Over ten million women in the United States currently use an oral contraceptive, "the pill," to prevent pregnancy.

The pill is also widely used to regulate menstrual periods, reduce menstrual cramps, and treat hormonal imbalances and ovarian cysts.

The pill is a combination of estrogen and progesterone. These are the same hormones that are naturally produced in the ovaries and are responsible for ovulation and the menstrual cycle. There are a number of different brands available, manufactured by several different companies.

The questions and answers outlined below provide important information to assist you in using the pill in the safest and most effective manner.

Be sure to read this information before you start taking birth control pills and refer to it any time that you have a question about them.

Please feel free to discuss any questions or concerns that you may have about taking the pill, with your provider.

How does the pill work?

It prevents ovulation
It alters the cervical mucus, making it less penetrable to sperm
It alters the endometrial lining, inhibiting implantation of a fertilized egg, if ovulation has occurred.

How effective is the pill?

The pill is 97-99% effective when taken correctly. If you stop taking the pill, you may become pregnant very soon, so you must be sure to immediately start using an alternative method of birth control, when birth control pills are discontinued, to avoid an undesired pregnancy.

Who should or should not take the pill?

Each person is evaluated on an individual basis. Determining factors include past medical history, family history and findings of a physical exam. You should not take the pill if you have any of the following conditions:

History of heart attack or stroke
Blood clots in the legs, lungs or eyes
Unevaluated chest pain
Known or suspected breast cancer; or cancer of the cervix, vagina or uterus
Unexplained vaginal bleeding
Liver tumors
Known or suspected pregnancy

What are the benefits of the pill?

Decreased blood loss and iron deficiency anemia, due to lighter periods
Decreased menstrual cramps
Regulation of menstrual periods
Decreased risk of fibrocystic breast condition
Decreased risk of ovarian and endometrial cancers and ovarian cysts
Protection against PID (pelvic inflammatory disease), which is a major cause of infertility. HOWEVER, birth control pills DO NOT provide any protection against sexually transmitted diseases.
Reversibility -- ovulation is reestablished quickly and side effects quickly diminish, when the pill is discontinued. Loss of fertility is NOT caused by birth control pills.
Acne improvement

What are the side effects?

There is a wide range of common side effects that can be annoying, but not usually harmful. Most people will experience only a few of these and, by the end of the third package of pills, the side effects will have resolved spontaneously.

If you continue to experience unpleasant side effects, you should contact the McKinley Dial-a-Nurse or come to the Women's Health Department during Walk-In hours, McKinley Health Center, (217) 333-2700. Usually, a switch to a different pill will resolve the problem.

Some of the common side effects, and suggestions for coping with them, are:

Spotting/bleeding while on active pills:

may occur as very light spotting or as heavy as a period, and may occur anytime in the cycle of active pills; continue taking your pill at the same time every day.
It usually will improve as you continue additional cycles of pills and, by the third cycle, should not be occurring.

Call the Dial-A-Nurse, McKinley Health Center, (217) 333-2700. for an appointment if there is pain or fever, or if there has been a change in the normal vaginal discharge prior to bleeding onset.

Nausea:

usually not severe enough to cause vomiting. Try taking your pills with a meal or with food at bedtime. Eat small, frequent meals and snacks. Vitamin B-6, 50-100 mg. daily, often helps and is available at the McKinley Health Center, (217) 333-2700.

Breast tenderness:

decrease caffeine and salt intake. A few women will experience increased breast size. Contact your provider if you notice a lump or other changes involving only one breast.

Headache:

usually relieved by over-the-counter medications. If accompanied by light sensitivity, visual disturbances, or nausea, or if you notice a significant increase in frequency or severity of headaches, contact your provider right away.

Weight changes:

in most instances, weight gain is only 3-4 pounds. Women may also lose weight when starting the pill.

Skin changes:

initially, acne may seem to increase -- but, with continued use, usually will improve. Infrequently, darkening of skin pigment, especially on the upper lip, under the eyes, or on the forehead, may occur. A few women will also notice increased hair growth on the face -- but, more commonly, facial and body hair growth decreases.

