Most women can be successful with many different types of the birth control pill. However, you and your gyno can discuss options, and there are a few principals we use to make sure you are on the right pill. It goes without saying that the idea is to protect against pregnancy (all formulations are very effective), to have the fewest side effects, and to maximize your non-contraceptive benefits. Here are also a few thigs you should discuss with your gyno:
- Do you want no estrogen, a newer estrogen, or just a lower estrogen dosage. The lower the estrogen dosage, the greater margin of safety. Newer estrogen E4 may be the safest of all Therefore, most women should be on a lower than 30 mcg of estrogen.
- How to switch your contraceptive. Most women can easily be stepped down to a lower dosage of pill with no adverse side effects and no reduction in contraceptive effectiveness.
- What is your life style like? Sunday start pills are designed so that your monthly periods do not occur on the weekends, but maybe having very few a year or no periods is best. .
- Minimizing breakthrough bleeding with the right pill is helpful. Breakthrough bleeding or having some bleeding when you are in the middle of a package is not uncommon. Breakthrough bleeding is not a reason to start doubling up on your pills, and never change your own dosage without speaking to your gyno. Breakthrough bleeding doesn’t mean you have no contraceptive protection, and is not typically a sign of pregnancy. The two common causes of breakthrough bleeding are smoking cigarettes and cervical infection. There is no evidence rare exposure to secondary smoke can cause breakthrough bleeding. Women who have breakthrough bleeding on long cycle pills (pills designed to have 4 periods a year as noted) will likely do better with pills designed for light monthly periods.
- Birth control pills suppress the formation of the lining of the uterus. There not really a need for a ‘cleansing’ or ‘detoxification’ by actually having a period. Unless you feel more comfortable seeing a menstrual period so that you know you are not pregnant. The long cycle pills that are designed to have a period every 84 days are best to treat medical problems such as bleeding disorders, menstrual seizures, menstrual migraines, endometriosis, and those such as women who are athletes and don’t want a period.
- Back up contraception (for instance with a condom), even for the first cycle, is really not necessary. If you start your pills no later than the fifth day of a cycle, without missing any pills, you are protected from failure.
- If you miss 2 pills within the first two weeks of a cycle, take two pills on the next two days and use back up until 7 days of no missed pills. If you have only missed one pill during the cycle, take two as soon as you realize and no back up contraception is needed. If you miss 3 pills, again use back up for 7 days, and start to take your pill every day until a Sunday, and restart a new package on Sunday.
- Pills do not protect against STD’s. Condoms are protection against STDs, and should be worn if at risk.
- Don’t just run pregnancy tests all the time. And a money saving trick few gynos even know: if you worry you are pregnant, but don’t want to spend money on pregnancy tests, take your temperature at the end of your pill-free week of pills: a morning basal temp of less than 98 degrees is not consistent with being pregnant. Just keep taking your pills, whether you got a period or not, and know you are safe and protected!
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