Birth control or oral contraceptives pills (OCP's or OC's) were first introduced in the 1960s. Today they are used by more than half of all women using a reversible methods of birth control. Over the years, a great deal of research has been done on their effects, but despite the large body of knowledge available, scientists are still at work investigating them here are some important facts scientists have found regarding OC's.

The OC's works through three mechanisms 1) they blocking ovulation, 2) they make the cervical mucous impenetrable to sperm cells, and 3) they changing the lining of the uterus. Even if an egg is produced and fertilization does occur, the egg would find it extremely difficult to implant within the lining of the uterus.

OC's have now been used by millions of women for up to 20 years or more without interfering with being able to get pregnant once these women stop using OC's.

It is not necessary to take any breaks or go off OC's for any length of time while on them.

Virtually all women (with some limitations listed below) can safely use OC's. All healthy nonsmoking women can use OCs all the way through menopause without significant risk to their health.

Evidence now tells us that the OC's help to reduce the incidence of ovarian and endometrial cancer, ovarian cysts, and benign cysts of the breast, with the singular exception of malignant melanomas (a skin cancers). There is still some question about breast cancer but so far there is no definite reason to believe that there is a causative relationship.

The Pros and Cons of Oral Contraceptives

In order to help you decide whether oral contraception are right for you, we present a brief overview of their pros and cons:

Advantages:

OC's are highly effective means of contraction essentially 99.5% effective

OC's do not interrupt sex or force couples to make changes in their sexual habits

OC's are safe for most women, with the exception of smokers

OC's protect against ovarian and endometrial cancer, ovarian cysts, and benign cysts of the breast

OC's decrease menstrual cramps and pain before and during menstruation

OC's reduce menstrual blood flow, thereby reduces the risk of anemia

The short and long term effects of OC's are completely reversible

OC's are easy to use and can be discontinue after completion of any menstrual cycle

OC's have been well researched and we know a lot about them

Disadvantages:

OC's offers no protection against sexually transmitted diseases

OC's can be expensive

OC's can produce certain rare but dangerous complications (see below)

OC's can be responsible for mood changes in certain women

OC's may give rise to nuisance side effects such as headaches, weight gain, and breakthrough bleeding

OC's must be taken correctly on an almost daily basis to be completely effective

Who Should Not Use Oral Contraceptives

OC's are not for all women. Despite OC's beneficial effects, they are associated with some risks. Most medical doctors advise women who are already high risk for heart attacks, strokes, or blood clots--especially those who smoke--to choose other type of contraception. Several other conditions, such as high blood pressure, diabetes, or sickle cell disease, may also relative contraindications to using OC's.

Your OC Options

Birth control pills come in packs of either 21 "active" pills (active in that they contain hormones), or packs of 28 pills, in which 21 of the 28 tablets are active and the last seven tablets are inactive spacers. The spacer pills are simply a way of keeping the woman in the habit of taking a pill every day of every day of the month as long as she desires to use OC's. This means even while taking a pill during the time of the menstrual period.

OC's are divided into two type or methods of contraception. These are monophasic type pills and triphasic type pills. Monophasic pills provide the same dosage of hormones all through the entire active cycle, whereas triphasic pills give different dosage levels during each week of the month. Triphasics are designed to more closely duplicate the woman's natural hormonal pattern. Many experts, however, believe that the dosage fluctuations don't really matter and may even cause extra problems, such as increased "breakthrough" bleeding (sporadic menstruation) while on the pill, or an increase in Pill-related headaches. In all cases once started you should determine if you feel better or worse on the pills prescribed for you. If you feel worse then when not taking OC's you should discuss changing the type of pill. If you feel okay then the pill you are taking is okay for your body and you.

Birth control pills are also divided into combined OCs or progestin only OCs. The combined pills are a combination of the two female hormones estrogen and progesterone. Progestin only pills, also called minipills , lack the estrogen component. Since many women should not use estrogen containing products because of problems with estrogen or when they are breastfeeding, minipills are often prescribed for women who want protection from pregnancy six weeks after they give birth. Minipills also have lower doses of progestin than combination forms, making them a good choice for women worried about metabolic effects of the hormones. However, they are not as good a choice for women who want highly effective birth control. Because they are of such a lo dose they also require the woman to take them on a very regular basis and hence are not good for women who are dating, unstable in their life or unreliable in taking medications.