Mood swings:

irritability or depression may occur, especially premenstrually. Regular exercise and adequate sleep decreases these symptoms and Vitamin B-6, 50-100 mg. daily, helps relieve symptoms.
Fatigue: usually tapers off quickly during the first 4-6 weeks of use.

Scant/absent menses:

the hormones in the pill cause a decrease in the thickness of the uterine lining, which is why pill users usually experience shorter, lighter periods. Occasionally, a woman may experience only slight spotting or will skip a period entirely.

This seems to occur more frequently when under increased stress. If you missed or took pills late, were on antibiotics, or had vomiting or diarrhea for longer than 24 hours, during the most recent pill cycle, you should have a pregnancy test done.

Otherwise, continue your pills for another cycle. If you miss two periods in a row, contact your provider.

These are a list of the most common side effects. There are other side effects which you, as an individual, may experience.

If any symptom is severe or persistent after completing three pill cycles, contact the Dial-A-Nurse, McKinley Health Center, (217) 333-2700 or come to the Women's Health Department during Walk-In hours and talk with a provider BEFORE discontinuing your birth control pills. We can often change the type of pill you are taking and resolve the problem.

What are the risks?

The risks of using birth control pills are low, when compared to the risks of pregnancy and childbirth. Nearly all the risks are associated with the formation of blood clots in the large veins of the body.

The estrogen component in birth control pills used today, is much lower than in pills used 20 years ago. When estrogen dosages were lowered, there was a corresponding decrease in the development of blood clots.

Currently, a woman on the pill has a relative risk for the development of a blood clot of 11 per 100,000 women on the pill; for stroke, the risk is 3 per 10,000 women on the pill; and, for heart attack, 5 per 100,000 women on the pill.

Factors increasing the risk of blood clot formation (potentially leading to heart attack or stroke) include smoking, especially if over the age of 35; high cholesterol; diabetes; consistently elevated blood pressure; and body weight greater than 50% above ideal body weight.

If you experience any of the following symptoms, you should seek medical care right away:

A - abdominal pain (severe)
C - chest pain, shortness of breath, coughing up blood
H - headache (severe), numbness or weakness in arms or legs
E - eye problems (vision loss, blurring, flashing lights)
S - severe leg pain in calf or thigh

What about cancer and the pill?

Since 1960, when birth control pills first became available, important information about pills and cancer has been learned:

Pills reduce the risk of ovarian cancer: three years of use reduces the risk of ovarian cancer by 40%; ten years of use reduces the risk by 80%.
Pills reduce the risk for endometrial (uterine lining) cancer.
Most studies suggest that pills neither reduce nor increase the risk for breast cancer. Research continues to evaluate this. Women are encouraged to do monthly self-breast exams and report any changes or problems to their health care provider.
Some studies indicate an increased incidence of cervical cancer.

However, this may be more related to factors such as numbers of sexual partners, STD exposure, etc., than to birth control pill use. Annual pap smears provide the best screening for cervical cancer.

How do I get a pill prescription?

First-time pill users must attend a birth control education session at McKinley. All pill users must have a breast exam, pap and pelvic exam done within the year, by a McKinley provider or outside health care provider. If you have any questions, call the Dial-A-Nurse, McKinley Health Center, (217) 333-2700.

Ho do I take the pill?

Taking your birth control pill at the same time every day is important. This provides a steady dose of medication in your body every day, increasing its effectiveness and reducing the risk of breakthrough bleeding.

Missing pills increases the risk of pregnancy, and often causes spotting or breakthrough bleeding. Starting a new pill cycle LATE also increases the risk of pregnancy.

You must use backup birth control until you have been back on active birth control pills for 7 days, if you do not start your new pill cycle on the day you are scheduled to do so.

Your pill pack contains 21 active pills and 7 reminder pills. Begin with the first active pill in the cycle, and take an active pill every day. When the active pills are gone, begin the reminder pills. Your period should start and end while taking the reminder pills.

When all the pills are gone, open a new package of pills and begin the active pills again. You do not take any days "off."

