How to Take Contraceptive Pills

The contraceptive pill, also called oral contraceptive, is a method of birth control since the 1960s. If taken correctly, the contraceptive pill has a failure rate of only 0.1%. However, in real life, due to mistakes in taking the medicine, about 9% of women who use the pill end up becoming pregnant, especially in the first year of use.

Therefore, for the contraceptive pill to be a reliable method of contraception, women need to know perfectly how to use it and have the discipline to take it correctly, without failures.

Contraceptive pills
Contraceptive pills

What is contraceptive pill?

There are several types of birth control pills on the market. The most common are so-called combined oral contraceptives, which are pills made up of two female hormones:
  • Estrogen: in the vast majority of cases the synthetic estrogen used is Ethinyl estradiol.
  • Progestin: name given to the synthetic form of progesterone. There are several types on the market, such as Levonorgestrel, Cyproterone, Norethisterone, Desogestrel, Drospirenone, Linestrenol, among others.

Combined oral contraceptives are, in general, a combination of Ethinyl estradiol with one of the above-mentioned progestins. Examples of brands of combined oral contraceptives:
  • Yaz
  • Minesse
  • Yasmin
  • Diane
  • Marvelon
  • Mercilon
  • Selene
  • Dalyn

There are also progestin-only (estrogen-free) pills known as minipills. Examples of minipill in the market:
  • Cerazette
  • Micronor
  • Minipil
  • Nortrel

The contraceptive effect of the contraceptive pill occurs in several ways. The main is through interference in the menstrual cycle, preventing women from having the natural hormonal variations that stimulate ovulation. But hormones in the pill also have other effects, such as making the mucus produced by the cervix thicker, making it impermeable to sperm, slowing the motility of the fallopian tubes, and making the uterus an inhospitable medium for the implantation of a fertilizing egg.

For the pill to work without risk of failure, it needs to be taken daily, since even a brief change in estrogen and progesterone levels may be enough for the ovary to be stimulated to ovulate.

How to take contraceptive pill

There are a few different ways to take the birth control pill. The best method is chosen by the gynecologist in order to better adapt to the clinical history and life activities of each woman. I will try to explain the most common ways to take the pill, but it is important that despite the guidelines given here, you follow the doctor's directions and the package leaflet.

Combined pills - estrogen and progestin

The menstrual cycle of the pill is 28 days. In most cases, in each cycle, women take the pill for 21 consecutive days and take a break for 7 days. During the break, as the hormones stop, menstruation usually goes down. The pause should always be 7 days, regardless of the duration of menstruation. Even if the woman is still menstruating, the pill must invariably be restarted on the eighth day. Likewise, if menstruation is very short and has already disappeared on the third day, the pause remains for 7 days.

Most birth control pills come in boxes with 21 tablets, but there are 28 tablets, the last 7 being made up only of sugar or any other innocuous substance. The boxes with 28 tablets serve so that the woman does not have to stay every month for 7 days without taking the pill. In this way, it can mend one box in the other without major concerns.

Some contraceptives have a different pause period, as is the case with Yaz´┐Ż, whose pause is only 4 days. In this case, the woman takes the pill for 24 days and pauses for 4 days.

There are also two other ways to take the contraceptive pill: continuous regimen and extended regimen. In the continuous regime, the woman takes pills with hormones in an uninterrupted way. All the pills in the box have hormones and the woman never menstruates. In the extended regimen, the woman takes pills for 84 days in a row and then takes a 7 day break. Thus, menstruation only once every 3 months.

Progestin pills - minipill

The mini-pill, a form of a contraceptive pill that contains only progestin, usually comes in boxes containing 35 tablets. This form of pill should be used every day, uninterrupted. There are no breaks.

The mini-pill has much lower doses of hormones, so it should be taken daily at the same time every day. A delay of more than 3 hours is enough for contraceptive effectiveness to be impaired.

Since the use of the mini-pill is continuous, the woman does not usually menstruate. However, given the low dose of hormones, some bleeding from the leak may eventually occur. However, if blood leakage is very frequent, seek advice from your gynecologist because the pill may not be working properly.

How to take contraceptive pill for first time

Combined pills - estrogen and progestin

Women who are going to start the pill for the first time in their lives, or who will restart their use after a few months or years of rest, are usually told to start the box on the first day of menstruation. This form of contraceptive initiation is the most effective and guarantees immediate contraceptive safety, and there is no need to use a condom during the first days of use, since protection against pregnancy occurs from the first tablet.

In fact, the pill can be started at any point in the cycle. However, this way of starting has the disadvantage of not providing protection immediately. The patient will only be fully protected against pregnancy after 7 days of use of the pill. If the patient is at risk of being pregnant, this mode of initiation is also not appropriate. If this is suspected, it is best to wait for menstruation before starting the pill.

Once the pill has been started, the woman should take it as prescribed, be it continuous 21 days and pause of 7 days, 24 continuous days and pause of 4 days or continuous use without pauses.

One should not change brands from one cycle to another. For example, it's no use buying Diane in one month, and the next switch to Yasmin. It is not the correct way to take the pill.

