Contraceptive pill

The Pill is the common name given to the oral contraceptive pill.

There are two main types of oral contraceptive pills: the combined pill and the progestogen-only pill. The Pill consists of a combination of hormonal drugs, which help to prevent pregnancy. There are many brands of Pill available and many different formulae.
The combined oral contraceptive (COC) contains two hormones, oestrogen and progestogen. There are combined Pills ,which provide a constant daily dose of hormones (monophasic) or two (biphasic) or three (triphasic) varied doses over the menstrual cycle. In these types of Pill, the amount of oestrogen and progestogen is gradually increased over 21 days.
The COCs are taken every day for three weeks with no active tablets taken in the fourth week. The menstrual period should occur between 2 and 5 days after each course of 21 active pills has been finished. Some women may not have a period at all while on the Pill. This does not mean that they are at an increased risk of becoming pregnant. Packs containing either 21 or 28 tablets of COCs are available. Both contain 21 hormone pills but the 28-day pack also contains 7 inactive sugar pills, which help to maintain the daily routine of taking one tablet per day.
The progestogen-only Pill provides a small, daily dose of synthetic progestogen. This Pill (referred to as the minipill) is usually prescribed for women who are breastfeeding, for non-insulin dependent diabetics, migraine sufferers, heavy smokers more than 35 years of age, those with poor circulation and those who suffer from oestrogen side effects.

The Pill needs to be taken at a regular time each day to ensure effective protection. If a Pill is missed or is taken more than 3 hours late the missed Pill must be taken immediately and the next one must be taken at the usual time. If vomiting or severe diarrhoea occurs within 3 hours of taking the Pill another one will need to be taken. If either of these disturbances occur, it is a good idea to use another method of contraception for the next two days e.g., condoms, as an added precaution. The Pill should be taken at the same time each day. If a woman is 24 hours late taking the Pill, two Pills should be taken together and extra contraception (such as condoms) used for seven days. If there are fewer than seven active pills left, the next pack of active pills should be started immediately without the usual 7-day break.

Full contraceptive protection cannot be guaranteed if a dose is missed for more than 12 hours after the regular dose time e.g., if the Pill is usually taken in the morning, this would give a woman 12 waking hours to remember to take her dose. If the Pill is usually taken at night and a woman forgets to take The Pill, then, assuming she has slept for eight hours, she only has four waking hours to remember to take her dose.

If more than twelve hours have passed since the dose was missed other forms of contraception e.g., condoms and spermicidal jellies should be used until another 7 active tablets have been taken. Do this even if this means using other forms of contraception for an additional 7 days while the inactive pills are finished and seven active tablets have been taken from the new pack.

TREATMENT OPTIONS
Your Doctor is the only person to prescribe the Pill. Your Doctor may give you a physical examination that will include a breast examination and pap smear before prescribing the Pill. Your Doctor will be able to answer any queries you may have about the Pill and possible alternatives. Contact a Doctor if any of the following is experienced: sudden, severe chest pain or headache, sudden loss of vision or blurred vision, swelling of one leg or severe pain in the calf. These symptoms may indicate that a blood clot has become lodged in a blood vessel, which could result in a medical emergency. See the Blood Clots topic.

DIET HINTS
• Taking the Pill may increase the body's requirements for vitamin A, vitamin C and vitamins B6 and B12. Most fruits and vegetables are high in these vitamins, especially those which are orange, yellow and dark green in colour. Dairy products are rich in vitamin B12 as are organ meats e.g., liver and kidneys, which are also good sources of vitamin B6.
• The body's ability to properly absorb and use folic acid may also be reduced by taking the Pill. Dark green leafy vegetables e.g., spinach, root vegetables, brown rice, salmon and brewers' yeast are rich in folic acid and should be included regularly in the diet.

INTERACTIONS
• The oral contraceptive pill may react with certain antibiotics therefore it is important to inform your medical practitioner if taking the pill when prescribed a course of antibiotics.
• Some antibiotics interfere with liver enzymes, which then increase the rate of metabolism of both oestrogen and norethisterone, thus lowering circulating concentrations of active hormones.
• Griseofulvin, an anti fungal agent, also has the ability to interact with antibiotics through liver activity. Check with your Pharmacist or medical practitioner.
• Some anti-epileptic medications can reduce effectiveness of hormones through increased liver activity.
The following herbal medicines may interfere with the oral contraceptive pill:
• Vitex agnus-castus (chaste tree) should not be taken with the pill or hormone replacement therapy.
• Liquorice combined with the Pill increases risks of hypertension, fluid retention and potassium loss.
• St. John's Wort may lead to break-through bleeding.
• Dong Quai may lead to oestrogen excess.
• Vitamin C may increase the amount of circulating oestrogen in women who are taking the two concurrently. This actually increases the effectiveness of the Pill in preventing conception. Problems may arise, however, when very large doses of Vitamin C are stopped suddenly and circulating oestrogen levels also drop. This can be avoided by gradually tapering the dosage of Vitamin C down over several days.

VITAMINS/MINERALS/HERBS
• Vitamin E may reduce side effects of progesterone (e.g. breakthrough bleeding).
• As the Pill is metabolised by the liver, liver support supplements such as milk thistle may be beneficial.
• Ginseng may be used to reduce fluid retention and improve general well being.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Let your Doctor know if any side effects occur. If you are suffering from excess bleeding or nausea it is advisable to see a Doctor immediately. You may be allergic to the ingredients in the Pill and your Doctor may need to prescribe a different type. If you have any queries about the medication, ask your Pharmacist.
3. Ask your Pharmacist about any special instructions with regard to the brand of Pill you have been prescribed. Remember, the Pill must be taken every day and preferably at the same time each day.