Pregnancy and the pill

Neverwhere

So I know that this sounds rather stupid, but to be honest with you I don't know much about the pill. I'm not really supposed to be taking it due to other health problems.

How does it work when it comes to pregnancy? I know you can still get pregnant on the pill. Could you still take a pregnancy test? I know it tricks your body into thinking your pregnant, but you aren't really sending out the pregnancy hormone...

Nevyn

http://www.patient.co.uk/showdoc/23068708/

Combined Oral Contraceptive Pill

The combined oral contraceptive pill is often just called 'the pill'. It contains two hormones, an oestrogen and a progestogen. If you take it correctly it is a very effective form of contraception.

How does the pill work?

The pill works mainly by changing the body's hormone balance so that you do not ovulate. That is, you do not release an egg (ovum) each month from an ovary. In addition, it causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg. The pill also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

The pill contains both an oestrogen and a progestogen. These can be different types and also different strengths.

How effective is the pill?

It is over 99% effective if used correctly. This means that less than 1 woman in 100 using the pill correctly will become pregnant each year. Correct use means not missing any pills, and taking extra contraceptive precautions when necessary (for example, when taking antibiotics - see below).

Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.

What are the advantages of the pill?

It is very effective. It does not interfere with sex. Periods are often lighter, less painful and more regular. It may relieve pre-menstrual tension. It reduces the risk of developing cancers of the ovary, colon and uterus (womb). In particular, the protection against cancer of the ovary is quite marked and the protection seems to continue for many years after stopping the pill. It may also reduce the risk of pelvic infection (as the 'mucus plug' may prevent bacteria, as well as sperm, from getting into the uterus). It may help to protect against some benign (non-cancerous) breast disease. It may reduce the risk of developing certain types of cyst in the ovary.

Are there any side-effects when taking the pill?

Most women who take the pill do not develop any side-effects. However, a small number of women develop nausea (feeling sick), headaches or sore breasts when they take the pill. These usually go away within days or weeks of starting the pill. If they persist, a different brand of pill may suit better.

Other side-effects are uncommon and include tiredness, change in sex drive, skin changes and mood changes. These are unusual and you should tell your doctor or practice nurse if you have any persisting side-effects. There is no evidence that people who take the pill put on weight.

The pill sometimes causes a rise in blood pressure. Therefore, if you take the pill you should have your blood pressure checked about every six months. The pill may need to be stopped if your blood pressure becomes too high.
Are there any risks in taking the pill?

The pill can have some serious side-effects, but these are very uncommon. For most women the benefits of the pill outweigh the possible risks. All risks and benefits of you taking the pill should be discussed with your doctor or nurse.

People taking the pill have a small increased risk of thrombosis (blood clot), especially in the first year of taking the pill. This is why people with a higher risk of clots cannot take the pill. However, this risk is considerably smaller than the risk of clot if you were pregnant. Although all pills now prescribed have low doses of oestrogens in them, some have lower strengths which may be more suitable if you have any risk factors for thrombosis. The low dose pills can lead to some 'spotting' of blood occurring in between your periods as a side-effect.

You must see a doctor straight away if you have any of the following: severe headache, bad pains in the chest, leg or tummy, leg swelling, breathing difficulty, coughing up blood, sudden problems with sight or speech, weakness or numbness in an arm or leg or collapse. (These symptoms could be due to a blood clot.)

Taking the pill can increase the risk of some types of cancer but also protect against other types. Research into the risk of breast cancer in people taking the pill is complex and the results are still conflicting. Some studies suggest a possible link between the pill and a slight increased risk of cancer of the cervix if the pill is taken for more than eight years. Some research suggests a link between using the pill and developing a very rare liver cancer.

However, there is a reduced risk of developing cancer of the ovary, uterus and colon in people taking the pill. When all cancers are grouped together, the overall risk of developing a cancer is reduced if you take the pill. Further research is ongoing.

Note: if you need to go into hospital for an operation or you have an accident which affects the movement of your legs, you should tell the doctor that you are taking the pill. The doctor may decide that you need to stop taking the pill for a period of time.

Who cannot take the pill?

Most women can take the pill. If you are healthy, not overweight, do not smoke and have no medical reasons for you not to take the pill, you can take it until your menopause. Women using the pill will need to change to another method of contraception at the age of 50 years.

Your doctor or family planning nurse will discuss any current and past diseases that you have had. Some diseases cause an increased risk or other problems with taking the pill. Therefore, the pill will not be prescribed to some women with a certain diseases. For example hepatitis or breast cancer, or if you are taking certain medicines.