How Effective OC's?

Given all the ways that OC's discourage fertilization it's hard to believe that anyone can get pregnant while using them. And in fact, OC's do have an effectiveness rate of over 99% when used correctly, (taking an active tablet every day during the 21day cycle). However, because women do forget to take a pill now and then, the actual overall effectiveness in real world use is about 97%.

This may sound pretty good, but remember that it does fall short of total certainty. For example, even assuming that OC's are 99.5% effective, 84,000 of the 16.8 million women currently using OCs will have an unintended pregnancy, even if they take their pills correctly every day! If you are concerned about accidental pregnancy while using OCs, you should always use a backup method--like a condom or spermicide--each time you have sex. A combination of rhythm or calculating safe and unsafe days is another reasonable approach. In addition to lessening your fears about getting pregnant, using latex condom, unlike OC's can help protect you from many types of sexually transmitted diseases (STD's). This is especially valuable for unmarried women who wish to make sure they never have to suffer from any STD's.

Are You a Good Candidate for OCs?

If you are sold on using OC's you would next want to find out if they are right for you and if you can use them. To find out it will be necessary to take your medical history and have a complete examination including breast exam and pelvic examination. A Pap smear should also be done and if you a sexually active with more than one partner, or your partner has or you suspect that he has more than one other partners, tests for STD's. Once it is found that you have no contraindications for the use of OC's you and your doctor should discuss the pros and cons of OC's for you personally. In general, OC's might not be right for you if you are:

Presently pregnant

Over 35 and you are a smoker (more than 15 cigarettes a day)

Over 50 years of age or are menopausal already

Suffering from migraine headaches which originally started after you had previously used OC's

About to have major surgery which would immobilize you for a prolonged period of time

Presently breastfeeding (although progesterone mini pills might be available to you)

Have had a child in the last two weeks

OCs might not be right for you, if you have or have had in the past:

Problems with blood clots (thrombophlebitis or cerebrovascular accidents) or blood-clotting problems

Heart disease

Cancer of the breast or reproductive tract

Liver problems or liver cancer

Kidney disease

High blood pressure

Diabetes

Active gallbladder disease

Congenital hyperbilirubinemia (Gilbert's disease)

Conditions which would make it difficult to take a pill on an every day basis (mental retardation, psychiatric illness, substance abuse, you are generally irresponsible)

The Benefits and Risks

OCs are among the most thoroughly studied medications in the world. The vast body of data collected on them indicates that although they do have certain side effects, few women are likely to experience them. Moreover, most of the information on side effects was collected from studies of which evaluated much higher dose pills than those generally in use today. Research done in the early years of OC's use generally involved women who had not been completely screened to see if they were good candidates. Today, women with a personal or family history of heart disease or other illnesses linked to OC's are usually steered away form OC's toward other methods of birth control. If you are healthy, you don't smoke more than 15 cigarettes a day, and no one in your family has suffered from major diseases such as cancer, a heart attack, or very high cholesterol, you may never experience any of the more serious side effects generally attributed to OC's.

OC's however, can produce "nuisance" side effects and even some more serious health problems. These included serious potential effects of increased risk for cervical and liver cancer (and possibly breast cancer, although so far studies regarding breast cancer are far from conclusive), heart and blood vessel disorders (blood clots and high cholesterol), high blood pressure, increased blood sugar levels, complications with the liver and gallbladder, cervical changes (increasing your risk for sexually transmitted diseases), eye problems, and delays in fertility once pills are discontinued. Many who might be at risk for some of these complications can, however, can use or continue to use OCs if they 1) are followed closely and 2) use them cautiously. Your doctor should be able to help you determine whether or not you should avoid using OC's.

