Our Bodies, Ourselves (50 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
If you experience any of the following symptoms while taking the Pill, you should call your health-care provider or go to an emergency room immediately.
⢠Severe leg or arm pain, swelling
⢠Chest pain or shortness of breath
⢠Severe headaches
⢠Eye problems, such as sudden blurred vision
Certain medications reduce the effectiveness of the Pill. These include antiseizure medications (phenytoin [Dilantin], phenobarbitol, carbamazepine [Xeloda]), rifampin (a tuberculosis drug), and Saint-John's-wort. If you are taking any medications or herbal remedies, tell the provider who is prescribing the Pill. You may need to add a backup method of birth control.
There have been anecdotal reports of antibiotics interacting with oral contraceptive pills. However, there is no scientific evidence that antibiotics (other than rifampin) interfere with oral contraceptives. Because of the anecdotal reports about this issue, some women choose to use a backup method (such as condoms) while taking antibiotics and oral contraceptive pills.
Women who want to become pregnant may stop using the Pill at any time. Pregnancy may occur right away or after several months. The Pill does not affect your long-term fertility.
⢠Irregular bleeding or spotting
⢠Nausea
⢠Breast tenderness
⢠Spotty darkening of the skin (melasma) (rarely)
⢠Mild headaches
⢠Mood changes, including depression or decreased sex drive
Side effects usually go away after two to three cycles of pills. If any side effects are bothersome after two to three cycles, continue taking your pills and call your health-care provider for an appointment. Though these side effects can make you uncomfortable, they are not dangerous.
Sometimes a different pill will make a difference. If you feel that you must stop the Pill immediately, be sure to abstain from vaginal intercourse or use another form of contraception. The contraceptive effects of the Pillâas well as the side effectsâgo away as soon as you stop taking it.
WILL BIRTH CONTROL MAKE ME GAIN WEIGHT?
*
The Pill (and also the patch and the ring) does not cause weight gain.
10
However, we sometimes
feel
as if we've gained weight after starting birth control. It's hard to know exactly why this happens. It may be because many women start birth control for the first time while transitioning from the teens into the twenties, a time of natural weight gain. If a woman gains weight at this time, it's easy to put the blame the Pill, the patch, or the ring. The truth is each of these methods can be used without an expected weight gain.
One method of birth control, the shot (Depo-Provera),
does
lead to weight gain for some women. A recent study showed that, in the first six months of use, one out of four shot users gained 5 percent or more of her starting weight.
11
(For example, if you were one of these women and weighed 170 pounds when you got your first shot, you would gain nine or more pounds within six months.) The women who gained weight in the first six months were more likely to go on gaining weight while they continued the shot. However, the majority of women (three out of four) didn't gain much weight, averaging 1.4 pounds in the first year of using the shot. The shot might not be the best choice if you already have trouble with your weight, particularly since there are options that provide protection against pregnancy and aren't linked to weight gain (like the implant, an IUD, the ring, the patch, and the Pill).
Long-acting methods that also contain progestins, such as the implant and the hormonal IUD, are not linked to weight gain like the shot.
*
Excerpted with permission from SexReally.com.
Some brands of the Pill can be used for emergency contraception. EC is taken within five days after unprotected intercourse to prevent pregnancy. (For more information, see
“Emergency Contraception,”
)
The contraceptive patchâcurrently marketed under the name Ortho Evraâis a prescription method of birth control. The patch looks like a square Band-Aid and is applied to the abdomen, buttocks, upper arm, or upper torso. The patch is changed once a week for three weeks, left off for one week, then resumed. The patch works by slowly releasing a combination of estrogen and progestin through the skin. These are the same hormones found in the combined birth control pill and therefore the patch works the same way and has the
same side effects
.
The patch is a very effective reversible method of birth control. With perfect use, the patch is about 99 percent effective; with typical use it's about 92 percent. The patch is less reliable in women over 198 pounds, but so few women over this weight participated in studies of the patch that the level of effectiveness cannot be reliably calculated.
The patch works best when it is changed on the same day of the week for three weeks in a row. Pregnancy can happen if an error is made using the patch, especially if
⢠It becomes loose or stays off for longer than twenty-four hours
⢠The same patch is usedâleft on the skinâfor longer than one week
If either of these things happens, follow the directions in your package insert, consider taking
emergency contraception
, and call your health-care provider.
These are the same as
for the Pill
, although some women find the weekly patch more convenient than the daily pill.
These are the same as
for the Pill
, except that you have to remember to use a new patch once a week rather than to take a pill every day.
Apply the patch within five days of the first day of your period or within five days of an abortion. If you start at another time, use a backup method for seven days. One patch per week is used for three weeks in a row. The day of the week you apply the patch will be the same day you change it a week later. On the fourth week, don't wear a patch, and your menstrual period should start. A new patch is applied seven days after removal to start another month of birth control. It does not matter if you are still bleeding.
