ORAL CONTRACEPTIVES

WHAT SHOULD YOU KNOW ABOUT ORAL CONTRACEPTIVES?

Oral contraceptives ("the Pill") are among the most effective ways to prevent pregnancy. They are also convenient and, for most women, free of serious or unpleasant side effects. Oral contraceptives must always be taken under the continuous supervision of a physician or nurse practitioner.

It is important that any woman who considers using an oral contraceptive understand the benefits and the risks involved. Although oral contraceptives have certain advantages over other

methods of contraception, they have certain risks that no other method has. Only YOU can decide whether the advantages are worth the risks. This handout will tell you about how the birth control pill works, common mild side effects and the most important risks. A more detailed leaflet is contained with each container of birth control pills.

WHAT ARE ORAL CONTRACEPTIVES AND HOW DO THEY WORK?

The most common type of birth control pill is a combination of estrogen and progestin, the two kinds of female hormones. Your Student Health Center has this type of combination pill. The amount of estrogen and progestin can vary, but the amount of estrogen is most important because both the effectiveness and some of the dangers of oral contraceptives are related to the amount of estrogen. This kind of oral contraceptive works primarily by preventing release of an egg from the ovary.

One of the major advantages of the oral contraceptive is its effectiveness. Used properly the pill is 97 to 99% effective. This effectiveness can be lowered if pills are taken irregularly or if other

medications are taken at the same time. Antibiotics, including tetracycline and ampicillin, sulfa medications and certain other drugs have the potential to interfere with the action of the contraceptive. For this reason, if you are prescribed an antibiotic or sulfa medication, etc., you should use a secondary form of contraception along with your birth control pill. If you are taking any other medications advise your health care provider and ask about drug interactions. Other advantages to oral contraceptives include shorter menses with a lighter flow, less cramping, less risk of iron deficiency anemia and a more regular schedule. Many women take the pill solely for these benefits. Some studies have also shown that oral contraceptives also reduce the risk of cancer of the uterus and the ovaries, lessen the risk of tubal pregnancies and give some protection against endometriosis and ovarian cysts.

Remember that the pill does not provide any protection against sexually transmitted infections, such as herpes, genital warts, HIV or chlamydia. A latex barrier gives only limited protection from these diseases. Abstinence is the only 100% protection.

WHAT IS INCLUDED IN THE INITIAL AND REGULAR EXAMINATIONS?

Prior to beginning the birth control pill your medical history will be taken by the nurse practitioner. You will have the opportunity to ask questions regarding the advisability of taking the pill. You will be asked if you have considered alternate birth control methods to make sure you are aware of all the options prior to beginning an oral contraceptive.

This initial exam will include blood pressure, weight, breast exam, instructions on doing monthly self-breast exams, Pap smear and pelvic exam. A blood count and a urinalysis will be done in the SHS lab. If you have never been tested for cholesterol or blood sugar or if these have been elevated in the past you may be requested to have these tested prior to starting the pill. If all testing and examinations prove to be normal you will be given a prescription of birth control pills for 3 cycles.

At the end of the 3 cycles you will return for blood pressure, weight and a consult with the nurse practitioner. Be sure to describe any problems or side effects noted during this time period. Normal adjustment to the pill can be expected. They may include spotting while on the pill (breakthrough bleeding), slight nausea, weight gain, etc. Most minor adjustment symptoms usually disappear by the 3 month visit. Any which remain should be discussed with the nurse. Occasionally the pill dosage needs to be changed to accommodate your special body chemistry. If a change of dosage is needed it is usually done at this 3 month visit. If you are currently on birth control pills and tolerating them well with no significant side effects or risk factors, you will be given a prescription for not more than 6 cycles. At the end of the 6 cycles you will return for blood pressure, weight and a consult with the nurse practitioner. Keep in mind school vacations and plan ahead to make sure you don´t run out of pills. Each year you will need a physical exam including Pap smear, breast exam, blood work and urine specimen prior to refill of the pill.

The initial/annual exam and lab work may be completed by your private physician. However, all Pap smear and lab results must be normal and current (within one year) and in your file at the Health Center before a prescription is issued. The nurse practitioner will review the medical history, take your blood pressure and weight and review instructions for the birth-control pill.

HOW TO TAKE THE PILL SO THAT IT IS MOST EFFECTIVE

The nurse practitioner will go over the instructions with you. She will discuss when to start and all the specifics of the particular birth control pill that is prescribed for you. Do not leave with a prescription unless you know when and how to take it. If you have a question, ask it. If you don´t think of it until you get home, please call us back.

The following suggestions may increase the pill´s effectiveness and cause you the least amount of adjustment problems.

During the week of "sugar pills" you should have a menses. Failure to have your period could be caused from several things: stress, weight loss, extensive exercise, pregnancy or adjustment to the birth control pills. The possibility of pregnancy is the primary concern. Your clinician will want you to come into the health center for a pregnancy test before continuing on the pills.

If you have missed even one pill use an alternate birth control method along with your birth control pill.

