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Perfect use versus 'Typical Use'
We've all heard about how using hormonal contracpetive methods is the guaranteed way to avoid any unwanted pregnancies, especially in comparison to relying solely on barrier methods such as condoms. While it is true that hormonal methods, on average, provide greater protection than anything else (aside from abstinence), that doesn't mean that there's no responsibility on you to put effort into utilizing your method of choice correctly. Similar to leaving no reservoir-tip with condoms or double-bagging it, there are many ways in which user error can decreas the effectiveness of hormonal contraception.
Typical use means how well the method works when real people in real life use it, occasionally taking a pill or two late, if not missing a pill entirely For IUD's, that could mean when the expulsion of the IUD goes unnoticed by the user.
Perfect use means how well the method works when it's used in a clinical trial. Since life isn't a clinical trial, it's up to you how much effort you're willing to put in towards paying closer attention to typical use numbers. If your birth control of choice has a lower typical use rate, you can get closer to the perfect use number by learning to use your method correctly and consistently.
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Weight gain
I know from my own personal experience before having gone on birth control that one of the main fears many girls having before taking the jump into using hormonal contraceptives is weight gain. That it’ll make you feel like a whale, uncomfortably bloated, etc.. Thankfully though, that’s for the most part nothing but a myth.
With birth control pills, they did have very high levels of estrogen and progestin when they were first sold in the 1960’s, the former of which can cause weight gain due to increased appetite and/or fluid retention. When birth control pills were first sold in the early 1960s, they had very high levels of estrogen and progestin.
Nowadays birth control pills have much lower dosages of hormones on average, so weight gain is a rare occurrence. A review of 44 studies showed no evidence that birth control pills caused weight gain. And, as with other possible side effects of the pill, any weight gain that does occur is generally minimal and will go away within 2 to 3 months.
Symptoms (3 month trial period)
We’ve also all heard about the dreaded negative side effects which many experience when they first start using hormonal methods, be it weight gain, moodiness, nausea, etc.. However, let’s not forget that you are putting a regular dosage of additional hormones into your body, so it will as expected, need a bit of an adjustment period.
Doctors and nurses generally recommend that most stick with whichever method they try, be it an IUD or pill, to stick with it for a 3-month trial period. During this time frame, most negative side effects generally resolve themselves. Until then, it’s perfectly fine to use other medications such as Tylenol or some over-the-counter anti-nausea pills to alleviate symptoms.
Combination hormonal birth control pills that contain a type of progestin called desogestrel increase the risk of blood clots more than birth control pills that contain other types of progestin. The progestin called drospirenone (found in second-generation pills such as YAZ or Yasmin) also might have a greater risk of blood clots than other types of progestin. Though again, keep in mind that the risk of getting deep vein thrombosis (blood clot in your leg) or a pulmonary embolism (blood clot in your lungs) is higher when you’re pregnant than when otherwise healthy, non-pregnant and taking a combination pill.
It is not recommended to be on the combination pill if over 35 and a smoker, as both of these will put you more at risk.
Though not many people use the patch, your risk of getting a blood clot is actually higher by use of the patch than the combination pill.
The known risk factors for blood clots (DVT or PE) include:
· Pregnancy and the first 6 weeks after delivery.
· Personal or family history of blood clots.
· Obesity.
· Surgery.
· Coagulation disorders, such as factor V Leiden mutation.
· Inactivity, such as during long distance travel in cars or airplanes.
Interactions that result in ↓ effectiveness
Though, with perfect usage of the pill and other hormonal methods of contraception, you’ll be given 99% protection, 90% effectiveness with ‘typical use’. However, there are certain other medications which will reduce the protection provided. Thankfully, the only antibiotic that has been shown to interfere is Rifadin (or the generic version, Rifampin). This antibiotic is used to treat things such as tuberculosis.
