (COCP) and the progesterone only pill (POP) today, and will cover other methods in part two. I was going to try cover them all in one post but then it started looking like a bit of a whole chapter on contraception! So we’ll start with the pills and cover IUDs, the implant, emergency contraception and more, in the next post on contraception. Contraception doesn’t need to be a taboo subject, so let’s have a little chat about it! (if you think it is a taboo subject - you're probably too young to be reading this!)


The most commonly used form of contraception is the combined oral contraceptive pill, however many other options exist and all are viable options depending on your needs.





 

What is the combined oral contraceptive pill?

Combined just refers to the fact that there are two hormones working away in there, which are 1. A type of oestrogen and 2. A type of progesterone. Put simply, the combined pill works via oestrogen preventing ovulation, by suppressing the natural release of sex hormones. Progesterone also helps by inhibiting the sperm from travelling into the cervix by thickening the cervical mucus. There are many different versions of the combined pill, which differ based on the hormones present, and/or the. amounts of these hormones present, and different pills. Will suit different people




How do my doctor and I decide which pill is best for me?


Preventing conception is not a disease, which is really important to remember, therefore balancing between benefit from prevention of pregnancy vs the possibility of pregnancy is not the same as with medicines used to treat disease (i.e. when you treat a disease you may have some side effects which you can tolerate because the benefits of treating the condition outweigh the side effects). The impact of adverse effects from contraceptives is proportionately greater as a result.


There are several options with regards to the suitability of an oral contraceptive to you, and it is

important to pick the appropriate treatment with several factors taken into consideration.

Firstly, your doctor will ascertain certain factors about your lifestyle, past medical and family history and certain personal preferences.Some questions you may be asked, and investigations which may be carried out, include the following:

Woman and her doctor discuss contraception
Discuss contraceptive options with your doctor

1. Do you smoke? Smoking greatly increases the risk of the development of a clotting event which is also an important risk to consider as it is associated with the combined oral contraceptive. If there is already an increased risk of clotting (leading to stroke, deep vein thrombosis, etc), then the combined oral contraceptive pill would not be appropriate as it increases your risk further.



2. Are you over the age of 35? Being over the age of 35 puts you at greater risk of having a blood-clotting related issue as explained above, so other options are recommended instead, if this is the case.


3. What is your BMI? Your doctor or pharmacist can calculate your BMI by measuring your weight and height. This is important as if your BMI is in the obese range, you would be at greater risk of a blood-clotting event, like deep vein thrombosis, and other options would be explored (such as progesterone-only pill – which we will come to later).


4. Have you used an oral contraceptive before/are you using one currently? If so, which contraceptive pill, and why do you want to change? This is important, as the reason you want to change will help to determine the pill you change to, e.g. if you are suffering from side effects, there may be a pill which will mean you are less likely to suffer from these side effects. Also, when switching from one pill to another, the new pill will not always have contraceptive efficacy immediately, and if you do not do so already, you may have to use a barrier method (condom) for one week while you take the pill.


5. Do you take any other medications? Some medications may interact with the pill and make it less effective, or the. pill may make your other medications less effective, so speak to your doctor about taking it with your other medications also, e.g. some epilepsy medications, some antibiotics… and others.. so always be sure that your pill does not interact with other medications by asking your doctor or pharmacist.


6. What is your preference? Would you like to take a pill every day? Have an implant and not have to think about contraception for up to three years? Do you think you would forget to take a pill but could manage a once-weekly patch? The choices available to you will depend on your answers to the questions above, but it is great to know that there are so many options out there to choose . from.

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How the combined oral contraceptive pill is taken:


It is taken at the same time every day, e.g. 9am when you start work, 1pm when on lunch etc, whatever time suits you, and a time that you can stick to.


There are plenty of apps available which can help you to remember to take your pill, or you can use the reminders app on your phone. Even write a note and stick it on your mirror so you see it! Whatever works for you, and you can talk to your pharmacist about the best time for you and devise a plan together if you wish.


With the combined contraceptive pill, if you forget to take it, but when you remember it is within 12 hours of the usual time, you still have full efficacy of the pill e.g. if you normally take it at 9 am but you forget and remember at e.g. 2pm, or even 8.30 pm, you are still good to go, but I just wouldn’t make a habit of it, as you may not remember at all next time, and it has best efficacy when taken perfectly. This pill is usually taken for 21 days straight, and followed by a 7 day break, after which you start the 21/7 cycle again. However, your doctor may recommend a different regimen for you such as 21/4 or without break for 3 months then break… but do not alter your cycle from 21/7 unless your doctor has told you this is okay to do so, as it is not licensed.


Benefits Vs Risks of taking the combined oral contraceptive pill



Benefits and side effects of combined hormonal contraception
Benefits and side effects of combined hormonal contraception


 

Progesterone-only contraception

Progesterone-only pill – this contraceptive pill, as the name suggests, contains only progesterone, so works by preventing sperm from penetrating into the cervix and meeting the egg, but does not usually prevent ovulation, and has the same rates of effectiveness as the combined oral contraceptive, with both perfect and typical use.


How the progesterone-only pill is taken


The major difference between taking the combined pill and the progesterone-only pill, or ‘mini-pill’, is that the progesterone-only pill is always taken continuously, without any break, and usually the window of time within which you have to take your pill is shorter – i.e. 3 hours as opposed to the 12 hour window you have with a combined pill. However, the progesterone-only pill Cerazette allows a 12 hour window if you forget to take it.