If you notice that your periods start persistently before you finish the active pills, or that the period lasts into the active pills of the next cycle, you should notify your provider.

If you have vomiting or diarrhea, or take antibiotics, your pills may not work as well. Use a backup method of birth control during the illness, or while on the antibiotic, and for 7 days afterward.

Taking laxatives or the preparations required for certain types of x-rays or diagnostic tests may also interfere with the absorption of the pill. Again, use backup birth control for 7 days, after the tests are finished.

Birth control pills may interact with other medications, also. You should inform any health care provider whom you see, for any reason, that you take birth control pills. Also, review the handout, "Oral Contraceptives and Drug Interactions."

How do I start the first cycle of the pills?

You have a choice of which day to start your first cycle of pills. Review these instructions and decide which is best for you. Pick a time of day that will be easy to remember.

Day 1 start:

1. Take the first active pill of the package during the first 24 hours of your menstrual period.

2. You will not need to use a backup method of birth control, since you are starting the pill at the beginning of your period.

Sunday start:

1. Take the first active pill of the package on the FIRST SUNDAY after your period STARTS, even if you are still bleeding. If your period starts on Sunday, you may start your pills the same day.

2. Use a backup method of birth control if you have intercourse, until you have taken the next "Sunday" pill of the cycle (7 days after starting the package).

What do I do if I miss the pills?

If you miss ONE ACTIVE PILL:

1. Take the missed pill as soon as you realize that you forgot a pill. Take the next one at your regular time. This may mean that you take 2 active pills in one day.

2. You do not need to use a backup birth control method if you have intercourse.

3. You may experience nausea for 12-24 hours.

4. You may experience spotting or bleeding, off-and-on, until you finish your birth control pill pack.

If you miss 2 ACTIVE PILLS IN WEEK 1 OR 2 of your cycle:

1. Take 2 pills on the day you remember and 2 pills the next day, then continue taking 1 pill daily at the regular time, until the cycle is completed.

2. You MUST use a backup method of birth control when you have intercourse, until you begin your next package of pills.

3. Expect nausea to occur when you have to take 2 pills in one day. Taking them with food and eating small, frequent meals or snacks may reduce the nausea.

4. Expect to have spotting or bleeding during mid-cycle. It may continue until you begin your next package of pills.

If you miss 2 ACTIVE PILLS IN WEEK 3 of your cycle:

1. If you are a Day 1 Starter -- Throw away the rest of the pill pack and start a new package that same day. If you are a Sunday Starter -- Keep taking 1 pill every day until Sunday. On Sunday, throw away the rest of the pack and start a NEW pack of pills that same day.

2. You will probably spot or bleed, some; however, you may not have your regular period that month. If you skip your next period, you should have a pregnancy test.

3. You MUST use a backup method of birth control until you have once again taken 7 consecutive ACTIVE birth control pills.

If you miss 3 OR MORE ACTIVE PILLS ANYTIME during your pack:

2. You will probably spot or bleed, some; however, you may not have your regular period that month. If you skip your next period, you should have a pregnancy test.

3. You MUST use a backup method of birth control until you have once again taken 7 consecutive ACTIVE birth control pills.

If you forget any of the REMINDER pills (week 4) of your pill pack, you may throw the missed pills away. In fact, providing that you remember to restart a new package of pills on schedule, it is not necessary to take any of the reminder pills.

However, you MUST always restart your new pill pack no later than 7 days after taking your last active pill.

If, for any reason, you are not sure what to do about missed pills or interactions with other medications, continue taking a pill every day, AND use a backup method of birth control, until you can call your provider.

When backup birth control is recommended, condoms and spermicide provide an effective and easily obtained option.

