The Pill

As long as you follow the instructions on your packet, the Pill can be considered 99 per cent effective in preventing unwanted pregnancies -higher odds than any other form of contraceptive.

Why is the Pill such an effective contraceptive?

The Pill’s effectiveness is so high because it depends not just on one contraceptive action but on three, each of which takes place in different parts of a woman’s body. In contrast, other methods – the diaphragm, the IUD and other rival methods – have only one, or at most two, contraceptive actions.

Briefly, the Pill contains two synthetic hor-mones- oestrogen and progestogen. Oestrogen is similar to the natural hormone involved in your monthly cycle, but progestogen is not the same as your natural progesterone. These synthetic hormones interfere with the body’s natural sex hormones and effectively’trick’ the body into believing it is pregnant.

If you are on the Pill, the synthetic hormones impose their own pattern on your monthly cycle. Firstly, they stop the ovary from releasing and expelling an egg. Secondly, they act on the Fining of the womb, so that instead of developing its usual rich lining – ready for a fertilized egg — it remains thin and poorly nourished, so that no egg can embed itself or be allowed to develop.

Finally, the synthetic hormones affect the womb’s natural secretions. Normally, at the time of the month when the egg is mature, the wombusually advise against a longer stretch. Remember, releases a clear fluid, rather like the white of anthough, that when you first start on the oral egg, which enables the sperm to move easilycontraceptive you should always use some other along the vagina. The Pill inhibits this mucus,form of contraception while taking the first and, instead, a thick sticky fluid effectively plugspills from the first packet. This does not apply to the entrance to the womb, so that the spermthose on the new pill which gives you cannot pass through.immediate protection.

Because of the changes brought about by the Pill, the periods you have when you take it are not ‘true’ periods. Although the womb sheds its lining, the lining itself is slightly different from normal, partly because no egg has been released.

In fact, the lining is shed because you stop taking the Pill. There is no need to have a period at all on the Pill, but the scientists who developed it found that women preferred to retain a monthly cycle, with the added advantage of being able’to predict exactly when their period was due. Most brands therefore contain just 21 pills, giving you a seven-day break when bleeding occurs.

The reason that some brands have 28 pills is that manufacturers have included an extra seven ‘blanks’ which contain no hormones at all. This allows you to keep up the habit of taking the Pill each day, but still gives you seven days ‘off’.

Because you don’t need to menstruate each month, you can take up to three of the 21-day packets in succession, without a break, so that your period comes at a time which is convenient to you.

Many women experience some side effects from the Pill, but usually they are not serious and will probably settle down with time. Some of them may be positively beneficial.

One of the things you may notice when you start taking the Pill is that your periods are not only more regular, but also shorter and lighter than before. The blood will be dark, rather than bright red, with no clots. If you previously suffered from period pains, you may also find that these lessen. Although the reasons for this pain – known as – are not clear, it seems probable that they are linked to ovulation and consequently disappear when ovulation doesn’t take place.

The changes vary from woman to woman. Some find that their skin actually improves once they start taking the Pill, while others find that it aggravates a tendency towards acne. The vagina may become more moist and the discharge may increase. This can raise the chances of contracting ‘thrush’, a common vaginal complaint. So if you find the discharge is accompanied by irritation. See your doctor. On the other hand, very occa- sionally you inav find that vaginal dryness be-comes a problem.

Weight gain is a common source of complaint and often continues to rise in spite of dieting. Many women feel irritable, depressed or even nauseous when they first start taking the Pill; sometimes the breasts also become very tender.

These side effects are usually the result of the new hormone balance in your body and the changes in your general body chemistry. The alterations in your blood chemistry, for example, can account for weight gain, and may also increase your blood pressure, although if this is the case, your doctor will suggest you come off the Pill straight away. The acidity or alkalinity of your skin will also be altered – and this may make you more prone to thrush.

Some of the changes are due to the indirect effects of the Pill hormones on the part of the brain called the hypothalamus which monitors menstruation. The hypothalamus controls many other functions, including your water balance, appetite and mood: changes in one group of hormone messengers sometimes affects the hormone messengers relating to these other functions, so you may find you are retaining more body fluid, for example.

Many of these symptoms disappear after the first three months, but sometimes they persist, and vour doctor may suggest that you change vour brand or suggest that you come off the Pill.

Different Pills not only contain varying amounts of oestrogen and progestogen, but also different forms of these chemicals. Some women do better than others on the various types, according to their natural body make-up and hormonal balance. A doctor will try to prescribe the Pill which will suit you best, and you may have to try several different brands until you find the best one for you.

For example, if your periods are normally heavy, prolonged or frequent, you will probably respond best to a Pill which contains low oestrogen and high progestogen. Conversely, infrequent or painful periods will probably improve if you try a high oestrogenlow progestogen type. Women with acne, a poor sex drive, small breasts or a rather dry vagina will find that they benefit from a high oestrogen Pill while if your breasts become tender, or if you have varicose veins, your doctor will either prescribe a low-oestrogen Pill, or the mini-pill.

Of course, if you develop any of these symp- . toms on one type, they may be relieved by swapping to a different Pill which contains the opposite balance of hormones.

Unlike the standard ‘combination’ Pill, the mini-pill contains only one hormone – progestogen. This has the advantage of avoiding those side effects which are due to oestrogen. A woman who is breast-(ceding, for example, and who does not want to change to another form of contraceptive will probably be prescribed the mini-pill because it does not reduce milk-production; indeed, it may increase it. It also avoids side effects like nausea and vomiting, ‘bloatedness’ and breast tenderness.

