Oral contraceptives also called birth control pills have been used by women for over four decades to prevent pregnancy. Today’s low dose oral contraceptives are safer and more effective compared to pills when they were first introduced in the 1960’s.

Dr. Brett Hodge

Currently more than 100 million women rely on the pill as a form of contraception. Most women can become pregnant from the time they are in their early teens until they are in the late forties. The number of unplanned pregnancies still continues in many countries, including Anguilla, despite the many different methods of birth control now available.

Methods of Birth Control
There are a number of methods of birth control available in Anguilla. Each method has good points as well as side effects. Birth control allows a woman to plan her family - both the number and spacing of children. All of these methods are safe when used appropriately. Oral contraceptives are just one of the methods of contraception available in Anguilla.

Oral contraceptives
Oral contraceptives are a type of hormonal birth control. In this method a woman takes hormones similar to those her body makes naturally. There are two types of birth control pills: the combined oral contraceptive pill and the progestin only pill.
The combined oral contraceptive pill contains progestin and oestrogen. These hormones prevent ovulation. A woman has two ovaries and each month one of the ovaries releases an egg. This is called ovulation. Ovulation typically occurs about 12-14 days before the start of the menstrual period. When there is no egg to be fertilised by the sperm, pregnancy cannot occur. Oral contraceptives also cause changes in the cervical mucus and the uterus (womb) that help prevent pregnancy.

How to take combined oral contraceptive pills
You can start taking the oral contraceptive pill on the first day of your menstrual period. If you are not sure when to start taking the pill, talk to your health care provider. The pills only work if you take them correctly. Do not skip pills for any reason - even if you bleed between periods or feel sick. Get in contact with your doctor or nurse if you are concerned. Even if you do not have sex very often you should keep taking the pill.
Oral contraceptives may not work very well if you are taking other medications, including herbal treatments and over-the-counter medications. If you are vomiting you should use a backup method for the rest of your cycle. Oral contraceptive pills come in packs of 21 or 28 pills. If your pack has 21 pills, take one pill at the same time each day for 21 days. Wait 7 days before starting a new pack. During the week you are not taking the pill, you will have your period.
If your pack has 28 pills, take one pill at the same time each day for 28 days. When you finish all the pills in the pack, start a new pack the next day. During the week you are taking the last seven pills, you will have your period. If you are still not clear you should have a consultation with you doctor.
There are many different types of combined oral contraceptive pills. These give a woman the choice of finding the brand that agrees with her. Several types of oral contraceptives have similar strengths of the same hormones and have similar properties although they may come in different packages. If you are not clear about which type of oral contraceptive to use please discuss this with your health care provider. If you do decide to change from one type of oral contraceptive to another please discuss this with your doctor or nurse before making the change.

What are some of the benefits of the combined oral contraceptive pills?
Research continues to assess the benefits and risks of the combined oral contraceptive pills. The greatest benefit, of course, is effective contraception which gives women more control over their lives and avoids the risks of pregnancy and childbearing. Among women who miss no pills, only one in every one thousand becomes pregnant in the first year of using even the lowest-dose pills. Combined oral contraceptive pills offer a variety of other health benefits and these include decreasing the risk of the following:
• Cancer of the endometrium (lining of the uterus)
• Cancer of the ovary
• Ovarian cysts
• Pelvic inflammatory disease
• Anaemia (low blood)
• Bone loss
• Benign breast disease
• Ectopic pregnancy
• Acne
You are less likely to get the above conditions if you use the combined oral contraceptive pills. You should discus these further with your nurse or doctor.

What are some side effects of the combined oral contraceptive pill?
Some women have side effects when they are on the pill. These may include the following:
• Nausea
• Headache
• Tender breast
• Depression
Most side effects are minor and often go away after a few months. There will likely be fewer side effects if the pill is taken at the same time every day.

What are some risks of the combined oral contraceptive pill?
Some women should not use oral contraceptive pills. The pill may not be good for a woman over 35 years who smokes. Women with certain health problems should also not take the pill. If you are over 35 or have a health problem, you should talk to your doctor about whether the pill is a good choice for you. In very rare cases the pill can cause blood clots in the legs and lungs. Women with a history of blood clots in their legs should not use the pill. If you are on the combined oral contraceptive pill and have any of the following symptoms you should see your doctor:
• Sudden unexplained chest pain, cough or shortness of breath
• Severe headaches and dizziness
• Severe abdominal pain
• Weakness or numbness on one side of your body
• Blurred vision, severe pain in leg (calf or thigh)

Some myths about the combination pill
Myth - Taking the pill causes weight gain. In reality as many women lose weigh as gain weight while taking the pill.
Myth - Taking a break from the pill now and then is a good idea. There is no health benefit from taking a break from the pill. If you do take a break you should use another method of contraception.
Myth - The pill causes cancer. Most studies show that the pill does not increase the risk of cervical or breast cancer but it decreases the risk of endometrial cancer. Recent research suggests that the combined oral contraceptive pill may somewhat speed up the diagnosis of already existing breast cancers but they do not increase lifetime risk of developing breast cancer.
Myth - A woman will not be able to become pregnant after she stops taking the pill. The pill is out of a woman’s system and she is able to get pregnant within 24 hours of not taking it!

Progestin-only Pills
These pills contain only progestin. They are also called the minipill. This type of pill is not as effective as the combined oral contraceptive pill, but is ideal for some women who have health problems such as a history of blood clots. The progestin pill also prevents ovulation and also thickens the cervical mucus. Changes also occur in the endometrium that combines to prevent pregnancy. Side effects include prolonged or irregular bleeding. If you are interested in the progestin only pill please see your health care provider.

Conclusion
The oral contraceptive pill has been the most studied of any family planning method. A great number of women in Anguilla have used the pill at some time in their lives and, because it is so widely used, it deserves the continued attention from users, health care providers and researchers. Despite the publicity associated with some side effects of the pill, it is clearly safer for women than childbearing. When the oral contraceptive is used correctly and appropriately it is a safe and effective method of preventing unwanted pregnancies. It is one of many methods of birth control that allows individuals to plan their families.

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