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Birth Control Pills : Are they really safe?

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Birth Control Pills to regulate periods

You can ask almost any woman out there, and she will agree – periods mean trouble! And we are not just talking about the pain and the discomfort. Unfortunately, periods do not work like clockwork. They could be early, late or you might even skip a cycle completely, for no apparent reason.

Every woman faces irregularity in her monthly cycles at least once during her reproductive life. 12 to 14% of women experience irregular periods often, while few suffer occasionally. With changing lifestyle and food habits, menstrual irregularities are on the rise in recent years.

The hormones secreted by the pituitary gland in the brain and those secreted by the ovaries play a key role in the functioning of a normal menstrual cycle. Disorder in the secretion of these hormones like FSH, LH, or TSH leads to a disturbance in the normal menstrual cycle.

Women can experience different types of menstrual disorders.

  • Irregular periods indicate either the complete absence of or infrequent periods. Medically, infrequent periods are known as oligomenorrhoea, in which, a woman has very few monthly cycles, just 6 to 8 times in a year. In oligomenorrhoea, periods can occur too late as per the expected date. The two consecutive periods are often more than 35 days apart, making family planning fairly difficult!
  • Complete absence of periods is known as amenorrhoea. Primary amenorrhoea is is said to occur when periods do not appear around the age of puberty i.e. 12-6 years of age. Secondary amenorrhoea is absence of periods for 3 to 6 months after otherwise regular monthly cycles occurring prior. Other than pregnancy, secondary amenorrhoea occurs due to several reasons like polycystic ovarian syndrome (PCOS), early menopause or a pituitary tumour.
  • Metrorrhagia is the diagnosis when periods occurtoo frequently at irregular intervals.
  • Polymenorrhea is when menstrual cycles occur unusually frequently and are less than 21 days apart while menorrhagia is heavy bleeding during menstrual period.
  • In dysmenorrhoea, the woman experiences painful bleeding with severe abdominal cramps.

Causes of irregular periods

Different causes responsible for irregular periods include:

  • Hormonal disorders like PCOS, thyroid disorders, Cushing’s syndrome, diabetes mellitus, etc.
  • Excessive exercises or extreme dieting
  • Extreme mental stress.
  • Hormonal medications like oral contraceptive pills, injections, implants, intrauterine devices, etc.
  • Fibroids
  • Medicines for epilepsy and mental disorders, etc.
  • Periods can be irregular at the time of first occurrence of periods and around menopause.

Treating irregular periods

Identifying and treating the underlying cause is the first line of treatment for irregular periods.

Menstrual disorders occurring due to irregularities in ovulation (amenorrhoea, infrequent periods and irregular periods) are commonly treated with oral contraceptive pill or birth control pills. Due to the hormone content in these pills, the pills regulate the balance of hormones in the body, thus helping to regularize your monthly cycle.

Two types of birth control pills are commonly used, the combined oral pill and the progesterone-only  pill or mini pill.

1. Combined pill or combined oral contraceptives (OC) contain both the female hormones i.e. oestrogen and progesterone.  It is to be taken every day for 21 days. Some strips of combined OC pills contain placebo pills that are taken in the last 7 days of a 28-day regime of medication. Period-like bleeding or withdrawal bleeding occurs during the pill-free period under the effect of the hormones in the pill. The combined pill helps in regulating irregular periods as it is easy to predict bleeding during the pill-free period, after taking it for 21 days.

However, thecombined OC pill is not advisable in certain conditions, as oestrogen in the combined OC pill can aggravate these disorders. According to WHO, the combined oral contraceptive pill should not be used in breastfeeding mothers, women with high blood pressure orsuffering from migraine, smokers, women having history of heart problems, stroke, liver disorders, blood clotting disorder, and for 4 to 6 weeks post-delivery. One of the serious adverse effects of the combined pill is the slightly increased risk of developing blood clots.

In such conditions, the progesterone pill or progestin-only pill can be used to regulate the periods.

2. The progestin-only pill is taken for 28 days, every day at the same time. There is no pill-free period like in the combined OC pill. Not only does the mini pill skip oestrogen, it also contains a lesser amount of progesterone than in the combined pill. Hence, it is safe for use by breastfeeding women, women undergoing major surgeries, etc. There are no complications of blood clotting disorders associated with the mini pill.

Many women experience unexpected spotting during the initial months after starting the mini pill. But, this typically resolves after 4 to 6 months of using the pill regularly.

Again, there are certain conditions where only progestin pill should be avoided. These include:

  • Breast cancer
  • Stroke and heart diseases
  • Cirrhosis and/or liver cancer
  • If you are on certain medication for epilepsy, tuberculosis (rifampicin) and anti-viral medicines

Research studies show that the combined OC pill is more effective in regulating periods as compared to the progestin-only pill. Apart from regulation of menstrual cycle, the birth control pills also have other benefits, such as decreasing cramps during periods, improvement of acne, and reduced risk for certain cancers.

Use of birth control pills for regulation of periods is usually safe. Some women, however, might experience a few side effects. Minor side effects that result from taking birth control pills include:

  1. Nausea
  2. Headache
  3. Tenderness in breast
  4. Dizziness
  5. Bloating in the abdomen, etc.

Gastric disturbances such as bloating of abdomen, nausea, etc. caused by combined oral pill result in discontinuation of the pill in a majority of women.

Menstrual periods follow a normal and regular pattern in a few months after stopping the birth control pill in many women who had taken them for regulating periods. However, they can go back to being irregular after a few months.

Is long-term use of birth control pill safe?

Apart from the concerned already mentioned, long-term use of birth-control pill does not cause specific health problems in healthy and non-smoking women. Taking birth pills also does not affect fertility in the long run.

However, some research studies show an increased risk of certain cancers like liver cancer, cervical cancer and breast cancer associated with birth control pills. It is also important to remember that like barrier methods of contraception (e.g. condoms), birth control pills are not effective in preventing sexually transmitted diseases, if you are sexually active while taking them.

Choosing appropriate birth control pills for regulating periods should depend on the health condition of the woman. It is best to consult a doctor before starting any medication. Remember that it might take a couple of cycles for your periods to start getting regular when you start taking the pills, so be patient!

Reference

https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/causes

https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/treatments

http://europepmc.org/articles/PMC3619033

https://www.uptodate.com/contents/progestin-only-pills-pops-for-contraception#H5

https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet

https://www.uptodate.com/contents/hormonal-methods-of-birth-control-beyond-the-basics?source=see_link#H17

https://www.uptodate.com/contents/absent-or-irregular-periods-beyond-the-basics#H1

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012071/

https://emedicine.medscape.com/article/257007-overview#a8

http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/Progestin-Only-OCs


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