If you have risk factors for venous thromboembolism (blood clot) then you may be advised not to take the pill. If you have two or more of the following risk factors then you should not take it:

* A family history of venous thromboembolism (blood clot) in a first-degree relative (eg sister, mother) aged under 45 years.
* Obesity. If your body mass index (BMI) is above 30 kg/m2 (you should not be taking the pill if your BMI is over 39 kg/m2 even if you do not have any other risk factors).
* If you are not very mobile for a long period of time, for example if you are in a wheelchair or have your leg in plaster cast.
* History of superficial thrombophlebitis (inflammation of the veins on the surface of your legs).

If you have risk factors for arterial disease (circulation problems) then you may be advised not to take the pill. If you have two or more of the following risk factors then you should not take it:

* A family history of arterial disease (circulation problems) in a first degree relative (for example sister, mother) aged under 45 years.
* Diabetes mellitus (if you have had diabetes for more than 20 years you should not take the pill even if you have not other risk factors).
* Hypertension (high blood pressure that is not controlled with treatment).
* Smoking (you should not take the pill if you smoke 40 or more cigarettes a day, even if you have no other risk factors).
* Age over 35 years (You should not take the pill at all if you are over 50 years).

Note: The BMI is calculated by your weight (in kilograms) divided by the square of your height (in metres). For example, if you weigh 66kg and are 1.7m tall then your BMI would be 66/(1.7x1.7) = 22.8. If your BMI is 30 or above then you are obese.

If you are breastfeeding you should not take the pill as it can reduce the amount of milk. Other forms of contraception are available if you are breastfeeding.

Can I take the pill if I have headaches or migraines?

If you have headaches which are not migraines, then it is perfectly safe for you to take the pill. However, if you have migraines then you may be advised not to take the pill if your migraine is associated with aura or if you are over 35 years old. If you notice any increase in headache frequency or severity when taking the pill you should see your doctor promptly.

How do I take the pill?

There are different brands of pill which contain varying amounts and types of oestrogen and progestogen. There is usually a leaflet inside the packet of pills. Read the leaflet carefully and make sure you understand how to take the pill and what to do in special situations such as if you miss a pill or vomit. The following gives a general guide.

Brands with 21 day pills

Most brands of pill come in packs of 21. To start, it is best to take the first pill on the first day of your next period. You will be protected against pregnancy from then on. If you start the pill on any other day, you need an additional contraceptive method (such as condoms) for the first seven days. Take your pill at about the same time each day for the 21 days.

You then have a break of seven days before starting your next pack. You will usually have some bleeding in the seven day break. This is called a 'withdrawal bleed' and is like a period, although strictly speaking it is not a 'menstrual period'. You will be protected from pregnancy during the seven day break provided you have taken your pills correctly and you start the next pack on time. Start the next pack after the seven day break whether you are still bleeding or not. If you take the pill correctly, you will start the first pill of each pack on the same day of the week.

Most 21 day pills have the same amount of oestrogen and progestogen in each pill. Some brands called phasic pills vary the dose in two or three steps throughout the 21 days. The pills in these packets have to be taken in the correct order as directed on the packet.
Brands with everyday pills

These contain 21 active and seven 'dummy' pills. Instead of a seven day break, you carry on taking the dummy pills. The idea is that you don't have to remember to re-start the pill after a seven day break. So, you get in a routine of taking a pill everyday. The pills have to be taken in the correct order. Read the instructions carefully, particularly on when to start, which pill to start with, and how long it takes for the contraceptive effect to begin.
What if I miss or forget to take one or more pills?

Read the leaflet that comes with your brand of pill for advice on what to do. Ovulation (and therefore pregnancy) may occur if you miss pills, particularly if the missed pills are at the end or beginning of the packet. Generally, the advice depends on how many pills you have missed, and when they were missed in the cycle.

If you are unsure what to do, or are unsure that you have taken the pill correctly, then use other forms of contraception (such as condoms) and seek advice from a doctor or nurse.

Do other medicines interfere with the pill?

Yes, some do but most do not. Therefore, before you take any other medicines, including those available to buy without a prescription, herbal and complementary medicines, ask your doctor or pharmacist if they stop the pill from working properly. He or she will advise you what to do.

For example, certain antibiotics are the most common example of medicines that can stop the pill from working properly. Other examples include some medicines that are used to treat epilepsy and TB. St John's Wort is an example of a commonly used herbal remedy that can affect the pill.

Antibiotics

Your doctor will normally advise on what to do if you are prescribed an antibiotic. Generally, when prescribed a short course of antibiotics (up to three weeks) you should carry on taking your pill. However, in addition, you should use another method of contraception (usually condoms) whilst you are on the antibiotics and also for a further seven days after you have finished the course of antibiotics.

If, when you stop the course of antibiotics, you have less than seven pills left in the packet, you should not have the usual seven day break from taking the pill. You should start the next packet straight away. (If you are taking an 'everyday' brand and you have less than seven active pills left, then throw away the dummy pills and go straight onto the active pills of the next packet.)