Condoms are also recommended to decrease exposure to sexually transmitted diseases. Condoms and spermicide are available to U. of I. students at the Health Resource Centers:

(Reprinted with permission of the McKinley Health Center, (217) 333-2700, Web Site at: http://www.mckinley.uiuc.edu)

Jacqui




		Young Love
	"The Pill" (Courtesy of the McKinley Health Center) Over ten million women in the United States currently use an oral contraceptive, "the pill," to prevent pregnancy. The pill is also widely used to regulate menstrual periods, reduce menstrual cramps, and treat hormonal imbalances and ovarian cysts. The pill is a combination of estrogen and progesterone. These are the same hormones that are naturally produced in the ovaries and are responsible for ovulation and the menstrual cycle. There are a number of different brands available, manufactured by several different companies. The questions and answers outlined below provide important information to assist you in using the pill in the safest and most effective manner. Be sure to read this information before you start taking birth control pills and refer to it any time that you have a question about them. Please feel free to discuss any questions or concerns that you may have about taking the pill, with your provider. How does the pill work? It prevents ovulation It alters the cervical mucus, making it less penetrable to sperm It alters the endometrial lining, inhibiting implantation of a fertilized egg, if ovulation has occurred. How effective is the pill? The pill is 97-99% effective when taken correctly. If you stop taking the pill, you may become pregnant very soon, so you must be sure to immediately start using an alternative method of birth control, when birth control pills are discontinued, to avoid an undesired pregnancy. Who should or should not take the pill? Each person is evaluated on an individual basis. Determining factors include past medical history, family history and findings of a physical exam. You should not take the pill if you have any of the following conditions: History of heart attack or stroke Blood clots in the legs, lungs or eyes Unevaluated chest pain Known or suspected breast cancer; or cancer of the cervix, vagina or uterus Unexplained vaginal bleeding Liver tumors Known or suspected pregnancy What are the benefits of the pill? Decreased blood loss and iron deficiency anemia, due to lighter periods Decreased menstrual cramps Regulation of menstrual periods Decreased risk of fibrocystic breast condition Decreased risk of ovarian and endometrial cancers and ovarian cysts Protection against PID (pelvic inflammatory disease), which is a major cause of infertility. HOWEVER, birth control pills DO NOT provide any protection against sexually transmitted diseases. Reversibility -- ovulation is reestablished quickly and side effects quickly diminish, when the pill is discontinued. Loss of fertility is NOT caused by birth control pills. Acne improvement What are the side effects? There is a wide range of common side effects that can be annoying, but not usually harmful. Most people will experience only a few of these and, by the end of the third package of pills, the side effects will have resolved spontaneously. If you continue to experience unpleasant side effects, you should contact the McKinley Dial-a-Nurse or come to the Women's Health Department during Walk-In hours, McKinley Health Center, (217) 333-2700. Usually, a switch to a different pill will resolve the problem. Some of the common side effects, and suggestions for coping with them, are: Spotting/bleeding while on active pills: may occur as very light spotting or as heavy as a period, and may occur anytime in the cycle of active pills; continue taking your pill at the same time every day. It usually will improve as you continue additional cycles of pills and, by the third cycle, should not be occurring. Call the Dial-A-Nurse, McKinley Health Center, (217) 333-2700. for an appointment if there is pain or fever, or if there has been a change in the normal vaginal discharge prior to bleeding onset. Nausea: usually not severe enough to cause vomiting. Try taking your pills with a meal or with food at bedtime. Eat small, frequent meals and snacks. Vitamin B-6, 50-100 mg. daily, often helps and is available at the McKinley Health Center, (217) 333-2700. Breast tenderness: decrease caffeine and salt intake. A few women will experience increased breast size. Contact your provider if you notice a lump or other changes involving only one breast. Headache: usually relieved by over-the-counter medications. If accompanied by light sensitivity, visual disturbances, or nausea, or if you notice a significant increase in frequency or severity of headaches, contact your provider right away. Weight changes: in most instances, weight gain is only 3-4 pounds. Women may also lose weight when starting the pill. Skin changes: initially, acne may seem to increase -- but, with continued use, usually will improve. Infrequently, darkening of skin