Cancer:

Women who have used OCs sometime in their lives are less likely to develop cancer by age 55 than women who have never used OCs. OCs also do protect against certain kinds of cancer. If you use OCs for at least a year, your risk of developing endometrial cancer diminishes by 50% and it drops even more after three years of OC use. This protection can last up to 15 years after you have stop using OCs.

Ovarian cancer, the most lethal of all forms of female reproductive tract cancers, is also 40% less likely to develop in a woman who has used OCs. Even if you use OCs for as little as three months, you get some protection, but to get the full effect you need to take them for a minimum of 5 to 10 years. If you use them for more than 10 years, your risk is reduced by 80%. The protection lasts for at least 10 to 15 years after discontinuing OCs.

Endometrial and ovarian cancer are not the most common female cancers. Still, an estimated 2,000 cases of endometrial cancer and 1,700 cases of ovarian cancer were averted by OC use in the 1980s.

OCs do not protect women from cervical cancer. In fact, the opposite may be true. Women who take OCs for more than a year appear to run an increased risk of developing this disease, the risk appears to double when OCs are taken for 10 years or more. However, the most important risk factors for cervical cancer are not OCs, but rather the number of sexual partners a woman has had and how old she was when she first had sex. Exposure to human papillomavirus (HPV) and smoking also increase the risk of cervical cancer. Barrier contraceptive methods, such as a diaphragm, condoms or spermicidal foam, creams or gels clearly appear to protects against cervical cancer. It is difficult to determine the value of these factors in women with cervical cancer who also used OCs as research results have not been clear. One study conducted by the Centers for Disease Control and Prevention (CDC) showed that women who used OCs didn't get cervical cancer any more often than women who never used OCs. It has been suggested that the reason that OCs users may appear to have a higher risk is that the higher rate of cancer diagnosed among these women was simply due to more careful screening, including more frequent Pap smears. Hence, the use of OCs was in fact beneficial and in many cases life protecting.

Approximately 1 woman in 9 will develop breast cancer during her lifetime, so it's not surprising that breast cancer is the main concern of anyone considering use of OCs. There is now a large body of scientific evidence showing no evidence of association between the use of OCs and development of breast cancer, however most researchers aren't sure whether to conclusively accept these studies. It will likely take many more years before a final decision is reached. While most experts now do agree that OC use is not associated with breast cancer after age 45, there is still a question as to whether younger women might be at higher risk when they reach ages past the 50's, 60' and 70's. Several studies have shown that women who use OCs early in life, use them for longer than four years, and/or don't have a full term pregnancy early in life have a slightly increased risk for breast cancer. However, other studies conclude the exact opposite.

OC use has been implicated in a rare form of liver cancer known as hepatocellular carcinoma. However, since so few people ever develop this cancer, it has been difficult for researchers to determine with any certainty whether OCs were actually the cause or entirely innocent. The largest study to include data about hepatocellular carcinoma found no association with OC use. In addition, death rates from liver cancer in the United States haven't changed since the introduction of OCs to the marketplace in the 1960s.

Despite a suggestion that OC use might lead to skin cancer, follow up studies indicate no difference in the risk for OC users versus nonusers. There is also no proven relationship between OCs and kidney cancer, colon cancer, gallbladder cancer, or pituitary tumors.

Heart and Blood Vessel Disorders:

Although concerns about cancer are usually foremost in the minds of women using OCs, the OCs effects on blood chemistry are actually a greater cause for worry. Both the hormones in combined OCs are responsible for these problems, but in different ways.

The progestin component of OCs can alter the level of lipids (such as cholesterol) in the blood. Although estrogen works against this effect by increasing beneficial high density lipoproteins (HDL) and lowering harmful low density lipoproteins (LDL). The progestin component opposes the estrogen and does the opposite. Because high levels of LDL and depressed levels of HDL can cause fatty plaque to build up in the arteries, progestins have been implicated as a risk factor for coronary heart disease.

The estrogen component has been linked to a different problem: an increase in abnormal blood clotting, which can block circulation. A blood clot can appear in any blood vessel, but it is especially serious if it occurs in the brain, heart, or lungs.

