In a time of customized cappuccinos and "have it your way" burgers, it's no surprise that women now have a full menu of birth-control pill choices. In addition to the conventional 21/7 combination pills (21 days of an estrogen-progestin combo plus seven days of placebos resulting in monthly bleeding),there are now birth-control pills offering lighter periods, shorter periods, four-times-a-year periods and no periods at all.
There's one variety that's designed to end monthly bloating, moodiness and cramps and even clear up your zits. "Once a woman gets beyond the idea that she has to have monthly withdrawal bleeding, it opens up endless possibilities for (oral contraceptive) dosing regimens," says Dr. Pamela Deak, an obstetrician-gynecologist at the University of California San Diego Medical Center.
"There are lots of options today. Which pill an individual woman chooses to use depends on which one works for her and fits best into her lifestyle." Today, birth-control pills are used by more than 11.7 million American women, according to the Centers for Disease Control and Prevention, and considered one of the most effective reversible methods of birth control.
Combination pills, when used exactly as directed, have a 99.7 percent efficacy rate. First introduced in the 1960s, birth control pills meant a new sexual freedom for many women who had relied on the less effective barrier methods such as diaphragms and condoms to prevent pregnancy. Although the first pills with 50 micrograms of estrogen were much stronger than those prescribed today, the way the pill works remains the same. Birth-control pills enable a woman to maintain a consistent hormone level, which prevents ovulation or the release of an egg.
No egg means no possibility for fertilization and pregnancy. The pill also thickens cervical mucus so the sperm cannot reach the egg and makes the lining of the uterus unreceptive to the implantation of a fertilized egg. The original pill was designed in a 21/7 regimen to mimic the natural menstrual cycle. By creating a period every month, women felt comfortable using it. However, the monthly bleeding wasn't medically necessary. "The reason the pill was designed without one week of active (hormones) was to create a bleeding episode so women would know they weren't pregnant. That's what they were used to," says Dr. Elizabeth Silverman, an obstetrician-gynecologist at Scripps Memorial Hospital in San Diego.
"But, it's not necessary to shed lining every month on the pill, because you really don't build up much of a lining." A natural menstrual period happens two weeks after ovulation. The lining of the uterus, which had thickened to prepare for pregnancy, sheds because you're not pregnant. The bleeding women experience on the pill is not a real menstrual period, she explains. It occurs because of the withdrawal phase of the hormones or active pills. Because a "pill period" is not real menstruation, it can be manipulated by different dosing regimens. "Doctors have been extending dosing regimens long before the FDA approved it," Deak says.
"We've used it for patients who had severe pain with their cycles or patients with endometriosis and bad pelvic pain. Or sometimes just for convenience. If you didn't want a period on your vacation or your honeymoon, you could skip it." Contrary to what some people believe, less frequent periods aren't any heavier or painful. In fact, limiting bleeding to every few months may make them lighter, Deak says. And you can put to rest the worry that extended dosing pills will interfere with getting pregnant, if and when you're ready. "Women who have been on the extended pill seem to return to ovulation and fertility very quickly once they go off the pill," Deak says. If oral contraceptives are your birth-control method of choice and your current pill isn't working out for you, you've got options. Trial and error, along with your doctor's guidance, is the only way to know for sure which pill is for you. "On the right pill you should feel exactly the same as you do in your normal life. Maybe even a bit better," Silverman says.
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