A regimen of pills, taken one per day, that slightly alter the hormones of a woman to prevent pregnancy. They also help regulate the menstrual cycle, and some have other effects.

They were the leading cause of the sexual revolution, because they put women in charge of their reproductive systems, allowing them the freedom to have sex without the constant worry of pregnancy.

The common term for the female oral contraceptive pill (OCP) also known as the birth control pill (bcp)

Several flavours of the OCP exist. Generally, however, they all have revolve around different formulations of (chemical analogues of) the hormones progesterone and estrogen and work by fooling the woman's body into not ovulating. Most brands nowadays use 20 to 40 micrograms of ethinyloestradiol as the estrogen component and either a fixed or varying (the bi and triphasic pills) amount of progestogen as the progesterone analogue.

The pill usually comes in a packet that has days marked off for a cycle lasting about a month. There are usually sugar pills between the end of one cycle and the start of the next so that the woman's body is fooled into undergoing menstruation. That's the hormones taking over!

Taken correctly, the failure rate of the pill is less than 1%. It is the single most effective form of reversible contraception.

A commonly quoted side effect is weight gain. Other common side effects include:
nausea, headaches, depression, change in intensity of sexual desire and response, vaginitis and vaginal discharge, urinary tract infection, changes in menstrual flow, breast changes, skin problems and gum inflammation

Serious side effects that would indicate a need to discontinue the pill include:
pain or swelling in the thigh or calf, severe headaches, hypertension, dizziness, weakness, vision problems, chest pain or shortness of breath, abdominal pain.

These serious side effects are a result of the pill affecting coagulation, increasing the risk of blood clots causing DVTs (Deep Venous Thrombosis), stroke and heart attacks. This is especially so in women who already have some pre-existing vascular disease, in women who have a familial tendency to form blood clots (such as familial factor V Leiden), women with hypercholesterolaemia (high cholesterol level) and in smokers.

update #4: 6th April 2000 (original writeup started 1st April 2000) -- I really should start breaking this up into sections, huh?

The pill slightly increases the risk of breast cancer, while slightly decreasing the risk of ovarian cancer and uterine cancer. To understand why this is so, consider how in the pre-OCP pill, pre-modern society days, when women would get pregnant not long after menarche and continue having babies every 2 to 4 years thereafter, that that was the normal cycle and long periods of unpregnancy are actually abnormal in the evolutionary sense. Think about it.

update #5: Drug interactions of the oral contraceptive pill
Some drugs, when taken, reduce the effect of the pill and can cause breakthrough bleeding, or worse, pregnancy (together with unprotected sex, of course). The usual suspects are antibiotics, barbiturates, phenytoin and carbamazepine.

Some women take it because it can alleviate menstrual cramps and other abnormal physiological effects of that time of the month. (the birth control effect notwithstanding). I'm still not sure though whether it helps in the fight against the dreaded PMS or PMT. I think the only thing that can fight that is either a very very careful compassion and understanding, or avoidance.

The Pill is NOT an excuse to have sex without another form of protection. The 1% failure rate is higher than it sounds, for one thing, and that's when it's taken under ideal conditions. Kinda like...testing something in a vacuum. Ideal conditions almost never occur in real life, so have sex with no other prophylactic besides the pill ONLY if you are ready to have kids.

Some of the most common varieties, such as Ortho-Novum and Orthotryciclin also help with skin problems (much adult acne results from hormone imbalances, see). In my opinion, it also helps with PMT, but maybe that's just because pain definitely tends to cause tension!

Weight gain, btw, is relatively uncommon, but not rare. It's not a good reason to not try the pill if you need it, though. Recurrent nausea and weird breakouts are pretty common for the first cycle or two, but if you can last, it may be worth it to you.

I've heard anecdotal evidence of women who begin taking the pill while still in puberty, then stop taking it in their twenties and find that they've stopped ovulating permanently. A serious consideration, to be sure, when considering your birth control options.

Now, all the research I can find online says this won't happen, and I Am Not A Doctor myself. Doctors will tell you freely that it's not unusual for a woman's period to take up to six months to restart after getting off the pill. According to one source, it can take up to two years to restart in a small percentage of women. It's possible that some of the women in that last group are the ones seeking infertility treatment, since "infertility" is defined as being unable to conceive after trying for twelve months.

In addition, it seems some teenagers are prescribed birth control pills because of irregular periods, which also can be tied to infertility. For those women, going off the pill will cause the irregular periods to return, but not their fertility.

While birth control pills are VERY effective at preventing pregnancy, they may be equally effective at screwing up your life.

A friend of mine, Alice, began taking the pill in May of 1999, while in a monogamous relationship. The first week, in addition to a horrible menstrual period, she had headaches, nausea, leg cramps, and severe fatigue. After those symptoms went away, she had only occasional nausea, and random throbbing pains in various parts of her body. After the first week the physical side effects were mild. Her period became very regular, shorter, and less painful, and there was never any mid-cycle spotting.

The problem was that she became severely depressed without knowing it. Her boyfriend happened to be a psychotic freak. Also, she had just graduated from college and didn't know what to do with her life. Vaguely realizing that something was wrong, in October of 1999 she left her boyfriend (finally), moved far away, started graduate school, and got an apartment and a job. Still, she was so depressed she sometimes couldn't leave her apartment at all, and experienced horribly exaggerated sensations (for example, she couldn't stand to be in the same building as someone wearing perfume). She was afraid to talk to people, lost interest in everything, and sometimes couldn't even get out of bed in the morning.