During the first cycle of oral contraceptives you should use an additional method of birth control until you have taken the first 2 weeks of pills. Alternate methods, which provide added protection, include abstinence or a condom used with spermicide.

MILD SIDE EFFECTS OF ORAL CONTRACEPTIVES

Some women using oral contraceptives experience unpleasant side effects. Some of these may be temporary. Your breasts may feel tender, nausea and vomiting may occur, you may gain or lose weight and your ankles may swell. A spotty darkening of the skin, particularly of the face, is possible and may persist. You may notice unexpected vaginal bleeding (breakthrough) or changes in your menstrual period.

More serious side effects include worsening of migraine, asthma, epilepsy and kidney or heart disease because of a tendency for water to be retained in the body when oral contraceptives are used. Other side effects are growth of pre-existing fibroid tumors of the uterus, mental depression and liver problems with jaundice. Levels of sugar and fatty substances in your blood may be elevated, but the long-term effects of these changes are not known. Certain endocrine and liver function tests and blood components may be affected by the oral contraceptive. Women who wear contact lenses may need to change their prescription or may be unable to use that type of lens. Some women develop high blood pressure while taking oral contraceptives, which ordinarily returns to the original levels when the oral contraceptive is stopped.

You should consult your physician before resuming use of oral contraceptives after childbirth, especially if you plan to nurse your baby. The drugs in oral contraceptives are known to appear in the milk, and long-range effect on infants is not known at this time. Furthermore, oral contraceptives may cause a decrease in your milk supply as well as in the quality of the milk.

WHAT ARE THE DANGERS OF ORAL CONTRACEPTIVES?

Circulatory disorders (abnormal clotting, heart attack, and stroke due to hemorrhage). Blood clots are the most common of the serious side effects of oral contraceptives. There is evidence that the risk of clotting increases with higher estrogen doses. Furthermore, cigarette smoking by oral contraceptive users increases the risk of serious adverse effects on the heart and blood vessels. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and begins to become quite marked in women over 35 years of age. The risk of abnormal blood clotting increases with age in both users and nonusers of oral contraceptives, but the increased risk from oral contraceptives appears to be present at all ages.

Formation of tumors. Studies have found that when certain animals are given the female sex hormone estrogen continuously for long periods, cancers may develop in the breast, cervix, vagina and liver. These findings suggest that oral contraceptives may cause cancer in humans. However, studies to date in women taking currently available oral contraceptives have not confirmed that oral contraceptives cause cancer in humans. Several studies have found no increase in breast cancer in users, although one study suggested oral contraceptives might cause an increase in breast cancer in women who already have benign breast disease (e.g., cysts).

Women who have a strong family history of breast cancer or have breast nodules, fibrocystic disease, abnormal mammograms, or were exposed to DES, a strong estrogen, during their mother´s pregnancy, must be followed very closely by their doctors if they choose to use oral contraceptives.

Dangers to a developing child if oral contraceptives are used in or immediately preceding pregnancy: Pregnant women should not take oral contraceptives because they may damage the developing child. An increased risk of birth defects, including heart and limb defects, has been associated with the use of sex hormones, including oral contraceptives, in pregnancy.

If you stop taking oral contraceptives to become pregnant, your health care provider may recommend that you use another method of contraception for a short while. A three-month break is usually recommended. However, if you do become pregnant soon after stopping oral contraceptives, and do not have a miscarriage, there does not appear to be evidence that the baby has an increased risk of being abnormal.

Gallbladder disease: Women who use oral contraceptives have a greater risk than nonusers of having gallbladder disease requiring surgery. The increased risk may first appear within one year of use.

POSSIBLE LIFE-THREATENING SIDE EFFECTS

Serious pill complications rarely come without warnings signs and symptoms. It is your responsibility to learn the pill danger signals and call the Health Center or your physician immediately if the following symptoms are noted.

EARLY PILL WARNING SIGNS

C A U T I 0 N A * Abdominal Pain (severe)
C A U T I 0 N C * Chest pain (severe, cough, shortness of breath or sharp pain on
C A U T I 0 N breathing in)
C A U T I 0 N H * Headache (severe), dizziness, weakness, or numbness especially if
C A U T I 0 N one-sided
C A U T I 0 N E * Eye problems (vision loss or blurring), speech problems
C A U T I 0 N S * Severe leg pain (calf or thigh)

See your clinician if you have any of these problems or if you develop depression, yellow jaundice, a breast lump, a bad fainting attack or collapse, a seizure (epilepsy), difficulty speaking, a blood pressure above 160/95, a severe allergic rash, or if you are immobilized after an accident or major surgery.

(reprinted from Contraceptive Technology, 1998)

WHAT TO TELL YOUR HEALTH CARE PROVIDER

You can make the most judicious use of the pill by telling your health care provider if you have any of the following:

Your health care provider asks that you read this information before starting oral contraceptives so that you can make an informed decision. Please keep it for future reference. If you have any further questions or concerns please call the nurse practitioner, your physician, or ask them at your appointment time.

Related information: Frequently asked questions about BCPs

STUDENT HEALTH SERVICES (661) 654-2394 1992MH/CK Updated 2/06 CK