Birth control pills. So many people take them, doing the best they can to be responsible in matters of health, safety, and family planning. But there are so many aspects of taking the pills, that it’s overwhelming sometimes: timing, drug interactions, effectiveness, storage instructions, and a myriad of other variables that can make knowledge of what to do very confusing. I have been taking BCP (Ortho Tri Cyclen) for about two years now, and, as someone who is absolutely hellbent of doing everything correctly as to avoid mishaps, have found my head constantly swirling with questions even my doctor and pharmacy couldn’t provide a 100% certain answer for without Google. So I did the research myself. And over these 2 years, I think I’ve made massive strides toward understanding how to use the pill, variables that determine its effectiveness, and how to achieve as close to that 99.9% “perfect use” level as possible while remaining a sane, imperfect human with a thousand other things on her mind. PLEASE NOTE: I am NOT a licensed health professional, so please always ask your healthcare physician about any of these topics. I am simply compiling all the research I have found online.
I’ll talk about three main topics in this post, which will hopefully answer all of your questions in one place, and help put your mind at ease. Please note, I am only discussing combined hormonal birth control pills, and there are so many other family planning options out there, so don’t be afraid to check those out too (the ring, patch, shot, implant, UID, NFP, condoms, etc.) The three topics I will cover (in exhaustive detail) will be: factors in bcp effectiveness, drug and food interactions, and timing/storage (logistics of use).
Variables in BCP effectiveness:
1) Weight: The hormones in birth control pills are only so strong. They used to be much stronger when pills first came out, but stronger hormones mean more health risks such as clots, heart issues, and weight gain. The amount of hormones has been decreased over the years, and now pills have quite low (yet effective) levels of hormones. Within the pill world, there are different levels of hormones (and the combined pill actually has 3: estrogen, progestrin, and androgen. You can check levels in your pill here:
Click to access Which+OCP+is+Best+Handout.pdf
) Also, if you wish to avoid hair loss associated with the pill, choose one with a low androgen level.
As far as all this is concerned, however, there have been some studies suggesting overweight women’s bodies need more hormones to prevent pregnancy, and could possibly be the reason some get pregnant even with perfect use. Here is a link : http://www.livescience.com/10743-birth-control-effectiveness-linked-weight.html
On the whole, however, normal doses in BCP tend to have you covered. If you are overweight, however, a low dose pill may not be the best option for you. Make sure to talk to your doctor about this.
Bottom line: if you are overweight, it’s possible that low-dose pills won’t be enough to ensure pregnancy prevention, though it would be rare. Talk to your doctor.
2) Timing of first week of active pills:
Although every site will tell you that your pills protect you at any time of the month, provided you have been taking them consistently, we all want to know if there still might be a time during which we are more likely to get pregnant. Though the pill works mainly by suppressing ovulation (no egg= nothing to fertilize= no baby) as well as thickening cervical mucus and thinning the uterine lining (making a possibly fertilized egg harder to implant), some women may still possibly ovulate on the pill. The biggest risk of this happening is starting a new pack late, and not being diligent in taking the first 7 active pills on time. While overall timing isn’t super important on the combined pill (it is very important in the progestrin only “mini pill”), making sure we take that first week of active pills ensures our body isn’t left for too long without hormones and thus allowing these new hormones to suppress ovulation again for the next month.
When looking at instructions for missed and late pills, pamphlets usually stress the importance of taking at least 7 active pills in a row to be fully protected, if we say, miss a pill. A more thorough list of instructions for missed/late pills can be found here: http://www.drugs.com/article/birthcontrolpill-missed.html
Bottom line: Always start your new pack on time, and just to be extra safe, take that first week of active pills at the same time.
Food and Drug Interactions:
1) Possible drug interactions: This stuff is always crucial to know. There are several groups of medications that can interfere with bcp: antibiotics, anti-seizure and migraine medications, anti-fungals, anti-anxiety meds, anti-depressants, HIV medications, respiratory meds, medications for diabetes, and even certain natural supplements like St. John’s Wort. Typing them all up here would be tedious, and this site has already done that for me: http://www.womenshealthmag.com/health/birth-control-drug-interactions.
Bottom line: Check with your doctor that other drugs you are taking won’t interfere with your bcp.