Clots or blockages to blood flow can lead to serious and sometimes fatal complications that are usually associated with the following risk factors:

Family history of heart attack or diabetes

Previous heart or blood vessel disease

Smoking

High blood pressure

Overweight

Inactivity (either from too little exercise or from being immobilized)

If you have any of these risk factors, you should ask your physician whether the benefits from using OCs outweigh their possible dangers. This type of decision, however, must be made on a case-by-case basis. Public clinics often have stricter rules against giving OCs to women with certain risk factors then do private practitioners.

Here is a description of the symptoms you might experience if you are suffering from a blood clot or blockage. Below is a list of potential problems and the most significant symptoms associated with them. If you think you have one of these problems, seek medical attention as soon as possible.

Cerebral infarction (stroke): Headache, impairment of the intellect, visual problems, weakness or numbness

Myocardial infarction (heart attack): Chest pain, difficulty breathing, left arm and shoulder pain, weakness

Thrombophlebitis (blood clot in a leg): Calf pain or swelling, pain, heat or redness in the thigh, pain, heat or tenderness in one or both lower legs

Pulmonary embolism: Chest pain, cough, shortness of breath

Mesenteric vein thrombosis (blood clot in the main vein in the abdomen): Abdominal pain, vomiting, weakness

Retinal vein thrombosis (blood clot in a vein in the retina of the eye): Headache, loss of vision

Pelvic vein thrombosis (blood clot of a pelvic vein): Cramps, lower abdominal pain

High Blood Pressure:

Although in itself not a life threatening condition, OC related high blood pressure--experienced by up to 5% of women taking high dose pills--can lead to heart disease and stroke. If your blood pressure is over 140/90, you should stop taking OCs until it is under control. All women using OCs should have their blood pressure checked once or twice a year; for women with a history of blood pressure problems, a check once every three to six months is suggested.

Increased Blood Sugar Levels:

Estrogen and progestin not only can affect blood clotting and blood lipids, they can also raise blood sugar levels. Most experts believe these changes are usually very slight at best and that they have no clinical significance. However, for women with diabetes the situation isn't so straightforward. Some doctors believe that diabetic women with no other risk factors can use OCs with minimal trouble, but others believe prescribing OCs to diabetics exposes them to unnecessary risks. Again this can only be decided on a case-by-case basis.

Liver and Gallbladder Complications:

OCs can cause jaundice--a liver condition that makes the skin and eyes look yellow--but only 1 in 10,000 OC users experience OC related jaundice. OCs can also cause another rare liver condition known as hepatocellular adenoma. The risk of developing this condition is about 3 or 4 per 100,000 OC users. Liver cancer is another rare complication. Gallbladder disease, which is fairly common among users--and non users--of the OCs, is not life threatening but could require surgery.

Cervical Changes:

The thickness and strength of the cervical lining varies with the ebb and flow of reproductive hormones; and OCs can lead to an increase in the area of thin, vulnerable cervical tissue susceptible to sexually transmitted diseases (STDs). Most doctors recommend that women with multiple partners or who have a partner with multiple partners use condoms for STD prevention while using OCs to prevent pregnancy. This appears to especially be true if you have more than one sexual partner and if you are less than 25 years old.

Eye Problems:

Use of older, high dose OCs occasionally caused an inflammation of the optic nerve, resulting in blurred or double vision, swelling, pain, or even loss of sight. This almost never happens with today's OCs. However, any loss of vision warrants an immediate discontinuation of OCs and a visit to your primary physician, ophthalmologist or neurologist. You should also stop using OCs if a vision problem accompanies a migraine headache.

Returning to Fertility:

For most women, fertility comes back quickly after discontinuing OCs. However, 1% to 2% of women may experience some delay in the return of normal reproductive cycles. In rare instances, hormones can stay suppressed for months or even years, although for the majority of women menstrual cycles normalize within one to three months. Cycle suppression is more likely to cause difficulty getting pregnant in older women, so if having a child is a high priority, you might consider switching to another reliable contraceptive method as you approach age 30.

