If you use the birth control pill — that is, an oral contraceptive — you're probably happy with its convenience and reliability. Still, you may have many questions about the potential effects of the birth control pill on your overall health.
Yes, birth control pills can be used to reduce or eliminate monthly bleeding. When birth control pills were first available, they were packaged as 21 days of active hormonal pills and seven days of placebo pills. During the week women took the placebo pills, they would have bleeding similar to a regular menstrual period.
Today women have many more options — from regimens with 24 days of active pills and four days of placebo pills to regimens that are all active pills. The first extended-cycle pill regimens introduced provide active hormone pills every day for three months, then one week of placebo pills or low-dose estrogen pills. Newer extended-cycle regimens are designed to be taken continuously for one year and suppress all menstrual bleeding.
Continuous or extended-cycle regimens have several potential benefits. They prevent hormonal fluctuations that are responsible for bleeding, cramping, headaches and other discomforts associated with getting your period. You also may find that you like the convenience of not having a period during important events or trips.
However, unscheduled bleeding and spotting often occur during the first few months on this type of regimen. It typically goes away with continued use, but some women continue to have unscheduled bleeding with continuous use of pills.
There are birth control pill regimens designed to prevent bleeding for three months at a time or for as long as a year. But it's possible to prevent your period with continuous use of any birth control pill. This means skipping the placebo pills and starting right away on a new pack. Continuous use of your birth control pills works best if you're taking a monophasic pill — with the same hormone dose in the three weeks of active pills.
After you stop taking the pill, you may have only a two-week delay before you ovulate again. Your period would follow about four to six weeks after you take the last pill. Once ovulation resumes, you can become pregnant. If this happens during your first cycle off the pill, you may not have a period at all.
In the past, doctors had concerns that if you conceived immediately after stopping the pill, you had a higher risk of miscarriage. However, these concerns have proved to be largely unfounded. The hormones in birth control pills don't linger in your system.
Most women have no more than a four-week delay in menses after they stop using the pill. However, if your periods were infrequent before you started taking the pill, they will likely be that way again after you stop the pill. Some women find that it takes a couple of months before they return to regular ovulatory cycles. If you plan to wait a few months, you may want to use a backup form of birth control while your menstrual cycles get back to normal.
If you don't get a period for several months, you may have what's known as post-pill amenorrhea. The pill prevents your body from making hormones involved in ovulation and menstruation. When you stop taking the pill, it can take some time for your body to return to normal production of these hormones.
Typically, your period should start again within three months after you stop taking the pill. But some women, especially those who took the pill to regulate their menstrual cycles, may not have a period for many months.
If you don't have a period within three months, take a pregnancy test to make sure you're not pregnant and then see your doctor.
You can get accurate results from a pregnancy test while you're on the pill. Pregnancy tests work by measuring a specific pregnancy-related hormone — human chorionic gonadotropin (HCG) — in your blood or urine. The active ingredients in birth control pills don't affect how a pregnancy test measures the level of HCG in your system.
If you continued taking your birth control pill because you didn't realize you were pregnant, don't be alarmed. Despite years of this accident happening, there's very little evidence that exposure to the hormones in birth control pills causes birth defects. Once you learn that you're pregnant, stop taking the birth control pill.
It's possible to use standard estrogen-progestin birth control pills for emergency contraception, but check with your doctor for the proper dose and timing of the pills.
There are two types of pills specifically designed to keep you from becoming pregnant if you've had unprotected vaginal intercourse. These medications are sometimes referred to as the "morning-after pill." Levonorgestrel (Plan B One-Step, Next Choice) is available over-the-counter. It's available at drugstores, as well as health clinics and Planned Parenthood. Ulipristal acetate (Ella) also is approved for emergency contraception. It's available only by prescription.
In terms of your overall health, it makes little difference when you stop taking the pill. When you finally do stop the pill, you can expect some bleeding, which may change the rhythm of your menstrual cycle. But you can stop at any time.
Taking the nonactive pills doesn't put you at higher risk of unintended pregnancy. If you're taking your birth control pills exactly as directed, they're 98 to 99 percent effective at preventing pregnancy.
If, however, you've missed a pill — or several pills — during a cycle, you might be at higher risk of unintended pregnancy during that cycle. To be safe, use a backup form of contraception, such as a condom.
Many women think so. But studies have shown that the effect of the birth control pill on weight is small — if it exists at all. Instead, you may be retaining more fluid, which can make you feel as if you've put on weight, particularly in your breasts, hips and thighs. The estrogen in birth control pills does affect fat (adipose) cells, making them larger but not more numerous.
Scientific evidence suggests using birth control pills for longer periods of time increases your risk of some cancers, such as cervical cancer and liver cancer, but it also decreases your risk of other types of cancer, including ovarian cancer and endometrial cancer.
The effect of birth control pills on breast cancer risk isn't quite clear. While some studies have shown a link between pill use and breast cancer, more-recent studies do not show an increased risk of breast cancer with the pill. If you're concerned about your risk of breast cancer, talk with your health care provider about whether the pill is the right contraceptive for you.
Birth control pills can affect cholesterol levels. How much of an effect depends on the type of pill you're taking and what concentration of estrogen or progestin it contains. Birth control pills with more estrogen can have a slightly beneficial overall effect on your blood lipid levels. In general, though, the changes aren't significant and don't affect your overall health.
Birth control pills may slightly increase blood pressure. If you take birth control pills, have your blood pressure checked regularly. If you already have high blood pressure, talk with your doctor about whether you should consider an alternative form of birth control.
Although women older than age 35 used to be told to stop taking birth control pills, these limits no longer apply to healthy, nonsmoking women. However, birth control pills aren't recommended for women older than age 35 who smoke because of the risk of cardiovascular disease. If you're 35 or older and you smoke, you need to quit smoking before you can safely continue using birth control pills.
The effects of antibiotics on birth control pills may be overstated — except in the case of one antibiotic, rifampin. Studies clearly show that rifampin decreases the effectiveness of birth control pills in preventing ovulation. However, rifampin isn't used widely today.
May 21, 2013
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