Womens Health

The Right Pill for You

Birth control pills, from their inception until this day, have been and continue to be the contraceptive of choice and for good reason. They are easy to use and they work. While the pill came in limited choices a few years ago, these days you can be overwhelmed with the variety of choice you have. It is possible to find a pill that works well for you, but you'll need to work with your health care provider to find out which one it is.

The Two Basic Types of Birth Control Pills

Basically, there are two main types of birth control pills - combination birth control pills that contain progestin and estrogen and the minipill, which contains only progestin. Depending upon how frequently you want to have periods, you can choose from a variety of mixtures of active and inactive pills to accommodate your lifestyle. The conventional packs of 28 pills contain 21 active pills and seven inactive pills, or they come in packs of 24 active pills with four inactive pills. The continuous dosing or extended cycle packs typically contain 84 active pills and seven inactive pills. With continuous dosing, you only bleed four times a year, when you take the inactive pills. There are formulations, like Seasonale, that are continuous and contain only active pills and therefore eliminate bleeding.

Low-Dose or Not? 

Another categorization of combination birth control pills is done according to whether the dose of hormones varies or remains static. In the monophasic type of pill, the amount of estrogen and progestin is the same. However, the multiphasic birth control pills have varying amounts of hormones in the active pills.

Low-dose combination pills are those that contain less than 50 micrograms of ethinyl estradiol, a type of estrogen. If you are hormone sensitive, then this is probably a good choice for you. The downside is that on low-dose pills you may experience more breakthrough bleeding between periods than you would on a higher dose birth control pill. The minipill doesn't afford you the kind of selection that combination pills offer. There is a single mixture and formulation and all of the pills in the pack are active.

The Pills Work Differently

The combination birth control pills:

· suppress ovulation

· thicken cervical mucus

· thin the lining of the uterus (to keep sperm from fertilizing the egg)

· contain both estrogen and progestin

The minipills:

· thicken cervical mucus

· thin the endometrium

· sometimes suppress ovulation

· do not contain estrogen like the combination pills do

· the progestin dose is lower than the dose in the combination pill

What's Suitable for You?

Not all pills are good for all people. Your health care provider will take a personal health history and based on it and the medications you may be on, will prescribe a pill that will be suitable for you to take. If you have any of the following situations or conditions, your health care provider will discourage you from taking combination birth control pills:

· breastfeeding

· older than 35 and smoke

· have poorly controlled high blood pressure

· have deep vein thrombosis or pulmonary embolism, or have a history of either

· have a history of breast cancer, stroke or heart disease

· have diabetes-related complication

· have liver disease

· have unexplained uterine bleeding

· have had major surgery and will be immobilized for a period of time

· take St. John's wort, or anticonvulsant or anti-tuberculous agents

If any of the following are present, your health care provider may discourage the use of the minipill:

· breast cancer

· unexplained uterine bleeding

· taking anticonvulsant or anti-tuberculous agents

The Good, The Bad, and the Ones You Better Not Take

The pros of the combination birth control pills are:

· a decrease in ovarian and endometrial cancers

· improved acne

· lessening of menstrual cramping

· reduced androgen production that comes from PCOS

· reduced heavy bleeding and accompanying anemia

· PMS relief

· shorter, lighter, predictable periods - or no periods at all

The cons of the combination birth control pills are:

· they do not protect against STDs

· there is an increased risk of blood clots, heart attack and stroke

· irregular bleeding, bloating, breast tenderness, nausea and headache side effects

The pros of the minipill are:

· they're okay to take if you have health issues

· can be used while breastfeeding

· quick return of fertility once they are stopped

The cons of minipills are:

· no protection against STDs

· possibly less effective than combination pills

· they must be taken at the same time every day (you have a two hour window for forgetting)

· mean side effects: irregular menstrual bleeding, ovarian cysts, decreased libido, headache, breast tenderness, acne, weight gain, depression and hirsutism (body hair)

· risk of ectopic pregnancy if conception occurs

It's Basically Your Choice

So, at the end of the day, the decision is between your health care provider and you. There are many types of pills to choose from which you can see in our article in this section.

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