Nuisance Side Effects

Some women experience minor "nuisance" side effects while using OCs. Of course, depending on your level of discomfort, a nuisance can become serious enough to warrant switching to a different OC or discontinuing OCs entirely. Additionally, some minor side effects could actually be masking a condition that needs medical attention. Never hesitate to mention a side effect to your physician. Among the minor side effects of OCs are acne, breakthrough bleeding or spotting, breast tenderness, depression, headaches, nausea and weight gain.

Acne:

While some OC users may notice an improvement or a worsening of their acne, most OC users notice no change in their acne. In some women, the progestin component of the OCs improves their acne; while in others it works like the male sex hormone, androgen, and makes it worse. Dietary, allergic, hygienic, or familial factors can also increase acne. A bad case could be a sign of an ovarian or adrenal tumor, although chances of this are minimal. Hence any worsening or new development of acne when it previously did not exist, should be brought to the attention of your doctor.

You have several options if you break out with acne while using OCs. Recently developed lower dose pills containing so-called "new progestins," have been recently introduced to the American market. These pills have been used in Europe and other parts of the world for more than 30 years with great success. Although many claims are made about them, so far their only real benefit appears to be their lower androgenic properties. Ask your doctor about these pills containing progestins called norgestimate (Ortho-Cyclen, Ortho-Tricyclen) and desogestrel (Desogen, Ortho-Cept). A third new progestin called gestodene, which could actually be the best of the three because it can be used at the lowest dose, it could become available in the U.S. sometime in the near future.

The new OCs are more expensive however, than the older higher-dose pills, so you'll have to decide if improving your acne is worth the added expense. You might choose to switch to another type of OC first and see if it can help. You can also consider more aggressive management of the acne with antibiotics, dietary changes, and using skin cleansers.

Breakthrough Bleeding or Spotting:

Intermittent minor menstrual bleeding could mean that your OC is not strong enough, or it could signal a pelvic infection (PID), endometriosis, an ectopic pregnancy or some other gynecologic or medical problems. Once your doctor has ruled out these more serious possibilities, he or she will either switch you to a different pill (probably one with a higher dose of progestin or one of the new progestin pills) or counsel you to try to tolerate the bleeding and spotting for a little while longer, especially if you just started on the pill. Breakthrough bleeding and spotting generally decrease rapidly over the first three to four months of pill use. Most physicians, however, do not recommend stopping using OC's because of this side effect. If you have any doubts, however, discuss this with your doctor.

Breast Tenderness:

If your breasts hurt, your doctor will first rule out pregnancy and breast cancer. He or she may then prescribe a different, lower dose pill. You may also want to try wearing a different bra with better support. Also try to avoid vigorous exercise when you have the most discomfort.

Depression:

It's difficult to prove a direct link between depression and OCs. A woman who's chosen to use OCs may still have strong moral or medical concerns about this. Starting on the pill may also coincide with increased sexual activity, which may cause deep psychological conflicts for her. This inner turmoil can easily seem like depression. It is important to decide whether there could be other reasons for your feelings, and to note whether your depression started or became worse when you began taking OCs.

If you eliminate depression from other sources than OCs, there are several OC-related remedies your doctor can try. Most likely the culprit is the progestin in your OC, your physician might try prescribing an OC with less of this hormone. OC-related depression can also be the result of fluid retention or a lack of vitamin B 6 . Talk with your doctor about the best plan of action. Another reason which is quite common is premenstrual syndrome PMS, which can occur all month long in OC users. There are a number of simple dietary changes you can make such as eliminating all refined foods, processed foods, sugar, caffeine and decreasing the total amount of calcium in your diet (dairy products especially). You can also take magnesium supplements (500 to 1,000 mg a day) and vitamin B6 (50 mg daily). If your depression seems severe, it may be best to discontinue use of the specific OC and talk with a specialist.

