Contraception 101 - The Pill

Eve Espey, MD [Faculty, OBGYN, University of New Mexico]: What we’re here to talk
about is the mix of contraceptives that are used in this country today and when people
think about birth control and I ask a patient uh, Do you use birth control?
They, they automatically assume that I’m talking about the pill. Uh, the pill is the
uh, most commonly- used method of contraception
uh, in this country. It was uh, developed in the 1960’s and it really revolutionized
the way uh, American women and women across the world were able to use contraception.
The standard method is a, It’s called a Twenty-one/Seven. So there are twenty-one
days of active pills and then seven days of placebo pills. Uh, there’s a period- uh,
a woman has a period on that regular regimen uh, every month. One of the problems with, with
this regimen is that most insurance companies only allow one month at a time to
be dispensed. So if you have a three-day window where you can get your next pack of
pills and you’re on vacation or you, you know, you forgot until it’s too late, the- the
pharmacy’s not open, that presents real problems with being able to comply, to, to
be able to take that, the regimen appropriately. There are some new methods
and I’m gonna talk about those. Now interestingly when I was reviewing these methods
uh, all of them have been licensed
approved by the FDA since 2000. So there, we really do have a lot of new- a- a lot of
new methods available, but the fact that there are so many methods really speaks to the
fact that there’s no perfect method. If there were a perfect, reversible method then that’s
what people would use and that would be the end of the story, but there’s not. There
are new extended dosing regimens. Uh, the trade
names are Seasonelle and Seasonique. These are uh, extended pill regimens where
there are eighty-four active pills and then either seven or four days of placebo. So when
you get a pack of Seasonelle, you get three months worth of pills and the way those
work is that you the, since the placebo pills aren’t until the end of that three months
of active pills, you don’t have a period except for
every season. So you have your winter period and your fall period and your spring period.
Uh, those, those methods do have some irregular bleeding up front uh, but
usually over time women only experience bleeding uh, during those, that that every
three-month uh, uh, time period when uh, the placebo pills are being taken. There are
generics uh, for Seasonelle. They’re called, Quasents and Jolessa. Uh, they are
really very similar to the standard birth control pill in terms of side effects uh,
and health benefits. The uh, the final type of pill,
the new pill is called, Librelle, and that is a, just
twenty-eight days of a, of active pills. So there’s no placebo. So if you took those,
if you took a, continuously took Librelle, a pack
every month, you would never have a period. So the, having a period is just an, sort of
an artifact of the way the pill was developed. You don’t have to have a period. You can
take pills continuously. Uh, Librelle has some
of the same problems that the standard pills have and that is that you only get one, one
month at a time. So one of the major benefits of the extended dose, Seasonelle and
Seasonique regimens, is that when you go to the pharmacy, you get three months of pills
and it turns out that that will probably help
women be more compliant cause they don’t run into those problems of running out of
pills at the end of the month and having to get a
new pack. So what, what are the health benefits of birth control pills? People have
negative feelings about birth control pills, but it’s important to know that there are
very few women for whom pills are not safe and
effective. Uh, there are a few medical conditions that some women have that make
them not good candidates for pills, but, but actually very few. The health benefits are
that women on pills tend to have a very regular cycle. They can predict when they are going
to have bleeding. They tend to have a much lighter period so not as many days of bleeding.
Uh, the bleeding is not as heavy. Uh, and they tend to have less cramping. So women
that have bad cramping, miss school or work uh, we often put those women on birth control
pills even if they don’t need contraception just because of those benefits of a regular
light cycle. Two major benefits of birth control pills and this, this covers all the extended
dose regimens as well, uh, are uh, a reduction in uterine and ovarian cancer. These, these
are really uh, underappreciated benefits of pills; that women who take birth
control pills long-term, long-term have a much lower risk of ovarian cancer and uterine
cancer than non-users and finally, less acne. And, of course, when I talk to patients you
know, the younger ones I talk to about acne and the older ones I talk to about
cancer, you know, they’re, they’re uh, everybody’s got their benefit. Uh, in terms
of side effects, the most common side effects are what, what we as as medical practitioners
call nuisance side effects. Uh, they’re hormonal side effects like bloating, headache
uh, breast tenderness, nausea and they tend to go away after a month or so of of pill
usage. Some woman are plagued by those longer term uh, but those are the major reasons
that women stop birth control pills;
that and just the fact that as it turns out human behavior is such that it is very difficult
to take a pill every day. Uh, and that’s one of the
biggest problems with the pill and some of these other methods that I’m going to talk
about that require an active motivation every day, every week, even every month. It’s just
too often for I’m gonna say women because that’s who uses these but really
for all uh, individuals to, to, to take pills on a
regular basis turns out we’re not very good at that. So the biggest problem with all these
is is adherence, is being able to take that pill every day uh, and the problem that you
can quit without doing anything. We would prefer a method where you have to do
something in order to quit, because then you’re more likely to be able to get on another
method if you want to continue to uh, prevent pregnancy. So we say that the perfect use,
if women used pills perfectly, that the failure rate would be less than one percent, but I
never even use that number when I counsel uh, patients because the real number is eight
percent and, of course, there’s a huge range because it’s so dependent on on whether
you take that pill or not. Some women are gonna have an eight percent failure rate.
Some women are gonna have a fifty percent failure rate. It all depends on your ability
to remember to take the pill and then to be able
to get the pill, to afford it uh, to get to the
pharmacy to actually take it. How much do they cost? Uh, generic pills are uh, you can
get them now for as ch, as cheap as eight dollars. There are several pharmacies that
have an eight-dollar program. That’s been extremely helpful for my patients and the,
two fifty dollars for a brand-name drug. And the,
you know, what’s the biggest birth control pill that’s that’s uh, used today? It’s it’s
Yaz, because it’s very heavily marketed. That’s a fifty-dollar-a-month pill. Uh, so
there’s a big range in price.