Oral Contraceptive Pill

Oral Contraceptive Pill (OCP) is a popular contraceptive birth spacing method among women.

Oral Contraceptive Pill (OCP) which contains a combination of estrogen and progestogen hormones is known as the Combined Oral Contraceptives (COC) pill.

Any women of reproductive age can take a COC to space between children. A number of COC pills can be found in the market. In order to select the right COC pill, one should consult a doctor.

COCs are the most popular contraceptive method in Bangladesh. It is safe, hassle-free and easily reversible, which means after stopping dose of COC pill, a woman can quickly get pregnant.

In addition to preventing pregnancies, COCs are also prescribed by doctors/health providers to treat acne, extreme menstrual cramps and a few other female health issues.

COC pills consist of iron tablets which helps prevent iron deficiency anemia among women due to excessive blood loss during the period.

There are many low-dose brands of COC available in the market such as Femicon, Femipil, Noret-28, Ovacon Gold, Mypill, etc.

A woman can start taking a COC pill any time she wants as long as she is not pregnant and not having any health issue or restriction to take additional hormones. She should start using a COC from the first day of her menstrual bleeding. (For details, please see the product insert inside of the pack).   

For women who want to switch to COC from other methods like IUD, Implant, and condom or a Progestin-Only Pill (POP) method can start COCs immediately after stopping the previous method.

A woman needs to take one pill every day until the pack is empty. When she finishes the pack, she should take the first pill from the next pack from the next day.

She should take the pills at the same time every day for better effectiveness. Before starting a COC pill brand, one must read the instructions given in the packet.

COCs are the most popular methods compared to other contraceptive methods. At the beginning of starting the pill (for first 2/3 months), a woman may face some changes in the menstrual pattern, headache, dizziness, nausea, breast tenderness, weight change, mood changes, etc. However, in the majority of the cases, these initial side effects or discomforts go away within two or three months of regular use.

If a woman misses a hormonal pill (white pills), she should take the missed hormonal pill as soon as she remembers and should continue taking the other pills as usual, one each day (see product insert for details).

She should take a hormonal pill as soon as she remembers and should continue taking the other pills as usual, one each day. There would be little or no risk of pregnancy. It is also advisable that her partner should use a barrier method (condom) till the start of next pill cycle. (see product insert for details). 

She should take a hormonal pill as soon as she remembers and ask her husband to use a condom or avoid sex for the next 7 days. And if she had sex in the past 5 days, she should consider taking an Emergency Contraceptive Pill.

If a woman taking the pill vomits within 2 hours after taking a pill, she should take another pill from her pack as soon as possible and then keep taking the pills as usual.

A woman can take the pill without a break as long as she wants unless she has any medical issues.

Progestin-only Pills or POPs as they are commonly known are contraceptive pills containing progestin hormone only. Unlike COCs, they do not contain estrogen hormone and therefore can be used safely by estrogen contraindicated women.

The most significant advantage of POP is that they can be used by lactating women at least 6 weeks after childbirth. In addition, it can also be used safely by women who want to delay their first child and those who cannot take estrogen because of various health reasons. A woman should consult a doctor for starting and continuing a POP.

A breastfeeding mother can start the pill anytime after 6 weeks of childbirth if her period has not returned. One pill must be taken at the same time every day. Because of a single hormone and very low dose, it is important to maintain regular timing to ensure maximum efficacy. (See product insert for details).  

No significant side effects has been observed. A woman may face some changes in the menstrual bleeding patterns like spotting and irregular and scanty bleeding. Other common side effects include: headaches, nausea, dizziness, mood changes and breast tenderness. These minor discomforts usually subside with regular use and there is no need to worry.

Emergency contraceptive pills prevent pregnancy when taken within 72 hours (3 days) to 120 (5 days) of having unprotected intercourse.

An ECP is made of synthetic progestin hormone only at a high dose. A sexual act may be unprotected meaning it could lead to pregnancy for various reasons such as breakage or slippage of condoms, missing of pills, rape, failure of the man to withdraw his penis before ejaculation if not using a condom, and others. There are a number ECPs sold through pharmacies such as Norix (protects within 72 hours).

ECPs provide couples with a second chance at preventing pregnancy if they are not ready and therefore protect them from seeking out abortion which may be highly risky and costly as well as brutal as an option to eliminate pregnancy.

There are two different packaging of ECPs available in the market: a higher dose single tablet version and a milder two tablet version such as SMC’s Norix. The single dose must be taken within 72 hours of unprotected sex. In the case of the two tablets, the first tablet must be taken within 72 hours of unprotected sex and the second tablet after 12 hours of taking the first tablet. Monthly menstruation may start a few days earlier or later than the usual date. If the next monthly periods do not return within 7 days from the usual time, then the woman should go for a pregnancy checkup. 

There are no long-term side effects has been observed so far after using an ECP. Some women may face initial discomforts after taking ECPs such as nausea, vomiting, headache, dizziness, abdominal pain, vaginal bleeding, etc. These are very temporary.

There are some common misconceptions regarding pill. For example:

• Misconception-1: A woman only needs to take the pill if she has had an unprotected sex/intercourse that day.

• Correct answer-1: She must take the pill every day whether or not she had sex that day. She should complete the entire cycle pack as instructed.

• Misconception-2: Taking the pill for a long period makes a woman infertile. 

• Correct answer-2: Pills do not cause infertility no matter how long it been is used.

A few other important things to remember that:

•OCPs, POPs or ECPs do not protect from HIV/AIDs or STIs.
•ECPs are not recommended as a regular contraception.
•Breastfeeding women should breastfeed her child immediately before taking ECP and wait for a few hours each time after taking the table before starting to breastfeed again.