pigment, especially on the upper lip, under the eyes, or on the forehead, may occur. A few women will also notice increased hair growth on the face -- but, more commonly, facial and body hair growth decreases. Mood swings: irritability or depression may occur, especially premenstrually. Regular exercise and adequate sleep decreases these symptoms and Vitamin B-6, 50-100 mg. daily, helps relieve symptoms. Fatigue: usually tapers off quickly during the first 4-6 weeks of use. Scant/absent menses: the hormones in the pill cause a decrease in the thickness of the uterine lining, which is why pill users usually experience shorter, lighter periods. Occasionally, a woman may experience only slight spotting or will skip a period entirely. This seems to occur more frequently when under increased stress. If you missed or took pills late, were on antibiotics, or had vomiting or diarrhea for longer than 24 hours, during the most recent pill cycle, you should have a pregnancy test done. Otherwise, continue your pills for another cycle. If you miss two periods in a row, contact your provider. These are a list of the most common side effects. There are other side effects which you, as an individual, may experience. If any symptom is severe or persistent after completing three pill cycles, contact the Dial-A-Nurse, McKinley Health Center, (217) 333-2700 or come to the Women's Health Department during Walk-In hours and talk with a provider BEFORE discontinuing your birth control pills. We can often change the type of pill you are taking and resolve the problem. What are the risks? The risks of using birth control pills are low, when compared to the risks of pregnancy and childbirth. Nearly all the risks are associated with the formation of blood clots in the large veins of the body. The estrogen component in birth control pills used today, is much lower than in pills used 20 years ago. When estrogen dosages were lowered, there was a corresponding decrease in the development of blood clots. Currently, a woman on the pill has a relative risk for the development of a blood clot of 11 per 100,000 women on the pill; for stroke, the risk is 3 per 10,000 women on the pill; and, for heart attack, 5 per 100,000 women on the pill. Factors increasing the risk of blood clot formation (potentially leading to heart attack or stroke) include smoking, especially if over the age of 35; high cholesterol; diabetes; consistently elevated blood pressure; and body weight greater than 50% above ideal body weight. If you experience any of the following symptoms, you should seek medical care right away: A - abdominal pain (severe) C - chest pain, shortness of breath, coughing up blood H - headache (severe), numbness or weakness in arms or legs E - eye problems (vision loss, blurring, flashing lights) S - severe leg pain in calf or thigh What about cancer and the pill? Since 1960, when birth control pills first became available, important information about pills and cancer has been learned: Pills reduce the risk of ovarian cancer: three years of use reduces the risk of ovarian cancer by 40%; ten years of use reduces the risk by 80%. Pills reduce the risk for endometrial (uterine lining) cancer. Most studies suggest that pills neither reduce nor increase the risk for breast cancer. Research continues to evaluate this. Women are encouraged to do monthly self-breast exams and report any changes or problems to their health care provider. Some studies indicate an increased incidence of cervical cancer. However, this may be more related to factors such as numbers of sexual partners, STD exposure, etc., than to birth control pill use. Annual pap smears provide the best screening for cervical cancer. How do I get a pill prescription? First-time pill users must attend a birth control education session at McKinley. All pill users must have a breast exam, pap and pelvic exam done within the year, by a McKinley provider or outside health care provider. If you have any questions, call the Dial-A-Nurse, McKinley Health Center, (217) 333-2700. Ho do I take the pill? Taking your birth control pill at the same time every day is important. This provides a steady dose of medication in your body every day, increasing its effectiveness and reducing the risk of breakthrough bleeding. Missing pills increases the risk of pregnancy, and often causes spotting or breakthrough bleeding. Starting a new pill cycle LATE also increases the risk of pregnancy. You must use backup birth control until you have been back on active birth control pills for 7 days, if you do not start your new pill cycle on the day you are scheduled to do so. Your pill pack contains 21 active pills and 7 reminder pills. Begin with the first active pill in the cycle, and take an active pill every day. When the active pills are gone, begin the reminder pills. Your period should start and end while taking the reminder pills. When all the pills are gone, open a new package of pills and begin the active pills again. You do not take any days "off." If you notice that your