How much do we all know about the pill?
Not much, it turns out—recent estimates are that one in five unplanned pregnancies could have been prevented if women taking the pill had understood how it worked. And up to a third of ladies think that the pill works by killing sperm (newsflash: it doesn’t).
I know that a lot of you will be pretty pill-savvy. But for the rest of us (myself included) our pill knowledge is a mishmash of half-truths, hearsay, and outdated science. The information leaflets that come with pills would seem like the best place to find out how the pill works, but often they’re written in medical gibberish that doesn’t make sense to anyone who just wants to know what to do if they’ve missed a pill.
Understanding how your pill works is really important. It means that you will be protected from unplanned pregnancies, and you can take advantage of some of the benefits, like managing painful periods, or skipping them completely.
How does the pill work?
I’m going to focus on the combined pill here, because that’s what about a third of women are on. The combined pill provides you with two hormones: estrogen and progestogen, and you take it daily. The hormones are given at a dose that tricks your body into thinking that it’s pregnant.
Tricking your body into thinking it’s pregnant isn’t as creepy as it sounds—back in the days before modern contraception, most of us would have seen out our fertile years with some bun or other in the oven. The estrogen and progestogen tell your body that it doesn’t have to release an egg from the ovary. Since no egg has been released, any sperm that venture up your uterus won’t have anything to fertilize.
In addition to keeping your eggs safe from wandering sperm, the pill makes the mucus that is released by your cervix thicker, so sperms can’t weasel their way past your cervix. It also makes the lining of your uterus thinner, so that any fertilized eggs have difficulty implanting. That’s kind of a back-up plan for when you miss a pill and your body has released an egg—but it’s by no means fail-proof, so make sure you take your pill like you’re supposed to, or take precautions if you’ve missed a pill.
How are you supposed to take your pill?
Glad you asked! You need to take the active pills for seven days in a row for it to work its magic. When you first start on the pill, you’re not safe for seven days, so you’ll need to keep using condoms, use other forms of contraception, or just go celibate for a week.
If you miss a pill (and who hasn’t!), then you can just take the pill when you remember if it’s less than 24 hours since you were supposed to have it. If you miss two or more pills, you’re not safe because your ovaries might have taken that dip in hormones as a sign that they need to release an egg. If you have had sexy times during that time, you might need to go get emergency contraception. If you don’t, you might be joining the illustrious ranks of my recently knocked-up sister.
Once you’ve realized that you’ve missed two or more pills, you’re going to need to use the seven day rule: Taking active pills for seven days. You need all seven days for them to build up in your system enough to start working. For those seven days, you’ll need to use alternative forms of contraception, or you can just have a glorious “not tonight dear” headache for a week.
You’ll also need to apply the seven-day rule if anything happens that means your pill may not have been absorbed properly (here’s looking at you diarrhea, vomiting and antibiotics!).
If the pill makes your body think it’s pregnant, why can you still get your period on it?
Most pills come with 21 days of active pills, and seven days of sugar pills. Those sugar pills are exactly what they sound like—they’re made of sugar. There’s no active ingredient in them at all. When you take them, your body withdraws from the hormone dosage it’s been on, and the bleeding you see is just that; a withdrawal from hormones.
Your doctor is likely to call this a “period” simply because it’s easier to describe it as that—but it is not a period. A “real” period is when you shed the lining of your uterus that your body has been faithfully preparing in the hopes that a baby is coming to town. When your body figures out that the egg you released this month hasn’t been fertilized, you get your period.
For the pill to be effective, you don’t need to take the sugar pills. Sugar pills were only introduced to the pill because when the pill was first introduced, drug developers were worried that not having a period would seem too unnatural to lady-folk. And nearly 50 years later, most women still think that they need to have their period every month when they’re on the pill. But this isn’t true. You can skip your sugar pills and not bother with the ‘pill period’. To do this, you just have to skip the sugar pills and go straight to the active pills on your new monthly pack.
How often can you skip your period?
The guidance on how often you can skip your period varies between countries, and often from doctor to doctor. This seems to be because there hasn’t been any decent research conducted in this area.
Where I live (New Zealand) the latest guidance is that you don’t have to have your “pill period” at all, a fact that makes me want to fist pump with glee. In the U.S. you’re usually told you can take up to six pill packets together, and in the U.K., it’s usually three.
Some ladies may find that they can get breakthrough bleeding if they skip their period too much, some feel that they are more bloated, and lucky beasts like me don’t notice a thing. And don’t worry yourself about the lining building up over the months you’re skipping the pill; the estrogen and progestogen work together to keep your womb wall thin. If you do have a long bout of breakthrough bleeding, the best plan of attack is to take sugar pills for a week, and then get back on to the active pills. It isn’t that different to how things would have been when you were pregnant for most of your life, and hence barely ever had a period. Like most things, you just need to figure out what works for you.
What are the pros and cons of skipping your period?
- You can bypass the downsides of having your period. If you have headaches that are triggered by sudden drops in hormone levels, then skipping your period could be for you. It’s also recommended for women with endometriosis, women with painful periods, and women whose periods cause mood swings or sad/angry/horrible times.
- You can skip your period for special occasions, like weekends away.
- You may be less likely to get pregnant—having more than seven days on the sugar pills is one of the most common reasons for the pill to fail. So if you take those sugar pills, only ever take seven, and then get back onto the active pills quick-smart.
- YOU DON’T HAVE TO HAVE YOUR PERIOD. Even if the perry fairy is kind to you and you float through your period on a womanly sea of calm and bliss, periods aren’t terribly fun, and pads and tampons are expensive.
- For the first couple of months, you can experience breakthrough bleeding. This usually gets less common over time as your body gets used to the new hormone regime.
- Not having withdrawal bleeds can make it a bit more tricky to tell if you’re pregnant. If you’re on the paranoid side and your period coming is a special “Hallelujah, I’m not pregnant!” moment each month, then you’ll probably want to take the sugar pills each month. And if you’re in the skipping periods club and you feel bloated, have tender breasts or any other pregnancy symptoms, put yourself out of your misery and get thee to a pregnancy test kit.
Want to know more about the pill?
Want to know how the pill affects your fertility? How it affects your risk for cancer? What it does to your weight? See this wonderful myths and misconceptions roundup here.
And if this has all been medical gibberish to you? Ask your doctor. Seriously: asking a couple of slightly awkward questions is totally better than a surprise pregnancy!
Do you have any health myths you’d like to see busted? Tweet us @litdarling