We are all familiar with the Pill, but it's sometimes easy to misread the fine print. If you feel like you've forgotten the facts, here's a reminder from gynaecologist and the director of
theWomanSpace, Dr. Carol Thomas.
What's on the market in South Africa?
Women in South Africa can access all oral contraceptives (available anywhere in the world), including the skin patch version.
How effective is the Pill?
If used correctly, the failure of the Pill in preventing pregnancy is less than 1%. The only more effective methods are long-term methods, such as the progestogen-only intra-uterine device, injections and implants; or the permanent methods of male and female sterilisation.
Why is the Pill effective?
The Pill works by suppressing the release of an egg at mid-cycle, so this is obviously an all or nothing situation: no egg, no pregnancy. In addition, a thick plug of mucus is formed in the canal of the mouth of the womb (cervix), which acts as a mechanical barrier to sperm and offers some protection against organisms that cause uterine and tubal infections, thus also protecting against infection-related infertility.
How long should/can you use it?
Because the formulations available for the last 20 to 25 years contain less than or equal to 35 micrograms of ethinyl estradiol, i.e. they are low dose, and provided you are generally healthy and have no specific contra-indications to hormonal use, there is no reason why you cannot use it continuously for as long as you need contraception. One of the greatest urban legends stemming from our parents' generation is the notion of giving your body a break from the Pill. The most common side effect of this practice is an unwanted pregnancy. If you don't like the idea of taking the Pill, if you want to experience ovulation, or are having unacceptable side effects, you should stop using the Pill and look at another contraceptive choice.
Which brands need a prescription from a gynaecologist or doctor?
All brands are available on prescription, but certain pharmacists and nurse practitioners have dispensing powers to ensure the Pill is easily accessible.
What are low-dose pills?
All pills available to women in South Africa are low-dose pills equal to or below 35 micrograms of the oestrogen. Once you have consulted with your doctor, he or she will determine which pill will best suit your needs.
• 35 microgram pills: Triphasil, Logynon ED, Diane 35, Ginette, Minerva
• 30 microgram pills: Nordette; Minulette; Femodene; Yasmin; Marvelon
• 20 microgram pills: Mercilon; Melodene; Loette
• 15 microgram pills: Mirelle; Yaz
What are the side effects of the Pill?
Now that we have such low-dose pills, side effects are minimal, but having said that, there is an extremely small group of women who do not enjoy being on the Pill.
Negative side effects of low-dose pills:
When you read the package insert, the possible side effects start at nausea and end at death, like with any other package insert. Because of the particular history of the Pill, the insert is extremely long. This should not scare you, but be reassuring. It means that it has been appropriately researched, thus making it safe for the current generation of users. Weight gain is the most common known side effect of the Pill, although I have not met a woman who doesn't worry about putting on weight. There may be a premenstrual bloated feeling, due to water retention, but this is temporary and should not be present by the time you reach the third packet of the Pill. If your libido is affected, changing Pill dose or formulation may help, but re-examine your relationship as well, if it occurs long after starting the Pill. The more progestogenic pills can make an underlying depression worse.
Positive side effects of low-dose pills:
Low-dose pills reduce the risk of ovarian cancer by 80% if used for eight years and beyond, as well as endometrial (uterine) cancer by 70% if used for more than six years. The Pill helps maintain bone mass, offering protection against osteoporosis, and prevents anaemia by decreasing blood loss by 30% to 50%. The Pill can also prevent and treat the most common ovarian cysts, decrease or eliminate period pain and improve acne.
Important facts:
• Take your pill at about the same time daily – decide whether your lifestyle makes you a morning or an evening person. The reason the return to fertility is restored so quickly after stopping the Pill, is because it exits via your urine within 48 to 72 hours.
• Always use extra protection if you miss tablets, are on antibiotics, vomit within two hours of taking your pill, have severe diarrhoea or have breakthrough bleeding.
• Check with your doctor whenever you start an additional medication – for example, some anti-epileptics and drugs used for mood disorders interfere with the action of the Pill.
• Importantly, TB medication interferes with the metabolism of the Pill and renders it less effective.
• Should nausea occur, change the time of the day that you take the Pill.
• Remember the Pill does not protect you against sexually transmitted infections and condoms should feature extremely high on the agenda until both parties in the relationship have presented each other with HIV reports, which include the window period.
• The placebo (inactive or hormone free) pills are included so that women can have a sense of menstrual level, but are not essential. This means that if you want to use the Pill continuously for a few months without having a period, it is perfectly safe and acceptable to do this.