Birth Control: The Pill

What Is It?

The birth control pill (also called "the Pill") is a daily pill that contains hormones to change the way the body works and prevent pregnancy. Hormones are chemical substances that control the functioning of the body's organs. In this case, the hormones in the Pill control the ovaries and the uterus.

How Does the Pill Work?

Most birth control pills are "combination pills" with a mix of the hormones estrogen and progesterone to prevent ovulation (the release of an egg during the monthly cycle). A female cannot get pregnant if she doesn't ovulate because there is no egg to be fertilized.

The Pill also works by thickening the mucus around the cervix, which makes it difficult for sperm to enter the uterus and reach any eggs that may have been released. The hormones in the Pill can also sometimes affect the lining of the uterus, making it difficult for an egg to attach to the wall of the uterus.

How Is the Pill Taken?

Most combination pills come in either a 21-day pack or a 28-day pack. One hormone pill is taken each day at about the same time for 21 days. Depending on the pack, the birth control pills are either stopped for 7 days or a pill that contains no hormones is taken for 7 days. During the week that a person takes no pills or pills that don't contain hormones, she has her period. Some women prefer the schedule in which pills are taken every day of the month because it helps keep them in the habit of taking a pill every day.

Also available is a combination pill that makes periods happen less often by supplying a hormone pill for 12 weeks and then inactive pills for 7 days. This reduces the number of periods to 1 every 3 months instead of 1 every month.

Another kind of pill that may change the number of monthly periods is the low-dose progesterone pill, sometimes called the mini-pill. This differs from other birth control pills in that it only contains one type of hormone — progesterone — rather than a combination of estrogen and progesterone. It changes the cervical mucus and the lining of the uterus, and sometimes by affects ovulation. It may be slightly less effective than the combination pills at preventing pregnancy.

The mini-pill is taken every day without a break. Someone who takes the mini-pill may have no period at all or may have irregular periods. For the mini-pill to work, it must be taken at the same time every day, without missing any doses.

Every type of birth control pill works best when the person takes it every single day at the same time of day, regardless of whether they're going to have sex. This is especially important with progesterone-only pills. It's very important not to take anyone else's pills. If pills are skipped or forgotten, a person is not protected against pregnancy and will need a backup form of birth control, such as condoms, or they'll need to stop having sex for a while.

For the first 7 days after someone starts taking the Pill, they should use a second form of contraception, such as condoms, to prevent pregnancy. After 7 days, the Pill should work alone to prevent pregnancy. This timing can vary based on the type of Pill and when someone starts taking it. Also, it's important to continue using condoms to protect against STDs.

How Well Does the Pill Work?

Over the course of a year, about 8 out of 100 typical couples who rely on the Pill to prevent pregnancy will have an accidental pregnancy. The Pill is an effective form of birth control, but even missing 1 day increases the chance of pregnancy.

In general, how well each type of birth control method works depends on many things. These include whether a woman has any health conditions or is taking any medicines or herbal supplements that might interfere with its use (for example, a medicine like antibiotics can affect how well the Pill works).

Protection Against STDs

The birth control pill does not protect against STDs. Couples having sex must always use condoms along with the Pill to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

The Pill is a safe and effective method of birth control. Most people who take the Pill have none to very few side effects.

Smoking cigarettes and using the Pill can increase the risk of certain side effects, which is why health professionals advise those who use the Pill not to smoke. Side effects that can happen from the Pill include:

• irregular menstrual bleeding (more common with the mini-pill)
• nausea, headaches, dizziness, and breast tenderness
• mood changes
• blood clots (rare in those under 35 who do not smoke)

Some of these side effects improve over the first 3 months on the Pill. When side effects are bothersome or don't get better, a doctor may prescribe a different brand of the Pill.

The Pill also has some side effects that many users enjoy. It usually makes periods lighter, reduces cramps, and is often prescribed for women who have menstrual problems. Taking the combination Pill can improve acne, and some doctors prescribe it for this purpose. Combination birth control pills have also been found to protect against some forms of breast disease, anemia, ovarian cysts, and ovarian and endometrial cancers.

Who Uses Birth Control Pills?

Someone who can remember to take a pill each day and who wants excellent protection from pregnancy can use birth control pills.

In some cases, other medical conditions make the use of the Pill less effective or more risky. For example, it is not recommended for those who have had blood clots, liver problems, or some kinds of migraine headaches.

If a girl has high blood pressure that's under control, she can sometimes use the Pill under a doctor's supervision. Those who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who think they may be pregnant should talk to their doctor.

Where Are Birth Control Pills Available?

A doctor or a nurse practitioner (NP) must prescribe the Pill. They'll ask about a girl's health and family medical history, and will do an exam, which may include a pelvic exam. If the doctor or NP prescribes birth control pills, they will explain when to begin taking it and what to do if pills are missed.

The doctor or NP might want to do a blood pressure check a few months later and make sure there are no other problems. After that, girls who are having sex should get routine exams every 6 months to a year, or as recommended.

How Much Do Birth Control Pills Cost?

The Pill usually costs between $0–$50 a month, depending on the type. Many health and family planning clinics (such as Planned Parenthood) sell birth control pills for less. And birth control pills and doctor visits are covered by many health insurance plans.