© M. Thompkins
Birth control patch
The patch can be applied anyplace on the body that is clean and dry except on open sores or on the breasts. Don't put it on after you have applied body lotion. The patch can be worn swimming or in the shower but should be checked afterward. About 2 percent of the time, a patch will completely fall off. If it partially or completely falls off, refer to the instructions.
After giving birth, wait three weeks to apply your first patch. You are at higher risk for blood clots for three weeks after a pregnancy, and adding the patch increases that risk.
Unlike the Pill, the patch provides a steady amount of estrogen that does not change over the course of a day. However, the average amount of estrogen in the blood of patch users is about 60 percent higher than in users of low-dose pills. There is conflicting evidence on whether this higher baseline of estrogen for patch users has serious health effects; some studies have shown a higher incidence of blood clots in women using the patch, while others have not. Other than this concern, the health risks and contraindications of the patch are the same as those for
the combined pill
.
Some research studies have shown that breast tenderness, painful periods, and nausea are more common with the patch than the Pill, and that women are more likely to quit using the patch than the combined pill.
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Another possible side effect unique to the patch is skin irritation, rash, or redness where you apply the patch. Other side effects are the same as for the combined pill.
A vaginal ring is a thin, transparent, flexible ring that you insert into the vagina to prevent pregnancy. The vaginal ring is left in place for three weeks and then removed for one week, providing one month of birth control. It slowly releases into the body estrogen and progestin, which stop ovulation and thicken the cervical fluid, creating a barrier to prevent sperm from fertilizing an egg. The ring does not protect against sexually transmitted infections, including HIV. Currently, the only type of ring available is NuvaRing, although a one-year ring is in development.
The vaginal ring is over 99 percent effective as birth control when used perfectly. With typical use, the effectiveness is about 92 percent.
⢠Can be worn for twenty-one to thirty days, providing protection from pregnancy one month at a time.
⢠Privateâno visible patches or pill packets.
⢠Does not need to be fitted for use.
⢠Otherwise the same
as for the Pill
, although some women find the monthly ring more convenient than the daily pill.
⢠May change vaginal discharge or cause vaginal irritation.
⢠Otherwise the same
as for the Pill
, except that you have to remember to use a new ring once a month rather than to take a Pill every day.
The vaginal ring must be inserted within the first five days of beginning your period or within five days of an abortion. You may also choose to change the ring on the first day of the month and use the calendar as your guide for when to replace each ring. The ring is effective after seven days during its first use, so use a backup method for the first week. After the first month, it is effective continuously, as long as you don't forget to insert a new ring after the seven-day break. If you started the ring on time, you are protected from pregnancy during the seven-day break.
If you're taking the Pill or using another form of hormonal birth control, you can switch to the ring without losing protection from pregnancy.
Inserting the vaginal ring is much like inserting a tampon or a diaphragm. You can squat, stand with one leg raised on a chair, or lie down. Squeeze the ring between your thumb and index finger or twist it into a figure 8, then gently push it into your vagina. Because the ring is not a barrier method, you don't have to worry about the exact placement. Push the ring
far enough in so it feels comfortable. Usually you can't feel it at all.
The ring remains in the vagina for three weeks, though if you prefer to have the ring out during sex, it can be removed for a maximum of three hours in any twenty-four-hour period. Remove it by inserting a finger into your vagina, hooking the side of the ring, and pulling it out. If you have completed the three weeks and are done with the ring, wrap it in its foil pouch and put it in the trash; avoid flushing it down the toilet to prevent hormones from being released into the environment. Your period should start within the next few days. For another month of birth control, insert a new ring seven days after removal of the last one, even if your period has not ended.
New rings should be stored until use in the refrigerator if possible, or at room temperature, but at no more than 77°F, and away from direct sunlight.
If the ring slips out of your vagina and it has been out for less than three hours, you are still protected from pregnancy. Rinse it with cold or lukewarm water (not hot) and reinsert it as soon as possible. If you lose the original ring, insert a new one as soon as possible. If more than three hours have passed, your protection is significantly reduced. You need another method of birth control until the ring has been back in place for seven days in a row. If you had unprotected intercourse when the ring was out for more than three hours, consider using
emergency contraception
.
Women with an easily irritated vagina, a dropped uterus, a dropped bladder, rectal prolapse, or severe constipation may not be able to use the vaginal ring. Your health care provider can help you decide.
The hormones found in the ring are similar to those found in the Pill. Women who cannot use the Pill for health reasons also cannot use the ring. The health risks, benefits, drug interactions, and danger signs of the ring are the same as those for
the combined pill
.
In addition to the side effects described for hormonal contraceptives, ring users may experience some minor side effects, including vaginal discharge or irritation.
Minipills are progestin-only birth control pills that contain progestin but no estrogen. Minipills come in packs of twenty-eight pills, and one is taken every day. The minipill prevents fertilization by thickening the fluid around the cervix and blocking sperm from entering the uterus. It also affects the transport of the egg through the fallopian tubes. The minipill may also prevent ovulation. It does not protect against sexually transmitted infections, including HIV.