Oral Contraceptives: The little pill that could (and did!)

June 4, 2010 at 3:55 pm 7 comments

Continuing our journey through the world of contraception, I think The Pill deserves special mention.  It has been used in the US since 1960 as a way of preventing pregnancy.  It continues to be one of the most popular methods of birth control.

Running the risk of waxing overly poetic, I’ll tell you that The Pill has a long and storied history which has helped shape the roles of women in society.  It has freed a generation of women from fear of unwanted pregnancy and has helped countless others battle the miseries associated with their monthly gift.  But what is this miracle tablet?  What’s in it?  And  how is it used?  

‘The Pill’ is a common term for what the medical community calls a ‘combined oral contraceptive’ or ‘oral contraceptive pill’ (OCP).  This consists of a combination of estrogen and progesterone which is taken in order to prevent pregnancy. 

It does this in several ways.  The most important of these is that OCP’s prevent ovulation, the release of an egg from a woman’s ovary.  No egg, no baby.  Easy. 

It also causes a thickening of cervical mucus.  While this may sound kinda icky, it actually serves the important purpose of reducing the likelihood sperm will be able to pass through the cervix and up through the uterus and tubes on its way to fertilize an awaiting egg (which isn’t going to be there anyway… see above).  No egg-sperm rendezvous, no baby.

It also causes a thinning of the lining of the uterus, reducing the likelihood that, even if a runaway egg and super-ambitious sperm were to elope successfuly, a resulting embryo would not be able to implant.  No implantation, no pregnancy.  (This, by the way, is NOT an abortion.  An embryo needs to implant in order to establish a pregnancy.  Otherwise, you get a normal period.) 

In order for an OCP to effectively prevent pregnancy, it needs to be taken every day for 21-24 days a month.  In a best-case scenario, it should be taken at the same time every day.  This is what’s called “perfect use.”  Humans are not perfect.  Given an opportunity to screw up, we will most likely take it at some point in our lives.  This is called “typical” use.  Therefore, when we talk about the likelihood somebody will get pregant while taking OCP’s we talk about “perfect” and “typical” use patterns. 

The pregnancy rate among “typical” users of OCP’s varies depending on the population being studied and ranges from 2-8% per year. On the other hand, the rate of pregnancy among “perfect” users of OCP’s is about 0.3% per year.  I don’t know about you, but I think that’s pretty good motivation to stive for “perfection.” 

Some combined oral contraceptives aren’t pills at all, but are administered as a vaginal ring (Nuvaring) or a patch (Ortho-Evra).  These can be good options for some patients who can’t reliably take a pill every day.  (However, the Ortho-Evra patch has been scrutinized for the possibility that it delivers more estrogen than most other combined contraceptives, including the ring, and that it may lead to an increased risk of blood clots in some patients.  See below.)

A caveat:  You want to talk to your gynecologist before starting an OCP.  The pill doesn’t protect you against sexually transmitted diseases (STD’s).  If you are at risk for STD’s, you should be using a condom and getting tested at regular intervals.

The Pill also has some risks.  That’s because combined oral contraceptives (those containing estrogen) can increase a woman’s risk of blood clots, heart attack and stroke.  This risk is minimal if you are young (under 35– ouch!), otherwise healthy, and do not smoke.  You should ask your gynecologist (or other healthcare provider) about your risk factors to help determine whether The Pill is a safe option for you.

If you have certain medical problems (like heart disease, a prior blood clot, or a history of certain types of cancer), are a smoker over 35, or are taking certain other types of mediation, you should not take estrogen-containing combined oral contraceptives. Ever. There are other, potentially safer options out there for women who can’t take OCP’s.  More on that in a future post.

I’m also planning a post to explain WHY OH WHY there need to be SO MANY different pills out there!  Really, I promise there’s a good reason.  See you soon!

Entry filed under: Gynecology. Tags: , , , , , , , , , , , .

Condoms: A little something for everybody Why are there so many different types of oral contraceptives? – The Estrogen Equation

7 Comments Add your own

  • 1. Joshua McNolly  |  June 23, 2011 at 10:29 am

    Interesting post!… but im just worried. why would you recommend MANY different pills?… how will people know which is the best one?…. can’t there just be one good pill?…

    Pricing will be different too, that means poorer people are going to cheaper less quality pill… is that the best option?

    • 2. drnicoll  |  June 26, 2011 at 11:03 pm

      Hi Joshua,
      There are many different pills on the market. Each one has different types and doses of hormonal components. Different pills have different effects in individual users. Some women may like one pill more than another because, for example, it reduces acne or menstrual bleeding more so than another pill. The choice of which pill (if any) fits a woman’s needs is an individual decision a each patient must make with her heathcare provider. Some women try a few different pills before finding one that suits their needs.
      Also, cheaper pills aren’t necessarily any lesser in quality. Price reflects many different factors, including whether a generic version is available. Generic versions of popular pills are only available after a company’s patent on the medication has run out. So pills that have been on the market for a greater number of years may be cheaper, but no different in quality and effectiveness.
      -Dr. N

  • 3. Susan  |  June 23, 2011 at 2:33 pm

    what will happen if you don’t use them correctly?…. e.g take an overdose

    • 4. drnicoll  |  June 26, 2011 at 10:57 pm

      Hi Susan,
      If a person takes an overdose (i.e. too many birth control pills), they are more likely to experience mid-cycle spotting or bleeding. Depending on the amount of estrogen in the birth control pill used, the use of too manyl pills at the same time can also expose the user to a larger-than-recommended daily dose of estrogen. This can increase the user’s risk of blood clots and stroke. If you think you may have incorrectly used a birth control pill, you should contact your doctor immediately.
      Best of luck!
      -Dr. N

  • 5. Joshua  |  June 26, 2011 at 11:44 pm

    Interesting…. thanks doc!!!


  • 6. Harika  |  October 2, 2013 at 9:44 pm

    hi.. i am using hormonal contraceptives for the 1st time.. can i start with evra patch which says 35micro grams of estrogen per day? Or should i go for ocps(21days) which have a dosage of 30micro g for 1st 6 days, 40 for next 5 days and 30 for last 10 days.. I dont have history of any blood clots and heart diseases.. I am 26yrs old.. had medical abortion thrice.. please suggest me.. I wonder if you can suggest me whether can i start my contraceptive on my 5th day of cycle.. because today is my 5th day..

    • 7. drnicoll  |  January 26, 2014 at 3:25 am

      Dear Harika,
      As I’ve said before, I don’t offer individual medical advice on this blog. Go see a doctor to talk about your options.
      Best of luck,
      -Dr N


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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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