De Guzman, Khurt Gabriel T.

BSN2 - BLK2

Birth Control pills

What are birth control pills?

Birth control pills are also known as oral contraceptives (OCs) or, simply, “the pill.” They offer
protection against pregnancy by blocking the union of sperm and egg, thereby preventing conception.

How do they work?

Oral contraceptives or birth control pills contain synthetic female hormones. They work largely by
preventing the release of an egg from an ovary, or ovulation. If no egg is released, there can be no
pregnancy.

Types of birth control pills

 Combination oral contraceptives are birth control pills that contain both ingredients. The active
ingredients in birth control pills are synthetic versions of the female hormones estrogen and
progesterone.

The various brands of combination birth control pills generally come packaged in blister packs
containing 21 or 28 tablets. After finishing the 21 day pack, there is a week without any pills when
withdrawal bleeding occurs. This will be like a regular menstrual period but generally lighter. Then a new
pack is started on the same day of the week as the start of the previous pack.

In the 28-day pack, typically 21 pills are active pills containing hormones and the other pills are
"reminder" pills without hormones. Some reminder pills may contain iron. By taking reminder pills, a
woman takes a pill each day, which can help maintain her birth control regimen. The progestin-only pills
come in 28-day packs with all the pills being active containing hormone. With pills containing continuous
hormone, there isn't any scheduled time of bleeding, but spotting or unexpected bleeding may occur.
  Progesterone-only pills. Sometimes referred to as "minipills," progestin-only pills are especially
useful for women who cannot take estrogens. They are also suitable for women who are
breastfeeding because they don't interfere with the production of milk.

The progestin-only or “mini-pills” contain only norethindrone and each pill is active (there are no
placebo, inactive pills). When you finish one pack of progestin-only pills, you start another pack the next
day. With progestin-only pills you will get your period in the fourth week, get no periods, or have
spotting during the month. Your periods may be heavier or lighter. Do not stop taking your progestin-only
pills.

Are there differences among birth control pills?

Birth control pills can differ not only in the number of active ingredients, but also in the way ingredients
are dosed:

Monophasic birth control pills contain the same amount of ingredient in each active pill.

Multiphasic birth control pills contain varying levels of hormones through the month. They were
designed to minimize side effects such as breakthrough bleeding, which is bleeding that occurs between
menstrual periods.

Low-dose oral contraceptives contain less estrogen than other types of birth control pills. They contain 20
micrograms of estrogen, compared to 30 to 50 in other birth control pills.

What are the side effects/health risks of birth control pills?

In healthy women, oral contraceptives have few side effects.

 Nausea, breast tenderness, weight gain, changes in mood, and breakthrough bleeding are the most
common ones. Though oral contraceptives are usually well-tolerated in healthy women. Oral
contraceptives do not protect against HIV or other sexually transmitted infections.

The following symptoms may indicate serious -- even life-threatening -- side effects:

 Pain in the chest or abdomen

 Severe headache

 Blurry vision

 Pain and/or swelling in the legs or thighs

A woman who develops any of those symptoms should seek immediate medical attention.
For women with previous health issues, birth control pills may be a poor choice for contraception. The
biggest concern is the generation of blood clots, strokes, and heart attacks -- especially in women who are
older and who smoke. In fact, women who smoke and take birth control pills dramatically increase their
risk of developing strokes and heart attacks. The risk increases with age and amount of cigarette use.
Birth control pills that contain estrogen may worsen diabetes.

Women who experience migraine headaches, particularly those over age 35 and those who experience
migraines with visual symptoms, are also at increased risk of stroke when using oral contraceptives.

Oral contraceptives have been shown in studies to reduce the risk of ovarian and endometrial cancers.

Some of the key advantages of combined birth control pills include:

A lower risk of developing acne - Combined birth control pills like Yaz, Ortho Tri-Cyclen and Estrostep
are all approved by the FDA as treatments for acne. Studies tend to show that these pills work well for
stopping acne breakouts caused by hormonal fluctuations.

Milder, more tolerable periods - Combined birth control pills can make your period less intense and
painful, especially if you normally have a heavy, uncomfortable period. Many women also experience a
shorter period after starting combined birth control.

A significantly reduced pregnancy risk - Combined birth control pills block pregnancy from two
different angles: By thickening your cervical mucus to stop sperm from getting into your uterus, and by
stopping your ovaries from releasing eggs.

Some of the biggest weaknesses of combined birth control pills include:

Breastfeeding issues - Some women experience problems breastfeeding if they use a combined oral
contraceptive. This is typically due to the effects that extra estrogen can have on your body's ability to
make breastmilk.

Headaches and period discomfort - Some women experience headaches and period discomfort after
starting combined birth control. This is often caused by fluctuations in your body's estrogen levels, which
may trigger headaches and migraines.

Weight gain - Many women experience mild weight gain after they start using combined birth control
pills. This is almost always fluid retention caused by estrogen, and is rarely the result of fat or muscle
gain.

Blood clots - While blood clots are extremely rare in healthy women on birth control, it’s still possible for
them to occur. Your risk of experiencing a blood clot from birth control is highest if you're over age 35, a
smoker and use a combined birth control pill.
If you're at a high risk of suffering a blood clot or stroke, your doctor might recommend using a
progestin-only birth control form of birth control instead of a combined pill.

Strengths and Weaknesses of Progestin-Only Birth Control Pills

Progestin-only birth control pills have several benefits, the biggest of which is that they’re more
suitable if you're sensitive to hormones like estrogen. They’re also a better option if you plan to
breastfeed, as they're less likely to affect milk volume.

Other benefits of progestin-only birth control pills include:

No estrogen-specific side effects - Because progestin-only birth control pills don’t use ethinyl estradiol,
they generally don’t cause estrogen-specific side effects such as fluid retention and migraines.

Fewer effects on breastfeeding - Progestin-only birth control pills are generally a safer option if you
plan to breastfeed, as they generally don’t affect your body’s production of breast milk.

A lower risk of blood clots and stroke - While progestin-only birth control pills can still increase your
risk of blood clots and stroke, they’re generally regarded as a safer option for women with a high risk of
experiencing cardiovascular side effects from birth control.

Fewer drug interactions - If you use other prescription medication that can interact with estrogen, a
progestin-only birth control pill might reduce your risk of experiencing a drug interaction.

A faster return to fertility - If you want to get pregnant, you’ll generally get your fertility back faster
after you stop using progestin-only birth control than you would after stopping a combined birth control
pill.

These weaknesses include:

No protection against acne. Because progestin-only mini-pills don’t contain estrogen, they’re far less
effective as treatments for acne. Currently, the FDA hasn’t approved any progestin-only birth control pills
as acne treatments.

Slightly less protection against pregnancy - While progestin-only birth control pills are effective at
preventing pregnancy, missing a pill can make you more at risk of becoming pregnant than you would be
if you missed a combined birth control pill.

Higher risk of ectopic pregnancy - If you become pregnant while using progestin-only birth control, you
have a higher-than-normal risk of ectopic pregnancy (a pregnancy in which the embryo attaches outside
the uterus).
Are all kinds of birth control pills appropriate for everyone?

No. Your health care provider will ask about your medical history and any medications you take to
determine which birth control pill is right for you.

References:

https://www.forhers.com/blog/combined-birth-control-vs-progestin-only-mini-pills

https://www.rxlist.com/birth_control_pills/drug-class.htm#

https://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807