In addition to the conventional 21/7 combination pills (21 days of an estrogen-progestin combo plus seven days of placebos resulting in monthly bleeding),there are now birth-control pills offering lighter periods, shorter periods, four-times-a-year periods and no periods at all.
There's one variety that's designed to end monthly bloating, moodiness and cramps and even clear up your zits.
"Once a woman gets beyond the idea that she has to have monthly withdrawal bleeding, it opens up endless possibilities for (oral contraceptive) dosing regimens," says Dr. Pamela Deak, an obstetrician-gynecologist at the University of California San Diego Medical Center. "There are lots of options today. Which pill an individual woman chooses to use depends on which one works for her and fits best into her lifestyle."
Today, birth-control pills are used by more than 11.7 million American women, according to the Centers for Disease Control and Prevention, and considered one of the most effective reversible methods of birth control. Combination pills, when used exactly as directed, have a 99.7 percent efficacy rate.
First introduced in the 1960s, birth control pills meant a new sexual freedom for many women who had relied on the less effective barrier methods such as diaphragms and condoms to prevent pregnancy. Although the first pills with 50 micrograms of estrogen were much stronger than those prescribed today, the way the pill works remains the same.
Birth-control pills enable a woman to maintain a consistent hormone level, which prevents ovulation or the release of an egg. No egg means no possibility for fertilization and pregnancy. The pill also thickens cervical mucus so the sperm cannot reach the egg and makes the lining of the uterus unreceptive to the implantation of a fertilized egg.
The original pill was designed in a 21/7 regimen to mimic the natural menstrual cycle. By creating a period every month, women felt comfortable using it. However, the monthly bleeding wasn't medically necessary.
"The reason the pill was designed without one week of active (hormones) was to create a bleeding episode so women would know they weren't pregnant. That's what they were used to," says Dr. Elizabeth Silverman, an obstetrician-gynecologist at Scripps Memorial Hospital in San Diego. "But, it's not necessary to shed lining every month on the pill, because you really don't build up much of a lining."
A natural menstrual period happens two weeks after ovulation. The lining of the uterus, which had thickened to prepare for pregnancy, sheds because you're not pregnant.
The bleeding women experience on the pill is not a real menstrual period, she explains. It occurs because of the withdrawal phase of the hormones or active pills. Because a "pill period" is not real menstruation, it can be manipulated by different dosing regimens.
"Doctors have been extending dosing regimens long before the FDA approved it," Deak says. "We've used it for patients who had severe pain with their cycles or patients with endometriosis and bad pelvic pain. Or sometimes just for convenience. If you didn't want a period on your vacation or your honeymoon, you could skip it."
Contrary to what some people believe, less frequent periods aren't any heavier or painful. In fact, limiting bleeding to every few months may make them lighter, Deak says.
And you can put to rest the worry that extended dosing pills will interfere with getting pregnant, if and when you're ready.
"Women who have been on the extended pill seem to return to ovulation and fertility very quickly once they go off the pill," Deak says.
If oral contraceptives are your birth-control method of choice and your current pill isn't working out for you, you've got options. Trial and error, along with your doctor's guidance, is the only way to know for sure which pill is for you.
"On the right pill you should feel exactly the same as you do in your normal life. Maybe even a bit better," Silverman says.
The following are some birth-control pill options:
- Ultra low-dose birth-control pills: Pills such as Alesse by Wyeth and Mircette by Organon contain 20 micrograms (mcg) of estrogen. Although they contain enough hormones to prevent conception, they may result in more spotting and breakthrough bleeding than pills with 30 or 35 micrograms (considered the norm today) of estrogen.
One advantage of a pill with less estrogen is that it minimizes hormonal side effects, including headaches, mood swings, breast tenderness and bloating. These pills may be especially good for young women just starting the pill and perimenopausal women who are looking to taper down their estrogen use.
- Pills to minimize side effects of conventional pills: Yaz, an ultra-low-dose pill, and its sister pill Yasmin with 30 micrograms of estrogen (Bayer HealthCare Pharmaceuticals) contain a special progestin called drospirenone, which seems to prevent some of the negative side effects of the pills, such as bloating, breast tenderness and mood swings. Some studies say it can also help acne problems.
However, Silverman notes that although "a lot of women really like Yaz, the (projestin) in the pill does not effectively reduce negative symptoms for everyone."
