The Pill – How to use it, types and side effects

What is the contraceptive pill?

The contraceptive pill was invented around sixty years ago and has since become the most widely used method of contraception. It is a hormonal contraceptive that prevents pregnancy by stopping an egg from maturing in the ovary. Today, there are various types of contraceptive pills, of which the so-called combined pills containing oestrogen and progestogen are the most commonly used. An alternative to these is the mini-pill, which contains no oestrogen, only progestogen. The pill is a very safe contraceptive and has a Pearl Index of 0.2 to 0.5. This means that, out of 100 women who use the pill for a year, 0.2 to 0.5 will become pregnant.

How does the pill work?

The pill contains synthetic hormones that are similar to the body’s own sex hormones, oestrogen and progestogen, and thus maintain constant hormone levels. As a result, the egg does not mature and, normally, ovulation does not occur. Oestrogen prevents ovulation by inhibiting the production of LH, a hormone that triggers ovulation. The main contraceptive component of the pill – progestogen – usually also inhibits the production of LH. In addition, the cervical mucus becomes thicker, making it more difficult for sperm to reach the womb. Progestogen also alters the nature of the lining of the womb. It makes the lining less receptive to the implantation of a fertilised egg.

What types of the pill are there?

There are various types of contraceptive pills. The most common are combined pills, which contain oestrogen and progestogen. Compared to the past, they now contain only a small amount of oestrogen and are therefore often referred to as ‘micro-pills’.

A further distinction is made between single-phase preparations, in which each tablet contains the same dose of hormones, and two- or three-phase preparations, in which the hormone dose varies in each phase and which must be taken strictly as prescribed. These pills are beneficial, for example, if a woman experiences breakthrough bleeding whilst taking single-phase preparations.

Another option is the mini-pill, which contains only progestogen and no oestrogen, and generally has fewer side effects than combined pills. However, the mini-pill must be taken at exactly the same time every day, as with some of these preparations, even a delay of three hours can compromise contraceptive protection.

How is the pill taken?

You start taking the pill on the first day of your period, and it provides protection from that point onwards. The exact procedure for taking it varies depending on the type of pill:

1. Single-phase pill: Each tablet contains equal amounts of oestrogen and progestogen and is usually taken daily for 21 days. This is followed by a seven-day break, during which you stop taking the pill; however, some single-phase pills can still be taken during this time, albeit without active ingredients. During this period, withdrawal bleeding usually occurs. On the eighth day, you must start taking the first pill from a new pack.
2. Two- and three-phase pills: These pills contain different amounts of oestrogen and progestogen in the first and second halves of the cycle. The pills must be taken in the correct order.
3. Mini-pill: The mini-pill is taken without a break and should ideally always be taken at exactly the same time each day.

What are the advantages of the pill?

1. High level of contraceptive reliability: When taken correctly, the pill is one of the safest methods of contraception.
2. Regular periods: When taking the pill, periods are usually shorter and lighter than normal menstrual periods.
3. Positive effects on the body: For some women, the pill can help improve skin blemishes, hair loss and acne.

What are the disadvantages of the pill?

1. Side effects: The pill can cause side effects such as headaches, nausea, water retention (oedema), mood swings, reduced sexual desire, vaginal dryness and breast tenderness.
2. Bleeding disorders: In some women, the pill can lead to irregular bleeding or breakthrough bleeding.
3. Risk of thrombosis: The pill may increase the risk of thrombosis, heart attacks and strokes.
4. No protection against sexually transmitted infections: The pill does not protect against HIV, syphilis and other sexually transmitted infections.
5. Not suitable for all women: Women with certain pre-existing medical conditions or smokers over the age of 35 should not take the pill

How safe is the pill?

The pill is a very safe contraceptive and has a Pearl Index of 0.2 to 0.5. This means that out of 100 women who use the pill correctly over the course of a year, only 0.2 to 0.5 women will become pregnant unintentionally. By comparison, the Pearl Index for the natural cycle without contraception is around 85.

Although the mini-pill is also effective, it is slightly less reliable, with a Pearl Index of 0.3 to 3. This is largely due to potential errors in taking it as part of daily life, as the mini-pill must be taken at exactly the same time every day.

Are there any interactions between the pill and other medicines?

The effectiveness of the pill may, under certain circumstances, be impaired when taken at the same time as certain other medicines. These medicines include:

• Anticonvulsants (medicines used to treat epileptic seizures)
• Antipsychotics (medicines used to treat psychotic conditions)
• certain sedatives and sleeping tablets
• certain painkillers
• Migraine medicines
• Antihistamines (medicines for allergies)
• Muscle relaxants (medicines used to relax the skeletal muscles)
• certain antibiotics
• certain antidiabetics (medicines for diabetes)
• Certain lipid-lowering drugs (medicines for lipid metabolism disorders)
• St John’s wort

If you are taking any of these medicines, you should definitely discuss with your doctor whether it is necessary to switch to an alternative method of contraception, either temporarily or permanently.

It is also important to note that diarrhoea and vomiting within four hours of taking the pill can reduce its effectiveness in preventing pregnancy. In this case, you can take an extra pill or, if the diarrhoea and vomiting persist, use an additional method of contraception.

Can you change your contraceptive pill?

If you do not tolerate a particular pill well, you can switch to a different one. This should always be done in consultation with your gynaecologist, as the procedure for switching depends on which pill you are currently taking and which one you are switching to.

It is advisable to use a condom as an additional form of contraception during the first week after switching to a new pill to ensure reliability.

What happens if you forget to take the pill?

If you have forgotten to take the pill once, you should continue taking the remaining pills; however, there is no reliable contraceptive protection during the first two weeks, and you must use an additional method of contraception (e.g. a condom) during this time to prevent pregnancy.

How much does the pill cost in Austria?

In Austria, the cost of the pill is not covered by social insurance. Depending on the type of pill and the manufacturer, a pack of pills costs between four and 15 euros per month.