Progestin pills - minipill

The mini-pill can be started at any point in the cycle, but within the first 7 days there is no guarantee that it will prevent a pregnancy. After 7 days of correct use, the woman can already have relationships without condoms without risk of becoming pregnant.

As with the combined pill, if the mini-pill is started on the first day of the cycle, ie on the first day of menstruation, its contraceptive action is immediate and there is no need for another contraceptive method since the first tablet.

What to do if you forget the time to take the birth control pill

Combined pills - estrogen and progestin

In cases of combined oral contraceptives, the pill does not need to be taken at exactly the same time each day. However, it is not good to delay taking it for more than 12 hours. If you took a pill at 9am, the ideal is that the next day do not take it after 9pm.

If the delay is longer than 12 hours, take the pill as soon as you remember, but keep the next time unchanged, even if it means taking two pills on the same day. For example, you should have taken the pill at 7:00 p.m., but be remembered the next morning at 9:00 p.m. In this case, take one pill at 9am and another at 7pm. Delays of only 1 tablet (1 day) usually do not cause a flaw in the effect of the pill, especially if the woman has been using contraceptive for some time.

The danger of failure is high if the woman forgets to take 2 or more pills in a row (more than 48 hours late), especially if it is in the early days of the cycle. In this case, contact your gynecologist for advice. In general, he will suggest the following behavior:
  • 1. If 7 or more tablets are missing in the carton, stop using the pill, take a 7-day break and then start again with a new carton.
  • 2. If less than 7 tablets are missing in the carton, discard this carton and start a new one, without pausing for 7 days in this cycle.

If you are having sex, use a condom until you have at least 7 days in a row to use the new condom.

If you have had sexual intercourse during this period of 2 or more days of oblivion, use emergency contraception, popularly known as the morning-after pill.

Progestin pills - minipill

As the mini-pill has much smaller amounts of hormones, the concept of delay is much more rigorous. The mini-pill should always be taken at the same time of day. A mere delay of 3 hours is enough for the pill to lose its effect. If you miss a dose, take the mini-pill as soon as you remember, keeping the next dose at the usual time, even if it means taking 2 tablets on the same day. In the next 2 days, all intercourse should be done with condoms, as there is no guarantee that the contraceptive will be working during this period.

There are already in the market minipílulas, like the Cerazette, whose delay in the takes can be of up to 12 hours. If there are delays of more than 12 hours in tablet taking, take the mini-pill as soon as you remember, keeping the next dose at the usual time, even if that means taking 2 tablets on the same day. Likewise, during the next 2 days, all intercourse should be done with condoms, to avoid an unwanted pregnancy.

Common doubts about how to take oral contraceptives

In the case of the combined pill of 21 or 24 days, if I have unprotected intercourse during the break can I become pregnant?

No, even on the 7 or 4 day programmed break, the contraceptive continues to act normally. There is only a risk of failure if the pill is not being taken correctly.

What is the most effective pill, the mini-pill or the combined pill?

If taken correctly, both have effectiveness above 99%. However, since the tolerance interval of the mini-pill is much shorter, in practice, we see women taking the mini-pill more frequently and consequently having more unwanted pregnancies.

Can I take antibiotics while using the pill?

Yes, this is a myth. Except for rifampicin, which actually cuts contraceptive effect, no study has been able to prove that other antibiotics pose risks of pill failure.

I take the combined pill for 21 days and for personal reasons I want this month to delay my period for a few days. Can I continue to take the pill without taking the 7-day break so as not to menstruate?

No. These pills are meant to be used with breaks. You will be taking extra hormones and there are no guarantees that menstruation does not come anyway. There are pills on the market that can be used continuously, without pause for menstruation. Talk to your gynecologist to find an oral contraceptive that best fits your lifestyle.

Taking the pill for many years is wrong? Is it better to stop the pill from time to time to rest the ovaries?

No. There is no benefit in temporarily discontinuing the pill for a few months after years of use.

I took the contraceptive pill and vomited soon after. Should I take it again on this day?

If the pill has been taken less than 2 hours, it may have been vomited. In this case, the woman should take a new pill, yes. The next day, the next tablet should be taken at the usual time. If the episode of vomiting occurred more than 2 or 3 hours after pill intake, the dose need not be repeated. Obs: Diarrhea, except in very aggressive cases, does not interfere with the efficacy of the pill.

For distraction I took the pill twice the same day. What to do?

Do not do anything. Continue to take the pill the same way the next day. No need to skip a day to compensate.

Can I take oral contraceptives during breastfeeding?

In general, the woman does not ovulate during the breastfeeding period. If the mother wants to be more secure, and is not willing to use condoms, the ideal is to use the mini-pill, which has no effect on milk production.

Is there a minimum age to start taking the pill?

No. Once the teen has had her first menstrual period, she may become pregnant. Therefore, every adolescent with an active sex life can use contraceptives, without risk of hindering growth or reducing fertility in the future.

Does Contraceptive Pill Mean?

No. The risk of problems in young, healthy women is very low. The risk of thrombosis is 0.1% and cardiovascular events is only 0.02%.

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