The mini-pill does have disadvantages, though. Since it contains no oestrogen, it’s not so effective in preventing ovulation, and it is vitally important to take it each and every day, at the same time, for month after month, or you may risk becoming pregnant. Because the mini-pill has a higher failure rate, a few doctors recommend that a spermicidal jelly should also be used. Irregular bleeding is another problem – your periods may come at any time, or not at all for long spells.

Oestrogen can interfere with the body’s blood clotting mechanism, making it clot more easily. If a blood clot forms, this can lead to a stroke or a heart attack.

When researchers discovered this link, the dosage of oestrogen in the Pill was immediately lowered. Today, no brand is allowed to contain more than 50 micrograms of oestrogen and many contain a good deal less. As a result, the chances of a woman on the Pill dying as a result of a blood clot are less than 4 in 100,000.

There is no evidence that taking the Pill can cause cancer, but doctors will not usually pre-scribe the Pill for anyone who has had cancer of the breast, ovaries or womb.

It’s worth remembering that the Pill is one of the best-researched drugs in the world and the risks lower than in pregnancy and childbirth.

Because of the links between the Pill and heart problems, there are certain obvious circumstances when a woman will be advised not to take the Pill – if she has any history of heart disease, for example. Smokers, too, are encouraged to stop taking the Pill when they reach 30, and in any case, since the chances of heart problems increase with age, anyone over 35 should consider switching to one of the other contraceptives.

Anyone suffering from diabetes or diseases of the liver, kidnevs or gallbladder are also excluded, and doctors avoid prescribing the Pill for any woman found to have raised blood pressure, since it may raise it still further.

If you have an irregular cycle, with long gaps between periods, you may risk seriously upsetting the cycle permanently by going on the Pill. If your periods aren’t regular, but you want to go on the Pill, doctors normally recommend that you try the Pill for one year, and then come off for a break of three months or so, to make sure your natural cycle reasserts itself.

Finally, women who suffer from pre-menstrual tension (PMT), or those who develop it after having a baby, usually find that the Pill aggravates the condition. This is because the progestogen suppresses the production of the natural hormone progesterone; PMT is actually a result of too-low levels of progesterone.

Anvone who takes any drug for a long period of lime should always have a regular check-up, and Pill-users are no exception. Introducing extra hormones into the body, gives it more work to do; the oestrogen and progestogen have to be broken down in the liver and this can mean that it is less efficient in clearing the blood of other, potentially harmful chemicals. Such changes in the blood chemistry are responsible for some of the Pill’s more serious side-effects. Build up of some chemicals can increase blood pressure, for instance.

Regular check-ups make sure that the body is coping with the changes in the hormone pattern and with the waste disposal of oestrogen and progestogen. It also gives the doctor the oppor-tunity to assess how well the type of Pill is suiting the patient.

As a matter of routine, your doctor will ask about your general health to ensure that no side effects have developed, and if necessary, either change the type of Pill or advise that you switch to • forget to take vour pill even’ day. II you have forgotten one pill, take it as soon as you remember, even if you have already taken one that day. If you have missed more than one day, take two pills daily for the next two or three clays until you have caught up, and remember to use other contraceptives for the rest of the month. • take extra precautions for the first two weeks of the first cycle when you start taking the Pill. • take extra precautions if you have had diarrhoea or vomiting for more than one day, as this will have prevented the Pill from being absorbed properly. • lake the mini-pill every day at the same time, or you risk pregnancy. • consult your doctor if you start suffering from severe headaches, chest pains or breathlessness. • consult your doctor il your monthly periods stop. You may need to come off the Pill for a while or change your brand.

A completely different type of contraceptive.

Blood pressure and weight checks are particu-larly important but the doctor will also examine vour breasts, and give you an internal examination as well as taking a cervical smear (samples of cells from the entrance to the womb). He may also ask for a urine sample.

You should always tell your doctor about any side effects, however harmless they may seem. If vour contact lenses have been bothering you, for example, or if your skin has developed brownish patches. These are not serious, but may indicate to the doctor that you should switch to the mini-pill.

Should you develop severe headaches, migraine or painful veins or if you have anvpains in your chest or suffer from sudden breathlessness, you must consult your doctor straight awav. They are signs that you should change to another form of contraception.

Yes. Sexual desire is created by a combination of many different hormones. It the hormones in the body cannot adjust to the hormonal changes brought on by the Pill a woman may find that she no longer reaches a climax or enjoys lovemaking. When this happens, she should use a totally different form of contraception-just changing to another type of Pill will probably not be enough. The Pill’s side-effects may also cause problems- thrush can make intercourse painful, for instance.

Psychological factors can play a part too although these can be complex and difficult to pinpoint. For some women on the Pill, sex loses its appeal because having intercourse when there is a risk attached adds to the excitement. Others may feel that the Pill makes them less feminine, and this can also affect their sexual desire. At the opposite extreme, there are women who find that the Pill actually increases their sexual pleasure because it removes the fear of pregnancy.

Opinions vary as to whether you should come off the Pill regularly but all agree that there should be some break just to make sure that your system is in good working order. Recommendations range between once every year to once even’ three years, but naturally each case is judged on its own merits and many factors will be taken into consideration – your medical background, age and any other circumstances.

The whole point of contraception is to be able to enjoy your sex life without becoming pregnant. So it’s important to feel happy that the contraceptive you choose will not spoil your love making, as well as being a suitable method for your health and age.

Who decides about a contraceptive – a woman or her doctor? When you go to consult a doctor about contra-ception, his job is-as far as possible-to give you the kind of protection that you want.