periods start persistently before you finish the active pills, or that the period lasts into the active pills of the next cycle, you should notify your provider. If you have vomiting or diarrhea, or take antibiotics, your pills may not work as well. Use a backup method of birth control during the illness, or while on the antibiotic, and for 7 days afterward. Taking laxatives or the preparations required for certain types of x-rays or diagnostic tests may also interfere with the absorption of the pill. Again, use backup birth control for 7 days, after the tests are finished. Birth control pills may interact with other medications, also. You should inform any health care provider whom you see, for any reason, that you take birth control pills. Also, review the handout, "Oral Contraceptives and Drug Interactions." How do I start the first cycle of the pills? You have a choice of which day to start your first cycle of pills. Review these instructions and decide which is best for you. Pick a time of day that will be easy to remember. Day 1 start: 1. Take the first active pill of the package during the first 24 hours of your menstrual period. 2. You will not need to use a backup method of birth control, since you are starting the pill at the beginning of your period. Sunday start: 1. Take the first active pill of the package on the FIRST SUNDAY after your period STARTS, even if you are still bleeding. If your period starts on Sunday, you may start your pills the same day. 2. Use a backup method of birth control if you have intercourse, until you have taken the next "Sunday" pill of the cycle (7 days after starting the package). What do I do if I miss the pills? If you miss ONE ACTIVE PILL: 1. Take the missed pill as soon as you realize that you forgot a pill. Take the next one at your regular time. This may mean that you take 2 active pills in one day. 2. You do not need to use a backup birth control method if you have intercourse. 3. You may experience nausea for 12-24 hours. 4. You may experience spotting or bleeding, off-and-on, until you finish your birth control pill pack. If you miss 2 ACTIVE PILLS IN WEEK 1 OR 2 of your cycle: 1. Take 2 pills on the day you remember and 2 pills the next day, then continue taking 1 pill daily at the regular time, until the cycle is completed. 2. You MUST use a backup method of birth control when you have intercourse, until you begin your next package of pills. 3. Expect nausea to occur when you have to take 2 pills in one day. Taking them with food and eating small, frequent meals or snacks may reduce the nausea. 4. Expect to have spotting or bleeding during mid-cycle. It may continue until you begin your next package of pills. If you miss 2 ACTIVE PILLS IN WEEK 3 of your cycle: 1. If you are a Day 1 Starter -- Throw away the rest of the pill pack and start a new package that same day. If you are a Sunday Starter -- Keep taking 1 pill every day until Sunday. On Sunday, throw away the rest of the pack and start a NEW pack of pills that same day. 2. You will probably spot or bleed, some; however, you may not have your regular period that month. If you skip your next period, you should have a pregnancy test. 3. You MUST use a backup method of birth control until you have once again taken 7 consecutive ACTIVE birth control pills. If you miss 3 OR MORE ACTIVE PILLS ANYTIME during your pack: 1. If you are a Day 1 Starter -- Throw away the rest of the pill pack and start a new package that same day. If you are a Sunday Starter -- Keep taking 1 pill every day until Sunday. On Sunday, throw away the rest of the pack and start a NEW pack of pills that same day. 2. You will probably spot or bleed, some; however, you may not have your regular period that month. If you skip your next period, you should have a pregnancy test. 3. You MUST use a backup method of birth control until you have once again taken 7 consecutive ACTIVE birth control pills. If you forget any of the REMINDER pills (week 4) of your pill pack, you may throw the missed pills away. In fact, providing that you remember to restart a new package of pills on schedule, it is not necessary to take any of the reminder pills. However, you MUST always restart your new pill pack no later than 7 days after taking your last active pill. If, for any reason, you are not sure what to do about missed pills or interactions with other medications, continue taking a pill every day, AND use a backup method of birth control, until you can call your provider. When backup birth control is recommended, condoms and spermicide provide an effective and easily obtained option. Condoms are also recommended to decrease exposure to sexually transmitted diseases. Condoms and spermicide are available to U. of I. students at the Health Resource Centers: (Reprinted with permission of the McKinley Health Center, (217) 333-2700, Web Site at: http://www.mckinley.uiuc.edu) Jacqui Copyright 2002 Brandwynne Corporation. All rights reserved. Thank you for your trust.

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