Oral Contraceptive Pills: Uses, Side effects, And Alternatives
Birth control pills are medications used to prevent pregnancy or to regulate your menstrual cycle. Certain brands of birth control pills may be used for treating acne or as a "morning-after" pill for emergency contraception. However, before consuming the oral contraceptives you need a prescription from your doctor or a healthcare professional.
Birth control pills are used to treat many conditions including:
1. Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal imbalance which causes irregular menstrual periods, acne, and excess hair growth. For girls whose menstrual periods are irregular (very few or not at all), consumption of birth control pills works positively by lowering certain hormone levels to regulate menstrual periods. When hormones are at normal levels, problems related to acne and hair growth often improve.
2. Endometriosis: Most girls with endometriosis experience cramps or pelvic pain during their menstrual cycle. Birth control pills are often prescribed to treat endometriosis and work by temporarily preventing periods. Since periods can cause pain in young women with endometriosis, stopping periods temporarily usually improves cramps and pelvic pain.
3. Amenorrhoea (Absence of menstruation): Low weight, stress, or excessive exercise are some of the lifestyle factors which contribute to amenorrhoea. Birth control pills may be prescribed to replace oestrogen to balance the hormones, which helps to regulate the menstrual cycle. Normal amount of oestrogen levels and healthy weight are important for healthy bones. If absence of periods is caused due to low weight or an eating disorder, the best treatment is to gain normal healthy weight and attend counselling to address body image and health.
4. Menstrual Cramps: When over-the-counter medications don’t help with severe cramps, birth control pills may be the solution as they prevent ovulation and lighten periods.
5. Premenstrual Syndrome (PMS): Symptoms like mood swings, weight gain, breast soreness and bloating, along with acne can occur up to 2 weeks before a young woman's period. In such cases, birth control pills may be prescribed to stop ovulation and to help in keeping the hormone levels balanced. Symptoms of PMS may improve, particularly when oral contraceptive pills are prescribed continuously.
6. Primary Ovarian Insufficiency (POI): Birth control pills are often prescribed to girls whose ovaries are not producing sufficient amount of oestrogen because of radiation and/or chemotherapy or a genetic condition such as Turner Syndrome or other conditions. The objective of this treatment is to regulate the menstrual cycle and keep bones healthy.
7. Heavy Menstrual Periods: Birth control pills are prescribed during heavy menstruation, as it may reduce the flow and length of menstrual bleeding.
8. Acne: For moderate to severe acne, sometimes even the usual prescribed medications do not help. In such cases, birth control pills may be prescribed. The hormones in the pill can help in preventing acne from forming. Be patient though, since it can take several months before you see an improvement in your skin.
There are other medical benefits of consuming OCP. Right consumption of birth control pills helps in reducing heavy menstrual bleeding. This prevents anaemia. Anaemia is caused due to low number of red blood cells, which carry oxygen from the lungs to the tissues. Birth control pills help lower your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.
What are the side effects of OCPs?
1. Intermenstrual spotting- Breakthrough vaginal bleeding is common between expected periods. This usually resolves within 3 months of starting the pill.
2. Nausea- Some people experience mild nausea when they first take the pill, but symptoms usually subside after a while.
3. Missed periods- Even with proper pill use, a period may sometimes be missed. Factors that can influence this include stress, illness, travel, and hormonal or thyroid abnormalities.
4. Breast tenderness- Birth control pills may cause breast enlargement or tenderness. However, it normally resolves a few weeks after starting the pill.
5. Headaches and migraine - Symptoms normally improve over time, but if severe headaches start when you begin taking the pill, you should seek medical advice.
6. Mood changes- Oral contraceptives may affect the user's mood and increase the risk of depression or cause other emotional changes.
7. Decreased libido- The hormone or hormones in the contraceptive pill can affect sex drive or libido in some people. If decreased libido persists and is bothersome, this should be discussed with a medical provider.
What are the possible alternatives to OCPs?
This is a barrier method of birth control that prevents sperm from coming into contact with egg cells. Male condoms are sheaths that are placed over the penis. A female condom is a pouch with a ring at each end. It is inserted into the vagina.
This is a shallow, dome-shaped rimmed cup that is placed in the vagina to block the cervix. Used with spermicide, it prevents the sperm and egg from uniting. It also has disadvantages which include possible urinary tract infections and vaginal irritation. The irritation may stem from a reaction to the material the diaphragm is made of or the spermicide.
NuvaRing (vaginal ring)
A plastic ring is inserted into the vagina, and it releases hormones to suppress ovulation. Each month, it is inserted for 3 weeks and removed for 1 week, during which menstruation occurs. These hormones are very similar to the pill, so similar side effects can occur.
Intrauterine devices (IUDs)
A small device made from plastic and copper is inserted into the uterus at the doctor's office. IUDs can be hormonal or non-hormonal. Hormonal IUDs thicken the cervical mucus and suppress ovulation. However, the non-hormonal IUDs produce an inflammatory response in the uterus that is toxic to sperm. It lasts for up to 10 years and is almost 100 per cent effective in preventing pregnancy.
A small, plastic rod is implanted into the upper arm through a minor surgery. For the next 3 years, it releases a hormone to thicken cervical mucus, thin the endometrial lining, and suppress ovulation. It is almost 100 per cent effective.
Surgery is carried out in men, to block or cut the tubes that transport sperm from the testicles to the penis. In women, surgery blocks the fallopian tubes. This is normally permanent.
There are also other contraceptive injections which are considered 100 per cent effective, such as Depo-Provera suppresses ovulation and thickens cervical mucus to reduce the chances of sperm from reaching egg cells, just as the birth control pill does. It is a progestin-only contraceptive (POC).
The advantage of the shot is that you do not have to take it every day, but you do have to remember to take another shot every 3 months, and this must be done at the doctor's office.
Dr Nirmala Chandrashekhar is Consultant Obstetrics, Gynaecology and Gynaec Oncology at BGS Gleneagles Global Hospitals, Bengaluru.