Fairfield-Echo.com

I'd like to use the pill for contraception, but I'm worried. Are they safe?

Birth control pills can be used safely by most women and can even provide health benefits other than pregnancy prevention. The most serious side effect of the pill continues to be an increased risk of cardiovascular disease in certain groups, such as women who smoke, women over age 35, obese women and those with a history of high blood pressure, diabetes or elevated cholesterol levels.

I've heard that birth control pills "trick" the body into thinking it is pregnant. What does that mean?

The most widely used birth control pill is composed of estrogen and progestin, the two key hormones of pregnancy. A pregnant woman's placenta produces high amounts of both these chemical messengers, sending the body a signal to stop ovulating. After all, if the woman is already pregnant, why is there a need for another egg? This same signal is sent when a woman takes birth control pills because the levels of estrogen and progestin are constant--remember, it is the peak in estrogen that causes ovulation. The pill works by suppressing follicle-stimulating hormone, which rises in response to low estrogen at the end of the cycle. When a woman is through with her three weeks of active pills, the hormones drop as they would naturally and she begins her period.

My health care professional gave me the mini-pill as I was leaving the hospital with my newborn, and said to start right away. I thought I had to wait six weeks after giving birth.

Confusion over this is understandable, because health care professionals don't all agree about when breastfeeding women should start taking progestin-only pills (POP), or the "mini-pill." Although the World Health Organization and the International Planned Parenthood Federation advise women to start at six weeks postpartum, the National Medical Committee of the Planned Parenthood Federation of America and numerous US hospitals advise breastfeeding women to begin using POPs as soon as they get home from the hospital. Why the difference of opinion? A lactating woman whose baby's sole nutrition is from breast milk won't ovulate in those first six weeks. Many women discontinue full breastfeeding within the first six weeks, which means they can ovulate six weeks postpartum. Because many women don't return to their health care professional at this time, they wouldn't be able to get a prescription for birth control when they need it.

I've been using birth control pills for several years. Do I need to stop for a while and give my body a break?

Because the hormones in pills don't build up in the body, there's no need to take a break from using them. There are also many health benefits that would end if you discontinue taking the pills.

When do missed pills matter the most?

The pills you have to worry most about missing are the ones right before and right after those seven placebo pills in your pack. Known as the pill-free interval, the placebos are designed to be taken the week you have your period to help you stay in the rhythm of taking a pill every day. If you start a new pack late or take longer that seven days "pill free," you might ovulate and could become pregnant. Read the package insert that came with your pills; it will explain what to do about missed pills. In general, if you miss a pill, take it as soon as you remember. If you miss two pills, double up the next two days and use a back-up contraception method for the rest of the pack. If you miss pills in the third week, skip the hormone-free interval and continue with three more weeks of active pills from a new pack.

How do emergency contraceptive pills work? Do they cause an abortion?

Scientists still aren't completely sure how emergency contraceptive pills (ECPs) can help prevent pregnancies. They may prevent ovulation just as regular birth control pills would if they are taken early in a woman's cycle. If ovulation has already occurred, they may interfere with fertilization of an egg or the implantation of a fertilized egg in the uterus. ECPs won't work if implantation has already taken place, which is why it's important to take them within 72 hours of unprotected sex. That is also the reason ECPs are not considered an abortion; they have no effect on a pregnancy already established.

I'm 48 and getting close to menopause. Can I still use the pill?

Low-dose birth control pills (those with 20 mcg of estrogen) are a good option for the years just prior to menopause - called the menopause transition or "perimenopause," as long as you do not smoke, according to the American Academy of Family Physicians (AAFP). The AAFP recommends low-dose pills for women approaching menopause not only because the lower dose of estrogen in these pills is believed to be safer, but also because of the health benefits. Irregular or heavy periods can be common during perimenopause, and pills can help regulate them. Low-dose birth control pills also may prevent bone loss, potentially providing protection from bone disease.

Are chronic headaches a reason NOT to take birth control pills?

Not necessarily. Migraine headaches are the type of headaches that cause health care professionals the most concern when it comes to using BCPs, and even then only if the patient has migraine with "aura"—a type of migraine that causes visual disturbances. Some women find their migraines improve once they start on birth control pills, especially if those migraines precede their menses. But studies have shown that pill users with a history of migraine headaches are two to four times more likely to have a stroke than nonusers with a history of migraines.

A friend of mine got pregnant while using the pill, and she said it was because she was taking antibiotics. What's the deal?

Often, the blame for contraceptive failure is placed on a short stint of antibiotic use. Anecdotal reports abound regarding the reduction in pill effectiveness caused by antibiotics such as ampicillin and tetracycline and some studies find lower levels of estradiol (a form of estrogen) in the blood of women taking these antibiotics, but no studies have been able to prove these claims. Studies are clear, however, regarding drug interactions between birth control pills and some other medications, such as anti-seizure medications and drugs used to treat tuberculosis. Ask your health care professional or pharmacist about possible drug interactions that may alter the effectiveness of either your BCPs or another medication you are taking or are prescribed.

I've heard that it's possible to skip the placebo pills and start a new pill pack right away. Is that true?

Yes, there are several reasons to consider skipping the pill-free interval. You could actually skip the placebos twice and take a total of 63 active pills (three packs with 21 days each of active monophasic pills) for these reasons:

• headaches including nonfocal migraine, menstrual migraine and other bothersome side effects, if they occur during the pill-free interval

• unacceptably heavy or painful periods

• severe premenstrual side effects including depression

• use of seizure or tuberculosis medications that lower pill effectiveness

• endometriosis

• convenience (for example, if you want to avoid having a period during vacation)