All you need to know about the oral contraceptive pill
Dr. Christopher Ng of GynaeMD Women’s and Rejuvenation Clinic brings you valuable information about the contraceptive pill.
Combined oral contraceptive pills (OCP or "the pill") are used by over 100 million women worldwide and are considered to be almost 100% effective at preventing unwanted pregnancies when taken as directed.
Like any drug, the pill comes with a some side effects that may affect some. Breast tenderness, nausea and headaches are common reactions.
On the other hand, the Pill also has a range of benefits other than, of course, preventing unplanned pregnancies. These include regulating the menstrual cycle, controlling acne, and relieving premenstrual syndrome (PMS) and painful and heavy menses.
Dr Christopher Ng, obstetrician and gynaecologist from GynaeMD Women’s & Rejuvenation Clinic at Camden Medical Centre in Singapore, brings you expert information about the pill.
Q: What are the ingredients usually found in the pill and how do they work?
A: OCPs contain two hormones, oestrogen and progestogen. These prevent ovulation, making fertilization, and therefore pregnancy, impossible.
Q: How do you take the pill?
A: A pack of OCPs contains 21 pills, one for each day. At the end of those three weeks, the woman takes a break for seven days, wherein menstruation occurs. The woman then starts on the next packet.
For a women going on the pill for the first time, it is now the practice to take the first-ever pill on the first day of the period.
Q: Can anyone take the pill?
A: The pill is not suitable for women who:
- Might already be pregnant
- Are over the age of 35 and are heavy smokers or who have stopped smoking for less than a year
- Are overweight with BMI >35
- Have a past experience with blood clot
- Have heart abnormality, circulatory disease or high blood pressure
- Have very severe migraines or migraines with aura
- Have breast cancer now or within the last five years
- Have active liver or gall bladder disease
- Have diabetes with complications, or have had diabetes for more than 20 years
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Q: At what age can a woman start taking the pill?
A: There is no age limit as to when a woman can take the pill.
However, women over 35 years old who are also heavy smokers and obese (BMI > 35) should not take the pill as it can increase their risk of deep vein thrombosis.
Young pubescent girls who experience menstrual problems like menorrhagia, dysmenorrhea, irregular menses and Premenstrual Dysphoric Disorder that are severe enough to disrupt their schooling and daily lives, can also start on the pill after consultation with their doctor.
Women who are sexually active and who want to prevent an unplanned pregnancy can start on the pill provided they have no underlying health issues or risks factors.
Q: How soon do contraceptive pills start working once you take them?
A: If you start the pill on the first day of your menses, you are immediately protected. If you start it any other day, then you will need to take the Pill for 7 days before it is effective.
Q: What happens if I forget to take one and have sex on that day?
A: If you are taking the pill and you have missed one for less than 12 hours, you do not need to worry.
- Take the missed pill as soon as you remember and the remaining pills as per normal.
- You do not need to use any additional contraception.
- If you had unprotected sex, you do not need emergency contraception.
However if you have missed the pill for more than 12 hours:
- Take the last pill as soon as you remember and the remaining pills as per normal. This may mean taking two pills on the same day or even at the same time.
- If you have more than seven pills left in your pack, finish the pack and start the next packet after a seven-day break as usual.
- If you have less than seven pills left in your pack, finish the pack but skip the “pill-free break” and start a new pack the next day. This may mean you don't get a bleed until the end of the second pack. If you do not get a bleed by then, speak to your doctor straight away. You must use additional contraception (such as condoms) or abstain from intercourse for the next seven days.
- If you had unprotected sex in the last seven days, get advice from your GP or gynaecologist as you may need emergency contraception.
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Q: How do I get birth control pills?
A: In Singapore, you will need to consult a GP or a gynaecologist before the pill can be prescribed. They will assess your risk factors, medical history and lifestyle needs.
Q: What are mini pills and who can take them?
A: The mini pill, also known as the progesterone-only birth control pill (POP), is an oral contraceptive that contains the hormone progestin. Unlike combination birth control pills, the mini pill doesn't contain oestrogen. The progestin dose in a mini pill is lower than the progestin dose in any OCP.
Breastfeeding mothers can use this as a form of contraception. POP can also be used by women who can't use contraceptives that contain oestrogen. These can be women with high blood pressure, previous blood clots or are overweight. Women can take POP even if they are over 35 and smoke.
The disadvantage is that the POP must be taken daily and has a strict consumption schedule. If taken more than three hours late, it may not be effective hence it is not the best option for women who are busy and forgetful.
Q: Can I take other drugs while on contraceptive pills?
A: Some medicines can interact with the pill and reduce its effectiveness. The following medications cannot be taken with the pill:
- Some types of antibiotics, called rifampicin and rifabutin
- Some herbal remedies, such as St John's Wort
- Some anti-epileptic drugs (AEDs) that are used to treat epilepsy (seizures), such as carbamazepine
- Some antiretrovirals (ARVs) that are used to treat HIV, such as ritonavir
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Q: Do I need to take all the pills in the packet? Some of them are just sugar pills, right?
A: Some types of pills contain four “dummy pills” out of the packet of 28 pills. They are there so that women will not forget to take the Pill or get confused as to when to stop and start a new packet.
It is alright to skip these 4 tablets but you will have to remember to start the next packet four days after the last hormone pill. Some women choose to start the next packet immediately after the last hormone tablet and miss the four “dummy tablets”. By doing this (i.e., taking two consecutive packs without a four-day “dummy” break), the menstruation will not come during that month.
Q: At what age should I stop taking contraceptive pills?
A: It is safe to take the OCP beyond the age of 35 as long as you are not an active smoker and/or obese.
If you have no other underlying health issues or risks factors as mentioned above, you can continue to take the OCP as long as you need the contraceptive benefits, which for some women can be up to when they menopause.
theAsianparent would like to thank Dr Ng for his contribution to this article.
We hope you found this article informative. Do you take the pill? What’s your experience been like so far? Let us know by leaving a comment below.