Advantages: This is a great option for women who cannot take the combined oral contraceptive pill for the reasons outlined above (smoking, over the age of 35, other medications which interact, obesity, family history of heart/blood clotting problems… etc.). It is also safe to use if you are breastfeeding. You can use it at any age, within the childbearing-age window of course. It can reduce the symptoms of PMS and painful periods.


Disadvantages of progesterone-only pill: The progesterone-only pill can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings. If these do not go after a few months, it may help to change to a different pill. You also may not have regular periods while taking it. Your periods may be lighter, more frequent or may stop altogether. It does not protect you against sexually transmitted infections.

You need to remember to take it at the same time every day.

Some of the other possible side effects of the progestogen-only pill are: acne, breast tenderness and breast enlargement, an increased or decreased libido (sex drive), mood changes, headache and migraine, nausea or vomiting, cysts (small fluid-filled sacs) on your ovaries (these are usually harmless and disappear without treatment), stomach upset, weight gain.


 

Vomiting and diarrhoea:

When on:

- Progesterone-only pill:


- If you vomit within two hours of taking a pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

- If the replacement pill is not taken within three hours (12 hours for the 12-hour pill) of your normal time, use additional contraception, such as condoms, for two days.

- If you continue to be sick, keep using another form of contraception while you are ill and for two days after recovering.

- Very severe diarrhoea (six to eight watery stools in 24 hours) may also reduce the effectiveness of the pill. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for two days after recovering.

- Speak to your GP or family planning nurse if you are unsure whether or not you are protected or if your sickness or diarrhoea continues.


- The combined pill:

- If you vomit within two hours of taking a pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time. You should still be protected from pregnancy.

- However, if you continue to be sick, you may not be protected from pregnancy. Very severe diarrhoea (six to eight watery stools in 24 hours) may also reduce the effectiveness of the pill. Keep taking your pill as normal but use additional contraception while you have diarrhoea.

- Speak to your GP or family planning nurse .


Oh no! I’ve missed a pill, what do I do?




Don’t panic! Your patient information leaflet is your best friend here. It usually contains advice on what to do if you miss a pill, and if you have thrown it out, log onto the hpra.ie and search for your pill, or else type e.g. Yasmin PIL into google and it should come up. This is an example of an excerpt from a PIL (other patient information leaflets for other pills may differ in the advice they give, this is just an example), which gives advice about what to do if you miss your pill:



I have included some advice for missing pills below also:


- For the combined oral contraceptive pill: (Source: HSE information on contraceptive pills, link below in ‘useful links’)


If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

If you have missed one pill, anywhere in the pack:

Take the last pill you missed now, even if it means taking two pills in one day

If you forget a pill in the first week (week one) or the last week (week 3) of your pack, extra precautions may be necessary, so refer to your patient information leaflet, and if that doesn't clear things up for you, speak to your doctor or pharmacist, who will talk you through the best option(s).


If you have missed two or more pills (more than 48 hours late), anywhere in the pack:

take the last pill you missed now, even if it means taking two pills in one day. Leave any earlier missed pills. You may need emergency contraception, so speak to your doctor or pharmacist if you have missed two pills and are sexually active. You may need to start the next pack of pills without a break, but this will depend on the advice of your doctor or pharmacist


For the progesterone-only pill:


If you forget to take a progestogen-only pill, what you should do depends on:

1. The type of pill you are taking

2. How late you are taking the pill and

3. How many pills you have forgotten to take

4. Whether you have had sex without using another form of contraception during the previous seven days.

Again, referring to the handy patient information leaflet should give you all the information you need.


If you are taking a three-hour progestogen-only pill and you are less than three hours late taking it, or you are taking the 12-hour progestogen-only pill and are less than 12 hours late, you do not need to worry. Take the late pill as soon as you remember and the remaining pills as normal. Your contraceptive protection will not be affected, so you do not need to use any additional contraception. Do not worry if you have had sex without using another form of contraception. You do not need emergency contraception.


However! If you are taking a three-hour progestogen-only pill and you are more than three hours late taking it, or you are taking the 12-hour progestogen-only pill and are more than 12 hours late, follow the advice below:

Take the last pill you missed straight away (if you have missed more than one, take only one) take your next pill at the normal time.

Depending on when you remember, it may mean taking two pills on the same day (one at the time of remembering and one at the regular time), or even at the same time.

You will not be protected from pregnancy, so use additional contraception, such as condoms, for the next two days after taking the missed pill.


If you have recently had unprotected sex, you may need emergency contraception. Seek advice straight away from your GP or local sexual health clinic.


PLEASE NOTE: NB NB NB: Oral contraceptive pills do NOT protect against STI's. Use of a condom with a contraceptive pill is recommended, unless you are in a long term relationship and both of you have been tested for STI's, and neither of you have any.

 

I hope this post has shed some light on contraceptive pills for you, whether you are new to taking a pill, thinking about taking one, or already on one but wondering about other options. I will do a part two to this post where I will talk about Intrauterine devices, the implant, condoms and other contraceptive options that are available.


As always, if you have any questions or queries, send me a message or email, and if you want to you can pop questions/comments in the comments below. Also, feel free to read up more on this topic with some of the links I have posted at the bottom.


Love,


Lauren


Helpful links:



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