Birth control pills

Everywoman's mural form our original location

How do birth control pills work?
Birth control pills have two hormones – estrogen and progesterone. They work by preventing the change in hormones that triggers the release of an egg from the ovary. So as long as you are taking pills properly, you do not ovulate (no eggs are released).

How do you take the pill?
Take one pill at about the same time each day. Choose the time of day that will be easiest for you to remember. For example, you might choose to put them beside your toothbrush and take one every morning when you brush your teeth. Some women program a daily reminder on their cellphones or find another way to remind themselves. Pills come in different packages with hormone and sometimes “placebo” or sugar pills. Always take the hormone pills in the order they come in.

Using a 21 Day Pack: some packs have only 21 pills, all of which have hormones in them, and no placebo/sugar pills.

  • Conventional Use: The instructions that come with the package and some doctors or clinics may tell you to take a seven day break each month and this would cause your period to come.
  • Shorter Breaks: Research shows that birth control pills are more effective when you take a shorter three or four day break and that this can also lessen side effects. Finish your pack of 21 hormone pills, take a three or four day break with no pills, and then start your next pack.Even if you still have your period after three or four days or if it hasn’t come yet, it is time to start your next pack. You will probably get a shorter and/or lighter period. Each month, be sure to set an alarm or mark a calendar for your next start date.
  • Continuous Use: Taking no breaks between packs is even more effective in protecting against pregnancy. Just finish your pack and then start your next one the following day with no break in between.This means you will not have a period. This is safe because when you are taking the pill the lining in your uterus does not grow as much and does not need to shed, meaning it is not necessary to have a period. You may have some spotting, especially after a few months. Some women take a three or four day break every second or third month in order to have something more like a period rather than irregular spotting.

Using a 28 Day Pack: some packages of pills have 28 pills – 21 hormone pills and seven “placebo” or sugar pills. Placebo/sugar pills have no hormones in them, are at the end of the pack, and are often a different colour.

  • Conventional Use: If you took all of the pills in a 28 day pack, you would get a seven day break from the hormones each month while using the placebo/sugar pills, and this would cause your period to come.
  • Shorter Breaks: We recommend only taking three or four day of the placebo/sugar pills, throwing the rest away, and starting your next pack. Even if you still have your period after the three or four days or if it hasn’t come yet, start your next pack. This means you would probably get a shorter and/or lighter period and that you’d be more protected against pregnancy than if you took all seven placebo/sugar pills.
  • Continuous Use: Even better, you can throw all of the placebo/sugar pills away and just start your next pack. This means you will not have a period but you may have some spotting. If you do not like having irregular spotting, you can take a three or four day break every second or third month so that it is more like a period.

When to start your pills
We recommend starting your pills on the day after a surgical abortion or if you’ve had a medical abortion, once you have had a check-up ultrasound and the doctor says the abortion is complete. You can also start on any other day if you need to. Always back up with condoms or abstain from intercourse until you’ve had seven hormone pills in a row.

What to do if you miss a pill
You need to use “back up” birth control methods to make sure you are protected against pregnancy if you: 1) miss a pill or take your pill more than 12 hours later than your usual time 2) start a new pack of pills after more than a seven day break 3) vomit within 2 hours of taking your pills or have severe vomiting or diarrhea for two or more days 4) or are taking other medications that may interfere with your pill (consult a doctor for more info).

If any of these things happen, use condoms or abstain from intercourse until you have used seven pills in a row (which can mean skipping the break if a missed pill happens near the end of your pack). If you have unprotected sex before having seven pills in a row you should use emergency contraception – take Plan B (also known as the “morning after pill”) as soon as possible or have a copper IUD inserted within seven days after the unprotected sex.

You should also use emergency birth control if you had intercourse without any form of protection other than the pill (for example, condoms) within seven days before a missed pill (even if you were taking your pills regularly before you missed one – this is because sperm can live in the uterus for up to a week). Within five days after you can use Plan B and within seven days you can have an emergency copper IUD inserted.

Where can you get pills?
You need a prescription from a doctor in order to get pills. You can get one from your family doctor or from a youth, sexual health, walk-in or women’s clinic. Once you have a prescription, you can buy the pills from a pharmacy. They are sometimes free at youth clinics or sold for less at clinics. To find a clinic or doctor, call the Sex Sense Line at 604-731-7308 (or toll free at 1-800-SEX-SENSE).

What kind of side effects can the pill have?
There are many benefits to taking the pill. Women who take pills have a significantly smaller risk of developing ovarian and endometrial (uterine) cancers. They also have a much lower risk of having a serious pelvic infection, which means that the pill protects their future fertility. Many women find that their periods get lighter and less painful and this can help with anemia (low iron). Some women also find that their acne improves.

The most significant negative effect is a slightly increased risk of blood clots (deep venous thrombosis, DVT). This is highest in the first 6-12 months of use and is much lower with pill use than it is in pregnancy. Some women also have nausea, breast tenderness, bloating, headaches, mood swings, dizziness, loss of sex drive or spotting/irregular bleeding. Many or all of these side effects may lessen or go away after about three months or can be improved by switching brands. If you want to stop or switch your pills, talk to a healthcare provider first to lessen the chance of pregnancy.

If you are having any of the following symptoms, seek medical attention immediately as they may be serious danger signs (they spell out ACHES to make them easier to remember):

  • A abdominal pain (severe) upper right side
  • C chest or arm pain (severe), shortness of breath and/or coughing up blood
  • H headaches, severe and not relieved by Aspirin or Tylenol, dizziness or numbness
  • E eye problems such as blurred vision, flashing lights, double vision, blindness
  • S swelling/redness, severe leg pain, speech problems

Who should not use the pill?

  • Women who have migraine headaches with visual symptoms (seeing an ‘aura’, spots or lights)
  • Women who have breast cancer; impaired liver or kidney function; very high blood pressure; heart disease; a history of blood clots or clotting disorders; lupus; or diabetes with nephropathy, retinopathy or neuropathy
  • Women over the age of 35 who smoke cigarettes or have migraines
  • During breastfeeding, progesterone-only pills are best for the first 6 months
  • Women who have a family history of strokes and blood clots before age 50 need to check with a doctor first

Frequently Asked Questions

  • Will the pill make me gain weight? Most women do not gain weight on the pill. When they do it is usually no more than five pounds and may be due to other causes. Some women also lose weight when on the pill.
  • Will the pill make it harder for me to have a baby in the future or cause birth defects? When you stop taking the pill your fertility will return very quickly. In fact, the pill can protect your fertility because it lowers the risk of getting a serious pelvic infection. The pill does not cause birth defects even if you get pregnant while using it.
  • Does the pill cause breast cancer? The pill does not increase your risk of getting breast cancer. However, if someone already has breast cancer they should not take the pill.
  • Do I need to take a “rest” from the pill? The pill is so safe that your body does not need a rest from it. We recommend staying on it at all times to reduce the chance of getting pregnant.
  • Does the pill cause blood clots, heart attacks and strokes? The pill may slightly increase your chances of these things, but not nearly as much as being pregnant does. If you have a higher risk of blood clots, heart attacks and strokes, talk to a doctor about whether the pill is right for you.
  • Does the birth control pill protect me against sexually transmitted infections (STIs)? No. Using condoms with pills will provide you with protection against both pregnancy and STIs. It is also recommended to get tested regularly for STIs.



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