Everything you need to know before popping a birth control pill

Data suggests that there is a discrepancy between the awareness about the concept of birth control and the guidelines to use the many birth control options. We speak to gynaecologists to chalk out a primer

A report by American sexual health and reproductive rights NGO Guttmacher Institute reveals that in India, between 2015 and 2019, there were a total of 4,85,00,000 pregnancies annually, of which, 2,15,00,000 were unintended and 1,66,00,000 ended in abortions. “The unintended pregnancy rate declined 25 per cent between 1990-1994 and 2015–2019. However, during the same period, the abortion rate increased by 23 per cent. The share of unintended pregnancies ending in abortion rose from 47 per cent to 77 per cent,” mentions the report. Clearly, in the past few years, the cognisance about the many mediums of birth control—contraceptives, condoms, and even intrauterine devices—has augmented. A study on family planning presented by the Government of India throws light on the widespread awareness about contraceptives among Indians—98 per cent in women and 98.6 per cent among men. 

Despite this awareness, unintended pregnancies have continually occurred and posed a threat to women in India. Data from ‘Seeing the Unseen: The Case for Action in the Neglected Crisis of Unintended Pregnancy’, a report released by the United Nations Population Fund (UNFPA) in India, revealed that “of the world’s 12.1 crore unplanned pregnancies every year, 1 in 7 occurs in India,” which is indicative of the unreasonable imprudence towards the concept of protection. Things turn from bad to worse when abortions invite a slew of complications. The same UNFPA report threw light on the morbid reality associated with abortions in India: “67 per cent of abortions in India are unsafe and cause nearly 8 deaths every day.” 

Perhaps there exists a discrepancy between the awareness about the concept of birth control and the guidelines to use the many birth control options—contraceptive pills being the most common. We ask three gynaecologists to give us a lowdown on birth control pills—what they contain, the best ways to consume them and the caveats involved.

Understanding the basics 

Simply put, birth control pills are ingestible tablets used to prevent a pregnancy. “Birth control pills, also known as combined oral contraceptive pills or ‘the pill’, are oral medicines that contain synthetic hormones, usually a combination of estrogen and progestin,” explains Dr Yuvraj Jadeja, a gynaecologist and the medical director of Nimaaya Women’s Health Centre, Vadodara. Birth control pills, or oral contraceptive pills, are blanket terms for the three main types of over-the-counter pills available in the market. “The three types of birth control pills primarily fall into two categories—combination pills, which contain both estrogen and progestin hormones, and progestin-only pills. The specific hormones and their doses can vary among brands and formulations,” says Dr Abhishek Mangeshikar, a gynaecologist, founder and director of the Indian Centre for Endometriosis (ICE).

The third type is referred to as ‘continuous pill’, adds Jadeja, and it is usually taken for a longer period of time, affecting your menstrual cycle as a spin-off. “The three formulations vary in their chemical-hormonal composition as well as regimen for use. Plus, the type of estrogen varies based on its usage and desired effect; for instance, Dienogest with estrogen is prescribed for endometriosis patients or Cyproterone acetate for those with Polycystic Ovarian Syndrome (PCOS),” says the medical professional.

How do they work?

“Birth control pills primarily work by suppressing ovulation,” begins Mangeshikar, “as they inhibit the release of an egg from the ovaries. They thicken cervical mucus, making it difficult for sperm to reach the egg, and alter the uterine lining, making it less receptive to a fertilised egg.” Additionally, “birth control pills also thin the endometrium which prevents the released fertilised egg from getting implanted to the uterus,” says Dr Amodita Ahuja, a New Delhi-based gynaecologist.

However, it is imperative to note that the efficacy of the consumption of birth control pills is influenced by various factors, in addition to merely popping a pill. Moreover, just taking a pill doesn’t serve as a guarantee against pregnancy. “No method of birth control, including birth control pills, can guarantee 100 per cent prevention of pregnancy. While birth control pills are highly effective when used correctly, about 99 per cent of the time, they are not foolproof,” says Jadeja. Along the same lines, Mangeshikar adds, “Birth control pills are highly effective when taken consistently and correctly, but their effectiveness can be reduced if doses are missed or if other medications interfere with them. The failure rate is typically low but not zero.”

The effectiveness of birth control pills depends on timing—starting the pill at the right time in your menstrual cycle is crucial, and consistency—human error, such as forgetting to take a pill or vomiting shortly after taking one, can reduce its efficacy, says Jadeja. “To enhance the effectiveness of contraceptives, some individuals may use a combination of methods, such as condoms or an intrauterine device (IUD), for added protection against pregnancy as well as sexually transmitted infections (STIs), which birth control pills do not provide.”

The gynaecologist-approved way to use birth control pills

If you’re a rookie to birth control pills, it is highly advisable to consult a healthcare provider, opines Mangeshikar. “They can evaluate your existing health status, discuss potential side-effects, and ensure you choose the most appropriate method based on your unique needs and circumstances. Additionally, they will assess your medical history and lifestyle to recommend the most suitable option. Typically, combination pills are taken daily at the same time, while progestin-only pills may have a more forgiving window for taking them consistently.”

As safe as they are, birth control pills are not for everyone, In fact, they could also be damaging or life-threatening for individuals with Deep venous thrombosis (DVT), says Jadeja. “The basic fundamental is that no matter the type of pill, it needs to be taken on time and regularly, without missing even a single dose. The patient can fixate on a time that is convenient, which can be decided from the first dose itself, and that needs to be maintained through and through,” shares Ahuja. However, the kind of  pill, the exact concentration, how much and how frequently are all prescribed based on the patients, and vary from person to person.

Risks to be wary of 

While many individuals can safely use birth control pills, there are specific considerations. “Some medical conditions, such as a history of blood clots or certain cardiovascular issues, may contraindicate their use,” reiterates Mangeshikar. “Smoking, especially in combination with birth control pills, can also pose health risks. It’s essential to discuss your medical history with a healthcare provider to determine if birth control pills are a safe choice for you.”

Additionally, owing to the dose of hormones that you’ll be administering in your body, side-effects are bound to happen. “These can include nausea, breast tenderness, changes in mood, weight fluctuations, and irregular bleeding,” says the health expert. Alterations in blood pressure, changes in libido, vaginal dryness, and certain effects on the skin could also transpire, informs Jadeja. “However, not everyone experiences these side-effects, and many individuals tolerate birth control pills well. If you do experience side-effects, your healthcare provider can help manage them, minimise them, or suggest alternative contraceptive options.” It is crucial to note that many individuals do not experience significant side-effects, and for some, they may diminish or disappear after the first few months of use as the body begins to adjust to the hormones. 

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