2) Food interactions and considerations: Didn’t think this had an effect? It’s quite possible what we eat and drink effects our medications, especially hormonal ones. Some of the oddballs include concerns with soy products and grapefruit. I stressed out about this stuff so much it was obscene. And I have the skinny right here for you, so you don’t have to spend hours of research time and tear your hair out:
- Soy products: Soy is widely debated for containing estrogen-like hormones, but is it really dangerous? Not unless you eat it at every meal, most likely. And the estrogen in soy is different than that in your bcp, so you’re fine there too : https://www.healthtap.com/user_questions/598235
- Grapefruit: This one haunted me forever. I love grapefruit! It’s refreshing and tasty. But when I read of a possible drug interaction with my bcp, I had to look into it. Luckily (unless you literally live off of grapefruit) there is good news. As found on WedMD forums, user georgiagail sheds some light on what the actual interaction is: “The enzyme in grapefruit can affect certain medications that would, under normal circumstances, be slowly absorbed into the blood stream. The resultant effect would be an increase (not decrease) in the amount of these meds in the body…the level of serum estrogen might be higher when consuming grapefruit/grapefruit juice and birth control pills. While this does not reduce the effectiveness of birth control pills (rather, the opposite) one might notice increased symptoms of things like breast tenderness.
So it actually makes the BC aspect stronger. On the other hand, consuming too much could heighten your risk of breast cancer (possibly), so try to not eat only grapefruit. For some useful links on this topic, check out the following: - http://forums.webmd.com/3/gynecology-exchange/forum/16999
- http://www.healthcentral.com/cholesterol/c/59/10342/grapefruit-juice/
- Bottom line: if you want to be EXTRA cautious, don’t consume grapefruit within 4 hours of taking your pill. But really, you’re fine.
Logistics of taking your pills:
1) Timing: All the time we hear: “Take your pill at the same time every day!” or “around the same time.” But what does that actually mean? Is it okay if I take it 5 minutes late? 5 hours? Will this make my pill less effective?
The overwhelming amount of research suggests in combined pills timing doesn’t make too much difference, up to 12 hours. After that, it’s considered “late” in most cases. The only exception is the mini pill, which needs to be taken at the same time. But even there, you have a 3 hour grace period before you need to use backup protection! So my rule? I take the first 7 pills in my pack at the same time (within 15 mins, because I am very anal about it), just to ensure ovulation suppression, but for the other pills, I use the 3 hour mini pill window, which is super strict, pill-wise. Planned Parenthood says that as long as you take it daily, you are protected. Even if you miss one, and take 2 the next day, you are still protected. That’s why it typically takes 2-3 days of placebos to start your withdrawal bleeding. So if you wanna sleep in, do it girl.
The main reason people suggest taking your pill at the same time daily? So you make it a habit and don’t forget! I think of it as associating it with a daily routine, say brushing your teeth in the morning. If you brush them at 6am one day, and 11 am the next, you will be okay, though. For additional resources regarding pill timing, check these out:
- http://plannedparenthood.tumblr.com/post/23827960518/timing-of-birth-control-pills
- http://www.womenshealthmag.com/health/birth-control-faq <= this site is brilliant for all pill FAQs
2) Storage: Here’s another weird variable I encountered on my trip to Europe over the summer. It was very hot, and my grandma’s apartment has no air conditioning. I read that keeping pills in the heat can render them useless, and freaked out! Is this true? And if so, what’s the correct storage option/environment to ensure efficacy? Here’s the deal: Don’t store them in humid, hot temperatures about 85 degrees Farenheight (ideally 80, but I was told by my doctor that synthetic estrogen used in pills is pretty hardy). Don’t store them in your car on a hot day. Probably don’t store them in the steamy bathroom either. I usually just keep mine on my nightstand, near my phone, so I don’t forget to take them. For more info on pill storage, check this out: http://advocatesaz.org/2012/07/03/keeping-medications-and-contraceptives-safe-through-the-summer/ , and http://www.nytimes.com/2011/08/16/health/16consumer.html?_r=0 .
Bottom line: Store them at room temperature, leaning to cool vs hot, in a dry place, out of the sun.
ALRIGHT. I really hope this post has helped answer some of your burning questions about bcp. As a person who always freaks out about everything, I understand the anxiety, after all we just want to do everything right, and that’s because we are responsible. These are the topics that were always on my mind, so I think there’s some good nuggets here. If you have any other questions regarding this topic, please feel free to contact me! Again, I am not a medical professional, so all this is just what I’ve been able to find through personal research online. Please always contact your doctor regarding medications, and best of luck in your health.
-V
As the World [R]evolves 