Pills taken to prevent seizures such as Luminal or Topamax have been found to increase the metabolism of hormonal pills. Though this doesn’t necessarily mean that their effectiveness will be negatively affected, I’d say that it’s best to stay safe and use a secondary method of contraception such as a condom.
Additional things that are suspected to interfere with the effectiveness of birth control pills are things like St. John’s Wort, used to treat depression and sleep disorders. Secondary methods of protection should be used anytime these utilized.
STI’s
It’s perfectly fine to use hormonal methods as your primary and only form of contraception granted that you have sex with only one partner. If you’re sleeping with multiple partners, it’s best to use a condom as the pill/IUD/shot or patch alone offer zero protection against STI’s.
Combo time flexibility versus progestin
If you’ve decided that use of a birth control pill is your preferred method of hormonal contraception, you’ll have to decide which type of pill you’d prefer to go on. You can go with a combination pill, or pill with both progestin and estrogen that prevents pregnancy by not only suppressing ovulation, but also changing the cervical mucus and making it less hospitable to sperm. Another option would be the progestin-only pill, which is effective at preventing pregnancy only by suppressing the release of an egg at ovulation on a monthly basis.
One could argue that combination pills carry a greater risk to your well-being with the whole increased risk of blood clots. Though this may be true and not present as a risk in progestin-only pills, there’s a variance in the time frame in which both can be taken.
Meaning with the combination pill, you should make an effort to take the pill each day at the same time. However, you can miss this time by up to 12 hours before it is counted as ‘late’. With a progestin-only pill, you’ll have to stick to the schedule a bit more strictly. With POPs, you’ll only have a leeway of up to 3 hours before it is counted as ‘late’.
Perfect use versus regular use
Can you cut your sugar-pill week short or extend it a bit?
The ’21 pills straight’ rule was one thing that can help answer many questions many may have if they choose to use birth control pills as opposed to an IUD or the shot.
Are you able to have unprotected sex during your sugar pill week, and still be worry-free in terms of getting pregnant?
Yes. So long as you’ve taken a minimum of 21 consecutive pills, all on time, you’ll have enough hormones built-up in your system to provide protection for no longer than 7 days. Each one of your active pills, assuming it’s a 28-pack, will have a small surplus of hormones in it for this very reason.
Bleeding, continue to take
What if the bleeding from your sugar pill week hasn’t stopped, even if you’re starting your active pills back up today? Do you wait till there’s no more blood before you resume?
No. This is why it’s a good idea to take the sugar-pills, even though they have no hormones and so play no role in any actual protection from pregnancy. In accordance with the ’21 day straight’ rule, it doesn’t matter if you’re still bleeding. You can be without active pills for no longer than 7 days before their effectiveness wears off. It’s crucial to stay on schedule if you don’t want to fall pregnant.
Begin taking your active pills at the end of your sugar-pill week, even if you're still bleeding.
What if the bleeding from your sugar pill week hasn’t stopped, even if you’re starting your active pills back up today? Do you wait till there’s no more blood before you resume?
No. This is why it’s a good idea to take the sugar-pills, even though they have no hormones and so play no role in any actual protection from pregnancy. In accordance with the ’21 day straight’ rule, it doesn’t matter if you’re still bleeding. You can be without active pills for no longer than 7 days before their effectiveness wears off. It’s crucial to stay on schedule if you don’t want to fall pregnant.
Missed One Pill (…or more)?
Missed pills (even one, but especially more than one, and extra especially in the first week of a pack) can allow your hormone levels to change enough for ovulation to occur at any time in the month. Take your missed pill as soon as you remember (even if that means taking two pills in one day)
Emergency contraception's interactions with hormonal methods.
You must use a backup method of birth control until you have taken seven consecutive days of birth control pills or seven days use of the ring, patch or Depo-Provera following your use of emergency contraception. Emergency contraception is a huge shot of hormones to your system all at once, and perfectly capable of throwing your cycle off, including the suppression of ovulation.
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