The Pill: All You Need to Know

One of the most common forms of birth control arrives in the form of a small, circular pill. Birth control pills come in a wide variety of types resulting in many struggling to understand the differences, especially when faced with a convoluted medical explanation from a gynecologist. 

Here’s a breakdown of the pill so you can be educated on the options available to you.

Estrogen, Progesterone and Progestin

Estrogen and progesterone are the two main sex hormones for those who menstruate. 

Estrogen brings about the physical features and changes that occur during puberty such as the growth of breasts, growth of bodily hair, and the beginning and regulation of menstrual cycles. The ovaries, the adrenal glands and some fat tissue create estrogen and help distribute it throughout the body via your blood.

Progesterone prepares the lining of the uterus, called the endometrium, to accept a fertilized egg. If a fertilized egg does not reach the uterus, the body lowers the progesterone levels, triggering menstruation. The corpus luteum, a temporary endocrine gland that forms after ovulation, produces progesterone. 

However, the body has difficulty absorbing progesterone when given in its natural form, so scientists developed a synthetic form of progesterone, called progestin. Progestin binds to the progesterone receptors and works similarly. In addition, progestin can modify the endometrium’s development, reducing or stopping the lining from building up.

Types of Pills

Combination: Combination pills contain different ratios of active ingredients of estrogen and progestin and come in a variety of options.

• Conventional: Conventional pills come in the standard package of either 21 active pills and seven placebo pills or 24 active and four placebo pills. This is the most common form of birth control pills.
• Extended Cycle: Extended-cycle packets contain 84 active and seven placebo pills, reducing periods to about four per year.
• Low-Dose: Low-dose pills contain less than 50 micrograms of estrogen per active pill, making them a good choice to those just starting birth control and/or those sensitive to hormones.
• Monophasic: Monophasic birth control pills contain the same level of hormones for each active pill of the month. Monophasic are more common than multiphasic pills; conventional monophasic pills are what many think of concerning birth control pills. 
• Multiphasic: In multiphasic pills, the hormone level changes depending on where in the menstrual cycle you are at. Multiphasic pills may better suit those who are sensitive to hormones since the dosage of estrogen typically decreases near the end of the cycle.

Minipill: Minipills contain only progestin at a consistent active level with a lower dosage of that contained in combination pills. Minipills are less effective at preventing pregnancy than combination pills but work better for those sensitive to hormones or with certain medical conditions.

Each type and brand of pill may react differently to your body and has its own possible side effects and risks. Please consult your doctor first to see what may work best for you.

How the Pills Work

The combination pills help prevent pregnancy in three ways. First, by preventing the ovaries from releasing an egg to be fertilized. Second, by causing a buildup of a thick, sticky mucus at the opening of the cervix to help prevent sperm from entering. And third, by thinning the lining of the uterus, making it difficult for a fertilized egg to attach and develop.

Minipills mainly prevent pregnancy in the last two ways listed for combination pills — the thinning of the uterine lining and the mucus at the entrance of the surface create a difficult environment for fertilization and development. Some minipills might be able to prevent ovulation, but that is typically not the intended function.

Typically, at the end of each pack of birth control pills, a line of placebo pills will be included. These pills do not contain any hormones, instead, most placebo pills are just sugar that may have inclusions of vitamins or minerals. Placebo pills help those on birth control pills to stay on track of their pill schedule, but taking them is entirely optional as one can either keep track of when to start the next pill pack or skip straight into the next pill pack.

Pros and Cons

Overall, the birth control pill provides flexibility with control of your menstruation; however, the two types have different pros and cons.

Combination Pill:

• Pros: The pill can provide relief from premenstrual syndrome (PMS), relieve menstrual cramping, improve acne, promote shorter, lighter and more predictable periods, reduce bleeding, and reduce symptoms of endometriosis.
• Cons: Skipping days or taking pills at a different time every day may reduce the pill’s effectiveness. Additionally, the pill doesn’t provide protection against sexually-transmitted diseases or infections. There is an increased risk of high cholesterol, heart attack, stroke, blood clots and some forms of cancer. Other unwanted side effects may occur.

Minipill:

• Pros: The pill can be taken with certain medical conditions and is less likely to interfere with breastfeeding. There is also a lower risk of endometrial cancer.
• Cons: It requires you to be strict on taking at the same time every day, and there is no protection against sexually-transmitted diseases or infections. There is a slightly increased risk of an ectopic pregnancy. Other unwanted side effects may occur.

Providers

Birth control pills can be accessed and purchased through a variety of retailers. The most common will be through your local pharmacy with a prescription sent in by your doctor. Another option would be to consider using an online pharmacy like GoodRX Care, where one of their providers would provide a consultation and a prescription that would be sent by GoodRX Care or to your pharmacy. Other online pharmacies include Express Scripts and OptumRX.  However, please be careful and research online pharmacies thoroughly before ordering to avoid any safety concerns. 

One final option might be subscribing to a birth control pill provider company such as The Pill Club or Nurx. These companies focus on providing birth control through their service providers and provide delivery via monthly packages right to your doorstep.

Birth control pills are a popular option but not the only option. Don’t be afraid to advocate for yourself and ask questions about what’s available and best for you!