Then one day in March 2000, after taking in the morning the pill she'd forgotten to take the night before when she was too depressed to do anything at all, she suddenly realized that the pill was causing the problem. She stopped taking it right then, which was mid-cycle, and within a week her personality came back. Her problems did not all go away, but she was no longer incapable of dealing with them. She says it was like waking up, or all the lights coming back on after a thunderstorm, or all the color coming back into a monochrome painting. She felt good again for the first time in ten months, and she's had no major problems with depression since, nor did she have them before going on the pill.

I went on the pill in October 2000, also at the beginning of a monogamous relationship. I was especially alert for any negative side effects, having witnessed Alice's experiences. I had no side effects whatsoever. My period was more regular, but otherwise the same. Oh, and I didn't get pregnant. I was happy, I loved my boyfriend, I would never have said at the time that I was depressed. If I had been able to step outside myself, though, and watch myself on television, I might have noticed that I lost interest in social interactions, that I spent more and more time alone, doing nothing. My grades were dropping in school because I missed too many classes. Many times I would get up, get dressed for class, and then just sit at home doing nothing. I lost all ambition I had once had, I lost interest in most activities. Then I dropped out of college. But I was not specifically unhappy during most of this period.

In September 2001 I went off the pill, thinking that might have been responsible for some health problems I was having at the time. I don't think it was, incidentally, because here it is December and I'm still sick. But I stayed off the pill. About a month later, I woke up. It took about two days, and I can't say precisely what the real catalyst was, except that I started reading poetry again, a great love I had almost completely abandoned. Suddenly I had energy, I wanted to do things and I felt confident in my ability to do them. I decided to go back to college and finish my degree. Incidentally, I also broke up with my boyfriend at the same time, being unwilling to enter again into a long distance relationship.

Until today, it never occurred to me that my "waking up" had anything to do with going off the pill, even though Alice had experienced almost the exact same thing. Depression may be listed as a possible side effect of oral contraceptives, but how are you supposed to rationally identify that something is messing with your head? My symptoms were not obvious to me, I didn't even realize I had a problem. It was so subtle, in fact, that if I hadn't been talking to Alice about her experience I would never have made the connection.

The danger of this kind of problem, I think, is its subtlety, which is the same reason that most people are unaware that these kinds of problems exist. "Some part of my brain fell asleep the entire time I was on the pill, but a month after I stopped taking them I woke up" does not fall neatly onto a doctor's checklist of symptoms.

The pill works by adding hormones to prevent ovulation and implantation. It is chemically altering a major bodily function, and that's not something to mess with lightly. The emotional side effects do not disappear after three months. Their implications can be enormous and can change your life. Although the experiences of two women do not prove anything, we think we have evidence that the pill is always harmful to some degree, and you do not know what you're getting yourself into. We certainly didn't.

This was written together with Alice, who now leads a happy and productive life post-pill.

There's a funny (or sad) story about Japan not approving the pill until only recently. Despite pressure from women's groups, the Japanese government kept claiming there wasn't yet enough data for them to make a firm decision. This is like after 30 years. The Japanese Ministry of Health even tried to argue that pill production would be bad for the environment. The net effect of the pill not being available was abortion tended to be the number one method of birth control (in 1997 there was roughly a ratio of 1 abortion for every 2 live births) with condoms being a close second. If there was a silver lining, wide-spread condom use contributes to lower incidences of sexually transmitted disease. That said, when Viagra was approved in the USA, male Japanese authorities approved Viagra in record time (six months), using mainly American data.

Women's groups were absolutely livid. They had been urging the Japanese government for decades to look at American data for evidence of the pill's safety and effectiveness (notably the low dose version). The health ministry claimed they fast tracked Viagra because so many Japanese men were obtaining it via the net and traveling abroad. The willie was out of the bag, so to speak. Uh huh. In the words of a skeptical member of the Family Planning Federation of Japan "The old men who run the parliament were dying to try this Viagra."

Even the male Japanese authority had to admit some hypocrisy, or at least the potential for international embarrassment, and in 1999 they approved oral contraceptives for women.

Oddly, pill sales have remained low. Many Japanese women have heard horror stories for years and are reluctant to try the pill. As well, many Japanese gynecologists resist prescribing the pill. Some with a more conspiratorial mind set believe gynecologists are simply trying to protect their abortion cash cow.
Most systems of the pill have you take hormones for three weeks, then either no pills or sugar pills for a week. This causes a bleeding similar to menstruation.

For health reasons, this period of bleeding is not necessary. It was 'invented' because the people who invented the pill thought women would prefer the bleeding period, which makes it seem like you have a normal menstrual cycle. When you prefer not to experience this, because you're on holiday for example, you can opt to just keep on taking the pills and skip the bleeding.

Recent research suggests that when you never interrupt your taking of the pill, this may decrease your chance of pregnancy. There are two reasons for this: first, the steady flow of hormones means there's less chance of ovulation. Second, because there is no week in which you don't take any pills, there's less chance that you forget to take them when you need to again. When you don't observe the "stop week", there is a chance you get a bleeding anyway after a while; you could choose to stop taking the pill for 7 days if this happens.

Important! The above is not valid for all birth control pills. Ask your doctor to be sure if you want to try this!

I have tried this myself. The results were not very positive: in stead of a bleeding period of a few days, I got a trickle that lasted for weeks. Not much of an improvement...

Source: PhD thesis "Residual Ovarian Activity During Oral Contraception" by gynecologist Arne van Heusden, Erasmus Univeristy, Rotterdam

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