Headaches:

Although OCs sometimes initiate headaches or make them more severe, headaches can also be a warning of impending strokes or other circulatory disorders. Pay close attention to headaches that are different or more severe than those you had before starting on OCs. Estrogen seems to be the culprit in OC-related headaches, so you might find relief by changing to a lower dose pill, or switching to a progestin-only method like Norplant implants or Depo-Provera. If you usually get headaches only during the week you're not taking pills--the placebo week--you might have what's called an estrogen withdrawal headache. To determine whether this is the case, consider using an estrogen supplement. For example, during your withdrawal week, you can try wearing a transdermal patch which releases estrogen through the skin or taking a low dose of Premarin.

Another approach to estrogen withdrawal headaches is simply to put off withdrawal from the OC. Essentially, you postpone the headache by extending the amount of time you take active pills. A recent year-long study of 300 women showed that those who opted for an extended regimen--taking active pills for 9 weeks instead of 3 and then taking a one week withdrawal--had fewer headaches. Continuing the active pills for the extra time caused no serious side effects and no decline in effectiveness. While it may initially seem unnatural to take pills for longer than the standard 3 weeks, remember that the entire pill cycle is essentially unnatural. As one family planning expert puts it, "The day was made by God, the week was made by man."

Nausea:

Although it could signal pregnancy, early miscarriage, or some nonreproductive disorder, when nausea is related to the pill, it's the estrogen component that is generally at fault. For a new OC users, nausea usually subsides after the first few cycles or remains a nuisance only on the first day of each new cycle. In addition to switching to a pill with a lower estrogen dose or to a progestin-only method, another possible remedy is taking your pill after a meal. Swallowing a pill before going to sleep has also helped some women.

If the nausea is so bad that you vomit within 1 hour of taking a pill, take another pill from an extra pack. Also, if you missed a pill and are trying to catch up, take the next 2 pills at least 12 hours apart.

Weight Gain:

Some doctors refuse to acknowledge that OCs can cause excessive weight gain. Although your doctor might switch you to a different pill, it could be because you believe it will help rather than because he or she thinks it will. When weight gain occurs after you starting to use OCs this is often caused by fluid retention or estrogen-induced fat deposits in the thighs, hips, and breasts. Weight gain may also be related to a reduction in physical activity or increased intake of food. In some women the androgenic effects from the progestins in their OCs can increase their appetite. Switching to lower dose pills or to pills with less progestin content may help, but increasing exercise and reducing caloric intake is often the best solution.

Drugs That Should Be Avoided By Women Who Take OC's

Certain medications can interfere with OCs. They can and are sometimes the underlying reason for OC failures and unwanted pregnancies. These medications include: anticonvulsant medications and some antibiotics which stimulate enzymes which absorb estrogen and progestins prematurely. This means less of the hormones from your OCs are available to prevent pregnancy. These drugs can also act on the Norplant system.

If you need to take these medications for even as little time as a few weeks, you to use a backup contraceptive method such as condoms or spermicides. When long tern treatment is needed you should consider an entirely different method. Listed below are some of the medications which can reduce the effectiveness of OCs and implants:

Antibiotics: specifically rifampin, chloramphenicol, cephalosporins, possibly metronidazole, and nitrofurantoin.

Anticonvulsants: phenobarbital, primidone, carbamazepine, ethosuximide, phenytoin.

Antifungals: griseofulvin (this medication does not affect protecting by Norplant implants).

Summary:

OCs is an excellent method for preventing pregnancy. While there are some definite risks for some women, the greatest majority of women should have no problem using this method. Certain medications should either not be used when using OCs or secondary method of contraception should be used while on these medications or OCs should not be used at all.

Certain conditions may require that you see your doctor to be sure that they are not a complication of OCs in the following list we repeat what we have stated above:

See Your Doctor If Any of the Following Occur:

Abdominal pain (severe or persistent)

Chest pain (severe or persistent), cough, shortness of breath

Headache (severe or persistent), dizziness, weakness, or numbness

Eye problems ( loss or blurring of your vision), sudden speech problems

Severe leg pain (calf or thigh)

Jaundice

A breast lump

Or any of the following warning signals listed above.