If you are in the first week of your pill packet and you start some antibiotics and you have had sex in the last few days, then seek advice from your doctor or nurse. You may need emergency contraception.

For long courses of antibiotics such as those given for acne, ask your doctor for advice as taking antibiotics for more than three weeks does not usually interfere with the pill.

What if I vomit or have diarrhoea?

If you vomit within 2-3 hours of taking a pill, the pill will not have been absorbed. If you are well enough, take another pill as soon as possible. Provided that you do not vomit this second pill and it is taken on the same day, then you will remain protected from pregnancy. If you continue to vomit, then it is the same as 'missing pills' (see above).

Mild diarrhoea does not affect the absorption of the pill. Severe diarrhoea may affect it, so if you have severe diarrhoea, consider this as the same as 'missing pills' (see above).

What happens if I don't have a withdrawal bleed (like a period) between packs?

It is normal to have bleeding (like a period) during the seven day break between pill packs (or when taking the 'dummy' pills in everyday pills). However, it is quite common for there to be no bleeding between pill packs. You are not likely to be pregnant if you have taken the pill correctly and have not vomited or taken any medicines that can interfere with the pill. Start the next pack after the usual seven day break and continue to take your pill as usual.

See your doctor or nurse if: you don't have any bleeding after the next pack (two packs in total), or you have not taken the pill correctly, or you have any reason to think that you may be pregnant. A pregnancy test may be advised.

Bleeding whilst on the pill (breakthrough bleeding)

During the first few months while your body is adjusting to the pill you may have some vaginal bleeding in addition to the usual bleeding between packs. This is not serious but more of a nuisance. It may vary from 'spotting' to a heavier loss like a light period. Do not stop taking your pill. This usually settles after the first 2-3 months. If it persists, see your doctor or nurse. Another brand of pill may be more suitable for you.

Can I delay or skip a withdrawal bleed (period)?

There are times when it is useful not to have vaginal bleeding (a 'period' between packs). For example, during exams or holidays. Check with your doctor or nurse about the best way to do this with your particular brand of pill. For the commonly used pill types (that is, not 'bi-phasic' or 'tri-phasic' or 'everyday' types) you can go straight into your next pack without a break. Have the usual seven day break at the end of the second packet.
Further information

Your GP, practice nurse, family planning clinic and pharmacist are good sources of information if you have any queries.

The fpa (formerly the family planning association) also provide information and advice.
fpa's helpline: 0845 310 1334 or visit their website www.fpa.org.uk

The hormone which a pregnancy test checks for is only present when an embryo implants it's self in the wall of the womb and starts to grow, being on the oral contraceptive pill, the contraceptive patch, the nuvaring or having
an implant will not cause this hormone to be present.

If artificial hormonal contraception is not an option for you due to your health
then you should look into barrier methods of contraception such as
Condom, Female condom, Cervical cap (including Lea's Shield), Diaphragm
http://en.wikipedia.org/wiki/Barrier_contraception

Neverwhere

Cheers. I had read the pack it came with, but it really didnt tell me anything much. My doctor really is an asshole, he prescribed it, but wouldn't give me the time of day to ask questions or discuss contraception options. (Pregnancy for me is high risk, so I need to be careful) I'm thinking a new doc is in order??

I've got 99% of the side effects, and am honestly thinking that its not worth it seeing as the pill I'm on is the only one I can actually take,

Nevyn

I would say that every woman deserves a dr who listens and explains esp with it comes to
something this important.

If you are experiencing those sympthoms then please do not put your health as risk.

If getting pregnant is such a risk then maybe look into getting fitted for an I.U.D.
http://en.wikipedia.org/wiki/Intrauterine_device

Neverwhere

I had been thinking about the IUD originally, but my doc, like I said, didn't give me an oppurtunity to discuss my options....handed me a script for the pill and booted me out the door.

Funnily enough, it also appeared that he was encouraging me to get pregnant now if thats what I wanted (with proffessional help of course). Seeing as I have psychiatric problems including bipolar disorder, severe post partum depression and birth complications run in my family (my mother has five kids and had severe PPD all five times, candida in the breast, almost died of hemoragging after one ofthe births etc.) AND I'm 20 years old......

?????

thanks for the help!

Nevyn

Sounds like you need a dr who is willing to work with you on this topic.
If you are happy with your dr aside from this there is the option for attending
an ifpa or well woman clinic, personally I would want the 1 dr doing it all
and having all my records in one place.

The ifpa and well woman clinics were set up in a time when a lot of gps refused
to deal in contraception and women did not feel comfortable dealing with that
area of thier health with the family dr.

Given the consquences when contraception goes wrong and there is a lot to learn
about the subject gps imho should be having discussions with young women
about what is an important part of thier health.