Birth control pills are commonly prescribed in gynecology not only as an excellent contraceptive but also for its medical benefits. The pill contains both estrogen and progesterone. The same hormones in the daily birth control pill can also be delivered in a skin patch form applied once a week (Ortho-Evra®), and a vaginal form inserted once a month (NuvaRing®).
The progesterone component of hormone pills can be used alone for contraception as well as for medical treatment. Progesterone can be taken by mouth daily in the form of a “mini pill”, injected every 3 months (Depo-Provera®), released in the uterus continuously from the Mirena® IUD or placed under the skin for a duration of 3 years – Nexplanon®.
Progesterone is also found in emergency contraception (the “morning after” pill). Both Plan B One Step® and Next Choice® can be purchased without a prescription from behind the pharmacy counter. If under 17, it requires a prescription. The hormone needs to be taken within 72 hours of unprotected intercourse and works by delaying or preventing egg release until the sperm dies off. The risk of pregnancy is reduced by 89%. It is generally recommended that a pregnancy test be performed if menses is more than 1 week late following usage. There have been no reports of birth defects or serious complications if pregnancy should occur.
Benefits of Hormonal Contraception
…control heavy menstrual bleeding
…manage endometriosis symptoms
…decrease menstrual cramps
…decrease the risk of uterine cancer
…decrease the risk for ovarian cancer
…alter the date of menstrual cycle onset
Risks of Hormonal Contraception
Hormones can potentially cause an increased ability to form clots in the blood stream leading to deep vein thrombosis(a clot in the leg), pulmonary embolism (a clot in the lungs)or stroke(a clot in the brain). This risk of clots, however, is actually much lower than the increased risk associated with pregnancy. Signs and symptoms of a blood clot requiring immediate attention may include severe calf pain or swelling in one leg, chest pains, shortness of breath or severe headache. Hormone therapy is not recommended if you have had or have:
…active liver or gallbladder disease
Oral Contraceptive Usage Information
All birth control pills are very similar and work the same way to prevent ovulation. As a new start patient, the first month of hormone needs to be completed in order to rely on it for birth control. Also when starting for the first time, you may experience minor side effects like nausea, breast tenderness or irregular bleeding. These symptoms usually resolve after 3 months of usage; however if they continue please call the office to discuss switching to a different type that may work better for you. Often times, we can discuss this at your follow-up as well.
If you are taking the “minipill” or progesterone only pill keep in mind it needs to be taken the same time everyday within 3 hours. If you miss the 3 hour limit , take it as soon as you remember. If it’s the next day take 2 pills and finish the pack. In either case, use back-up contraception for 48 hours.
If more than 1 pill is missed stop taking them , discard the pack. Use emergency contraception if you need to. Your period should begin in 2-3 weeks. Start a new pack the day your cycle begins. Use a back-up method for 7 days.
If you are taking the combination birth control pill ( regular birth control) and miss 1 pill, take the missed pill as soon as possible and the next pill at the usual time. Use a barrier method until your cycle starts. If 2 pills are missed during the first 2 weeks, take 2 pills as soon as possible ,then 2 pills the next day and continue the pack but use a back-up until your cycles starts. If 2 pills are missed during the 3rd week or 3 pills at any time during the pack , then immediately start a new pack – skipping the pill free interval. Use a back-up method for 1 week. Breakthrough bleeding will usually occur when you miss a pill.
If you can’t remember to take the pill every day, then we would be glad to discuss other options.
Permanent Birth Control
Once a decision is made to stop having children, you may choose permanent sterilization as an option. Tubal ligation is a procedure to permanently prevent pregnancy. This procedure has traditionally been performed laparoscopically with burning and cutting the middle of the tubes. This is performed as an outpatient in the hospital and requires entry into the abdomen with 2 small incisions and general anesthesia.
The risks of entry into the abdomen and general anesthesia can now be avoided with the current option of hysteroscopic sterilization. This procedure , known as Essure® , is now performed in the office with no incisions.
The tubes are blocked by placing a small coil in each tube where it enters the uterus. Over the course of 3 months scar tissue develops to close off the tubes resulting in a 99.7% success rate.
You receive oral medication for sedation prior to the procedure and a local anesthetic. You will also be given a hormone prior to the procedure to prepare the uterine lining.
The coils are then placed through the vaginal route using a hysteroscope which usually takes less than 10 minutes. You will need to be protected against pregnancy for 3 months at which time a test will then be performed to confirm the tubes are blocked. The confirmation test is performed by a radiologist and involves injection of dye into the uterus followed by an x-ray. There is very low risk of the hysteroscopic tubal ligation procedure and most patients return to work in less than a day.
May download POSTOPERATIVE INSTRUCTIONS AFTER ESSURE®.