Oral Contraceptive Pills - Part 2

To all the ladies who had been taking oral contraceptive pills (OCPs) for quite some time, have you all ever wondered what you are actually taking? 

Do you know what these little pill contains and its potential side effects?

Do you know that there will be a risk of deep vein thrombosis (DVT) if you are taking the OCPs as a smoker? 

It sounds insane but this is the truth!

But first, let’s understand the whole picture of the oral contraceptive pill.

So, we had discussed on the ''morning after pills'' in the previous article entitled "Oral Contraceptive Pills - Part 1". If you are interested to know more or had not gone through it, please click into the link:

Link: http://storyofdrugs.blogspot.my/2016/05/oralcontraceptive-pills-part-1-how-much.html

This article will mainly discuss on the combined oral contraceptives (COCs). The Progestin-only pills (POPs) will be discussed in next article "Oral Contraceptive Pill - 3".

The combined oral contraceptives (COCs), also known as the regular birth control pills, consists of two female hormones, namely oestrogen and progesterone while progestin-only pills (POPs) has only progesterone in it. As the POPs do not contain any oestrogen, it may not have as many side effects compared to the regular birth control pills. Do take note that Progestin and progesterone are the same hormone, so get confused when you come across these 2 throughout the article.

The combined oral contraceptives (COCs) are highly effective. Among all women who correctly and precisely used the COCs, less than 1 percent of them will actually get conceived during their first year of using COCs.

The following pictures are examples of the combined oral contraceptives (COCs).

Questions Frequently Asked

1. When should you consider a regular birth control pill?

      When you need to take more than 2 course of "Escapelle/Postinor2" in a month or more than one Ella pill in a month.

      When other contraception methods, such as using condom or diaphragm, are not desired.

2. This is my first time taking the daily birth control pill. How should I take it?

It is recommended to take the first tablet on the first day of your menses because it will protect you from getting pregnant after your menses. Besides that, it should be taken daily at the same time if possible to avoid fluctuations of your hormones.

One strip of COCs usually contains 21 tablets for 21 days of administration. Once you had finished the 21 days course, there should be 7-pills-free-days and your menses should come within this period. A new pack should be continued after the free pills period.

Meanwhile, there are also the "EveryDay pills" which have 28 pills in a strip, with a 21 active tablets and 7 tablets with inactive ingredient.

It is your own choice on whether to take the inactive tablets but it will definitely help people who tend to be forgetful. So, if you had decided to take both active and inactive tablets, you must take the tablets in a right order. For example, you should take the pills according to the numbers stated on the strip as shown in the picture to avoid mistakes from occurring and you continue a new pack straight away after you had finished the strip.

3. What should I do when I take the pill later than my usual administration time (less than 24 hours)?

If you usually take the regular birth control pill at 8 a.m. (morning) and you only realized that you had forgotten to take it only in the afternoon or in the evening. Please take the pill as soon as you remember and continue your routine on the next day.

4. What should I do when I missed my pills?

Missed 1 pill: More than 24 hours but less than 48 hours without taking the pill.

Missed 2 pills or more: More than 48 hours without taking the pill.

Missed 3 pills or more: More than 72 hours without taking the pill.

5. Is it safe to take the regular birth control pills while I am an active smoker?

The answer definitely is a big "NO" because there will be an increased risk of deep vein thrombosis (DVT). Let's read further to understand what DVT is and why is that so.

DVT is a condition in which blood clots are formed in the vein, most commonly in deep vein of lower limbs.

Why is this condition dangerous?

The blood clots often dislodge from the deep vein and enter into the bloodstream to become an embolus (mobile blood clot). The mobile blood clot may end up obstructing the blood vessels in other areas and cause other complications, for example, in brain (stroke) and in lungs (pulmonary embolism - obstructed blood vessels in lungs).

How does smoking increases DVT risks in people taking birth control pill?

Cigarette contains numerous toxic chemicals, which will damage the blood vessels and will thicken the blood, leading to an increased risk of blood clot formation in an undamaged blood vessel.

Moreover, taking the oestrogen-containing birth control pill, which definitely increases the stickiness of the blood, which is a well-established risk factor for DVT. Hence, there will be further increased risk of DVT in an active smoker who are taking COCs. Aside from the DVT risks, an active smoker who are taking COCs will be at risk of heart attack and stroke due to the same reason as well.

6. Is it safe to take the regular birth control pills while I have high blood pressure?

Most of the COCs can cause a small increase in blood pressure. In fact, using regular birth control pills in a patient with high blood pressure can increase the risk of heart attack and stroke. So, please consult the doctor before starting any birth control pills especially if you have high blood pressure.

However, there are certain brands with Drospirenone (new generation of progesterone hormone) which can be used in patient with high blood pressure. Due to the fact that Drospirenone has diuretic (removing water from the body) effect, it will be more suitable than other COCs to be used in this group of patient. However, you still consult your doctor or pharmacist before choosing any birth control pills for yourself.

After reading these, are you more familiar with your regular birth control pills right now? We welcome any questions that pops out from your mind so don’t feel shy and go ahead and share it with us. Our team will try our very best to clarify your doubts in our next post "Oral Contraceptive Pills - Part 3".

Meanwhile, are you curious on what our next article will be about?

 If you ever experienced any "heartburn" - upper abdominal discomfort with burning feeling, please stay tune to our next article to know more about the gastric medications available for immediate relief and control.

Have a great week ahead!

Written by:

Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Edited by:

1. Chang Jen Nee

    BPharm (Hons) (IMU)

2. Ong Jijien

    BPharm (Hons) (IMU)