The projestin used in Yaz and Yasmin may increase potassium, so these pills should not be taken if you have adrenal disease or are on a daily long-term regimen of anti-inflammatory drugs, such as ibuprofen or naproxen.
- Pills for shorter periods: Instead of the conventional 21/7 pills, some offer a 24/4 cycle, giving you three more days of hormone pills a month and a shorter, lighter bleeding time. Some of the birth-control pills that offer 24/4 include Yasmin, Yaz and Loestrin FE 24 from Warner Chilcott (the four non-hormone pills are an iron supplement).
- Three-month pills: Seasonale and Seasonique, both from Barr Pharmaceuticals, offer 91-day pill cycles. The 84 active pills and seven placebos limit periods to once every three months.
The difference between the two pills is that some estrogen was added to Seasonique's seven dummy pills to lighten the menstrual flow.
Although users report some spotting and breakthrough bleeding, that problem seems to dissipate after some months on the pill. The three-month pill is recommended for anyone who wants to have fewer periods and can tolerate some spotting.
- 365-day pill: On the market since July, Lybrel (Wyeth) is an ultra-low-dose combination birth control pill that has no placebo phase so there is no bleeding. It's designed to be taken indefinitely.
This pill is especially good for the approximately 8 percent of U.S. women who suffer from debilitating periods and roller-coaster premenstrual dysphoric disorder. This pill may be helpful to women with endometriosis.
Because there are no periods with this pill, users must be vigilant about pregnancy testing, especially if Lybrel is not used exactly as directed. Breakthrough bleeding and spotting are common, but seem to decrease over time. There's scant scientific data on the long-term consequences of using the pill continuously.
- Progestin-only pills: Pills such as Micronor by Janssen-Cilag and Nor-QD by Watson Pharmaceuticals contain no estrogen and are sometimes called the "mini-pill." Taken every day with no pill-free phase, they work mainly by thickening cervical mucus and helping reduce ovulation.
They're often recommended for nursing mothers, because estrogen can decrease milk supply, and for women who cannot or should not use estrogen, such as those who are over 35 and still smoke.
Because these pills contain no estrogen, users have less risk of developing health problems sometimes due to estrogen including deep vein thrombosis and cardiovascular disease. They also will not experience common side effects of estrogren pills such as nausea, breast tenderness and cramps.
The downside of progestin-only pills is that they're not as effective as combination birth-control pills at preventing pregnancy. There is an approximate 90 percent to 95 percent efficacy range, compared with a 99 percent efficacy with combination pills when used as prescribed. This pill must be taken at the same time every day. If you miss just one pill or take it more than three hours past the regular time, you need to use a backup method of birth control for 48 hours after taking the late pill.
Another disadvantage of this pill is that there can be unscheduled spotting and bleeding, and it can increase the risk of ovarian cysts and ectopic pregnancy.
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The pros and the cons of the pill
By R.J. Ignelzi
Copley News Service
Despite a growing array of oral contraceptives, the pill still isn't the perfect form of birth control for everyone. As with any kind of medication, there are benefits and risks. Women who are considering starting oral contraceptives or who are currently on a pill regimen need to discuss with their doctor their health status, health history and family health history. Birth-control users should consider the following:
BENEFITS OF TAKING THE PILL:
- May decrease risk of ovarian cancer.
- May decrease risk of endometrial cancer.
- May improve endometriosis.
- May lessen the risk of ovarian cysts.
- Prevents ectopic pregnancy.
- Periods may be lighter or more regular.
- Reduces severe premenstrual symptoms.
- May reduce acne.
RISKS OR DISADVANTAGES OF THE PILL:
- May increase risk of cervical cancer.
- May increase risk of liver cancer.
- The effect of birth control pills on breast cancer risk isn't clear, but women with a family history of breast cancer may be discouraged from taking the pill.
- May raise total cholesterol level.
- May increase blood pressure, especially with age and duration of use. Women on the pill should have their blood pressure checked regularly.
- Women who are over age 35 and smoke should not take the pill because of the risk of cardiovascular disease.
- May slightly increase risk of ischemic stroke and blood clots in the deep veins. Women with a history of heart attack, stroke or blood clots should not take the pill.
- Side effects may include water retention, bloating, nausea, irregular bleeding, breast tenderness and moodiness.
- The pill does not provide protection from sexually transmitted diseases (STDs) or HIV.