Oral Contraceptiive Pills / Birth Control Pills

Oral Contraceptive Pills (OCP), or birth control pills as they are more commonly called, are a hormonal method of contraception.

All oral contraceptives discovered so far are applicable only in the female. No pills for males have been discovered, although research is on to find a suitable hormone preparation.

Almost all the OCP’s are combinations of the female hormones, estrogen and progesterone. The estrogens commonly used are either mestranol 50 micrograms or ethinyl estradiol, 20 to 50 micrograms.

A variety of progesterones are used in combination with the estrogen. The commonest are levonorgesterol, norethisterone, norgestrel, ethynodiol diacetate etc.

The OCPs are more effective than the birth control methods like condoms, the rhythm method and the intrauterine contraceptive devices (IUDs).

A newer birth control pill on the market which does not contain either estrogen or progesterone is Centchroman. It is believed to be more effective than the standard OCPs containing estrogen and progesterone.

How the Birth Control Pill works

The birth control pills mainly work by preventing ovulation. In a normal menstrual cycle, the pituitary gland secretes the hormones FSH and LH to stimulate the ovary to release an egg ('ovulation"). When pills are taken, the level of estrogen is increased in the blood. This sends a negative feedback message to the pituitary gland to stop secreting FSH and LH. The lowered levels of FSH and LH fails to stimulate the ovaries and ovulation is prevented.

The pills also work by causing changes that make the endometrium unreceptive to a fertilized ovum if ovulation and fertilization do take place in any menstrual cycle.

The progesterone in the pills also make the cervical mucus hostile to the sperm.

Dosage Schedule of Birth Control Pills

The pills usually come in packs of 21 tablets or 28 tablets. In the 28 day pack, the first 21 pills are the active pills and the last seven, usually of a different color, are inactive and does not contain any hormones.They may however contain vitamins or iron supplements.

The first pill has to be started from the 1st day of menstruation or on the first sunday after the period starts. One pill is to be taken every night daily until the pack is finished. Then she waits for her menses to occur which usually occurs within the next 7 days. The second pack is then started from the ist day of the period or on the first sunday after the period starts.

If the 21 day pack is taken, the entire pack is taken until the pack is finished. Then like the 28 day pack, she waits for her menses to occur which usually occurs within the next 7 days. The second pack is then started from the 1st day of the period or on the first sunday after the period starts.

Packs containing 24 active pills and 3 inactive pills have also come on the market.

According to some researchers, birth control pills should not be taken continuously for more than 2 years to prevent a condition known as 'post pill amenorrhea'. A gap of 6 months should be given after 2 years to restore the normal hormonal balance of the body and for ovulation to recur. Then the second course of OCP’s should be started.

Advantages of Birth Control Pills

Pregnancy rate is very low at less than 1%.
The woman enjoys a self-controlled regular menstrual cycle.
The method is aesthetically pleasing and requires no messy applications like creams or the insertion of contraptions like IUCDs or use of condoms.
The woman has full control over her own fertility and does not need to depend on the male partner for birth control.
The method is simple and can be followed by even an illiterate woman.
Discontinuation of the pills is quickly followed by restoration of fertility.
Risks of infertility are minimal.

Disadvantages of Birth Control Pills

The method is relatively expensive.
It is of no use in women who are forgetful and may not take their pills daily.
Side-effects like nausea, vomiting, headache and abdominal bloating can occur.
Increased cervical discharge can occur due to increased circulating estrogen and progesterone in the body.
Increased weight due to retention of fluids, especially before the period.
Breakthrough uterine bleeding can occur, typically described by the woman as spotting in between her periods.
Metabolic changes like hyperlipidaemia and lowered tolerance to carbohydrates can occur.
Hypertension and thromboembolism occurs due to increased coagulability of the blood. This increases the risks of conditions like deep venous thromobosis (DVT).
Increase in size of fibroids, if already present, may occur due to stimulation by estrogen.

Morning After Pill

The morning after pill , also called the Plan B or emergency contraception, is a method of contraception meant to be used when other contraceptive methods have failed, or when sexual intercourse takes place without any birth control methods being used.

It consists of pills containing a high dose of progesterone (usually 90 micrograms). The first pill should be taken immediately after the unprotected sex and the second after 72 hours. This disrupts the endometrium and prevents implantation of a fertilized ovum, if fertilization does occur in that cycle.

Oral Contraceptive Pills (OCP)

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