Hormonal contraceptive methods, such as the pill, work by taking oestrogen and progesterone, which are absorbed in different ways and at different times. These hormones prevent ovulation by blocking the secretion of gonadotropins that stimulate it.
They also act by altering the lining of the uterus to make it less suitable for the eventual implantation of a fertilised ovum. Meanwhile, they thicken the cervical mucus, creating a mechanical barrier that hinders the passage of sperm.
Which are the advantages of hormonal contraceptives?
Oral contraceptives offer several advantages. When used correctly, they are highly effective at preventing pregnancy, with a failure rate of less than 0.3% (Pearl Index). Furthermore, there is no need to worry about using them during intercourse, and you can be confident that your fertility will return quickly once you stop taking them.
These contraceptives can also have beneficial effects on women’s health. Some types can reduce the risk of ovarian and endometrial cancers, providing protection for years after use.
They can also help to prevent certain ovarian cysts, pelvic inflammatory diseases, and endometriosis. They can improve aesthetic issues related to hormonal imbalance, such as acne and excess hair growth, as well as gynaecological conditions like menstrual pain, premenstrual syndrome, heavy periods caused by fibroids and polycystic ovary syndrome.
Remember that the pill does not protect against sexually transmitted diseases – you need condoms for that!
How should the pill be taken?
Oral contraceptives usually come in packs of 21 or 28 pills. This is how they work:
- With packs of 21 pills, you take one pill every day for 21 days, starting on the first day of your period. Then you take a 7-day break, during which you will have your period.
- Packs of 28 pills contain 21 active pills and seven placebo pills (without an active ingredient). You take one pill each day without taking a break, thus maintaining continuity and avoiding the risk of forgetting.
Pills can be:
- Monophasic: all pills contain the same amount of oestrogen and progesterone.
- Biphasic or triphasic: the amount of oestrogen and progesterone in the pills varies depending on the phase of the cycle in which they are taken.
There is also a seasonal contraceptive pill consisting of 84 consecutive days of tablets containing the active ingredient levonorgestrel, followed by seven days of tablets containing ethinylestradiol. Unlike the seven placebo doses commonly used, this formulation allows for just four scheduled menstrual cycles per year.
What should you do before taking the contraceptive pill? Dispelling a myth
Rather than immediately relying on blood tests, a thorough evaluation by a doctor is necessary before taking the contraceptive pill. I have summarised the guidelines below to dispel some myths about laboratory investigations.
- Family history: your family’s medical history should be investigated. Your gynaecologist will ask whether any of your first-degree relatives (parents or siblings) have had a heart attack or stroke before the age of 45.
- Medical conditions: It is important to disclose any diseases for which the pill is contraindicated, such as migraine with aura, certain hormone-dependent cancers (e.g. breast or ovarian), epilepsy, or obesity. You should also inform your doctor if you have or have had cardiovascular or thrombotic problems during pregnancy.
- Age and habits: for example, the pill is not recommended for women over 35 who smoke.
- Blood pressure: measuring your blood pressure is essential, as it must not be high.
The guidelines indicate that it is not necessary to take specific blood tests to prevent thrombophilia (the risk of thrombosis) before taking the pill. However, it is important to identify any risk factors through medical history.
In summary, hormonal contraceptives are not recommended for people who have:
- frequent headaches
- who smoke more than 15 cigarettes a day
- a personal history of stroke, pulmonary embolism, or venous thrombosis
- hepatitis or liver tumors
- gallbladder problems
- chronic inflammatory bowel disease, as contraceptives can exacerbate these conditions
- breast or ovarian cancer
- a family history of thromboembolic episodes may also be a contraindication, in which case specific blood tests may be useful.
There are also other special conditions, such as epilepsy and obesity, that require the consultation of several specialists to find the best solution for the patient.
In addition, it is important to remember that the use of some medications, such as antibiotics or anti-epileptics, can interfere with the use of the pill to different degrees.
If you would like to learn more about the pill, what tests to do before taking it, its contraindications and the cycle-blocking pill, also read the second part of this post.
To request a medical consultation or simply to book a gynaecological examination you can contact me here or book online. As an obstetrician gynaecologist I receive my patients every week in my offices in Milan and Florence.
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