Everything you want to know about oral contraceptives, but were too scared to ask

Oral contraceptives are one of the greatest gifts of modern medicine. Housed in tiny birth control pills is the immeasurable boon of bodily autonomy, allowing women to conceive on their own terms – or not conceive at all. Over 139 million women and girls in India use modern methods of contraception. But birth control pills have a failure rate of just 6%, making them three times safer than condoms, according to a BBC article by economist Tim Harford. “When used perfectly, the failure rate drops to one twentieth of that.” That means fewer unplanned pregnancies, unsafe abortions and maternal deaths, not to mention astounding economic progress and sociopolitical clout.

Despite the obvious benefits, the much-touted side effects are probably uppermost in your mind. I was among the women who feared oral contraceptives. I’d heard it all. “I had so many side effects.” “You’ll gain so much weight!” “It gives you horrible acne, hair fall and mood swings.” These stories rattled me. As someone who already deals with many of these issues, I didn’t want to add fuel to a raging fire.

The experts I spoke to set about dismantling the fear factor surrounding oral contraceptives. Dr Nidhi Jha, fertility consultant, Southend Nova IVF Fertility, Delhi, explains that there are two types of contraceptive pills – steroidal and non-steroidal. You may have just shuddered after reading the word ‘steroid’ but they’re not as scary as they sound.

The steroidal pill is the most common, combined oral contraceptive. “Most oral contraceptives have a combination of two types of hormones like oestrogen and progestin (a form of progesterone). Both of these hormones may be naturally found in a woman’s body. There are different types of estrogens and progestins, that are given in combinations, but they all work in the same way,” adds Dr Pratima Thamke, consultant obstetrician and gynaecologist, Motherhood Hospital, Kharghar. The other less commonly prescribed one is the progesterone-only pill.

Jha explains that while they are preferred, there are conditions where steroidal pills cannot be prescribed. In those cases, there is another non-steroidal pill used, called centchroman (also known as ormeloxifene), like the Saheli contraceptive.

Steroidal pills require daily intake and “once the pill has been stopped, fertility may resume on an immediate basis,” adds Thamke. 

The best part about Saheli, according to Jha, is that you take it twice a week and when the system is established, after about 12 weeks, the person can continue with taking the tablet once a week.

How do oral contraceptives work, exactly?

The two hormones work in different ways. Jha says that these hormones alter every step of the body’s mechanism to stop conception and egg fertilisation, starting from the prevention of ovulation, making the cervical mucus thick, changing the contractions of the fallopian tubes and uterus, to changing the endometrial lining at every level, preventing implantation.

“Oestrogen releases one more hormone known as FSH (follicle-stimulating hormone) which causes ovulation to take place. Every cycle, one egg is released by the female. Oestrogen prevents the egg from forming and interferes with the contraction of the cervix,” says Jha.

There is a certain amount of contractions in our body that’s needed for the sperm to reach the egg – right from the cervix to the uterus and fallopian tubes. “So if this coordinated contraction doesn’t happen, the sperm will not meet the egg and there are fewer chances of fertilisation,” adds Jha.

Progesterone thickens the cervical mucus which hampers the movement of sperm. “Like a mattress for a bed, the uterus has an endometrial lining which supports a pregnancy. This lining is not properly able to form, because of the impact of progesterone.”

Which is the best pill for me?

The experts agree that oral contraceptives should be taken only with proper consultation and guidance by a professional. You must be honest with your medical history as well as your family history. Our pre-existing conditions and family history can determine which pill the doctor prescribes.

“Do not opt for combined contraceptive pills if you are a smoker and older than 35. Such women can take progestin-only pills (POPs or mini pills). Avoid combined contraceptive pills if you have breast cancer, heart attack, stroke, angina, diabetes, high blood pressure, and blood clots,” says Thamke. 

Combined and single hormone pills are the ones most commonly prescribed for good reason, explains Jha. They have higher efficacy and are highly researched.

Non-steroidal contraceptives, like Saheli and Chhaya, are considered ‘safer’ because they’re unlikely to have any side effects and not likely to interfere or negatively impact pre-existing conditions. “We generally keep non-steroidal contraceptives for patients who have severe side effects/contraindications like cardiac disease, hypertension, liver cirrhosis, and such,” says Jha.

For some people, oral contraceptives may not be an option at all due to their health history, which is why Jha reiterates the importance of an honest medical consultation with a specialist to find what works best for your needs and your body.

What about the side effects my friend keeps telling me about? 

This is a big one. When it comes to any oral medication, there are possibilities of side effects. And because of the nature of birth control pills, they can be very disruptive. “Side effects of oral contraceptives tend to vary based on the pill’s hormone levels and types, ” says Thamke.

These can include changes in bleeding pattern (very heavy or minimal bleeding), bloating, nausea, vomiting, tender breasts, acidity, and vaginal spotting. While some women have experienced varying degrees of side effects, others have none at all.

One of the most common side effects people cite is weight gain. Jha says this is mainly due to fluid retention. Many of the side effects are due to the oestrogen hormone.

“When I advise oral contraception, some girls come back to me saying ‘I have nausea, gastritis, I’m getting headaches’. These sensations might be there in the beginning, but they reduce gradually,” says Jha.

“We start with very high doses of oestrogen and progesterone, but we reduce it over a course of time. The recent, newer oral contraceptives have very low doses of the hormone. The hormones are just in the required doses to prevent pregnancy.”

Finding the right oral contraceptive for you can take some time and patience, but stick to it.

Do I need to use other methods of contraception if I’m also on birth control?

“Oral contraceptives will prevent unwanted pregnancies, but they will not protect you from any sexually transmitted diseases,” adds Jha, stressing the importance of barrier birth control methods as well. These include condoms, diaphragm, cervical caps and female condoms.

With condoms, dermatologist and venereologist, Dr Niveditha Manokaran says we must remember to change condoms between different sexual acts. “By using the same condoms, you tend to spread and transmit organisms between the sites and, in that way, spread infections,” she says.

These products create, well, a barrier between your genitals and prevent the transfer of STDs and STIs. The sex taboo has resulted in around 6% of the country’s adult population dealing with one or more STDs. That’s around 30-35 million cases every year, according to some studies.

Talking to your partner about STDs is rarely on anyone’s to-do list when getting into a new relationship. Bringing up sexual health with a prospective partner can get awkward — but considering STDs are spread through sexual contact involving bodily fluids like semen, vaginal fluids, sometimes even saliva and blood, it’s crucial.

Why am I being prescribed birth control for acne? 

While we know ‘The Pill’ as diminishing the possibility of us spawning, at the end of the day, it’s just a bunch of hormones in powder form. Hormones influence many aspects of our body and their daily functioning. In the case of a hormonal imbalance, what we know traditionally as birth control pills may be prescribed to treat a completely different ailment.

Thamke says don’t be surprised if you’re prescribed any of these pills to “regularise periods, mood swings, help with cramps, iron deficiency (anaemia), clear skin, prevent unwanted hair growth on the face and body, manage endometriosis symptoms, menstrual migraine, bone thinning and tackle ovarian cysts.”

Discuss your apprehensions with your doctor to better understand how this medication can help you, follow the guidelines and always share any side effects you may be experiencing.

A note of caution: This article includes expert inputs from trained medical professionals for educational purposes. Please consult your healthcare provider to discuss a treatment plan that is suited to your body and your needs.