Side effects of birth control pills: be careful with sex hormones

In families where regular sex life is the norm, partners often choose a reliable and convenient option as a means of contraception - taking hormonal oral contraceptives. But birth control pills have more than just benefits. Side effects of oral contraceptives can significantly worsen your health.

Are you taking COCs? OK or not OK?

The content of the article

One form of hormonal contraception is combined oral contraceptives. These drugs are based on the action of two sex hormones at once - estrogen and progestin (gestagen), which control the most important periods in a woman’s life. At a certain concentration, girls begin puberty, ovulation occurs—the body prepares for pregnancy, and, finally, pregnancy itself. These same hormones can be made to work in reverse, preventing unwanted pregnancies.

The principle of action of hormonal contraceptives COCs includes a number of effects. Tablets containing estrogen and gestagen, when taken correctly and in dosage, guarantee:

• Lack of ovulation .
  The egg does not mature or enters the fallopian tube defective and incapable of conception.
• Thickening of mucus in the cervical canal of the uterus
  . This makes it difficult for sperm to reach the egg.
• Decreased sperm activity
  , for which an excess of these hormones is harmful.
• Thinning of the uterine lining
  into which the egg is implanted during normal pregnancy. An insufficiently thick layer of the endometrium will in any case lead to the death of the egg, even if it is miraculously fertilized.

If there are no contraindications and the rules described in the manufacturer’s instructions are followed, taking birth control pills protects against unwanted pregnancy by almost 100%. If side effects, violations of intake, or neglect of contraindications occur, the result can be reduced by 50%.

Introducing: hormonal contraceptives

What are the requirements for contraceptive pills for women? The main goal is direct prescription and minimizing the risk of pregnancy, up to 99%. Naturally, the drug must be safe for the entire female body, including the reproductive system. Availability is also an important factor. Most modern hormonal drugs fulfill similar requirements.

In Europe, about half of all women of reproductive age use hormonal contraception. In Russia, the figures are much lower and amount to 10-15% of women, in large cities about 35%2.

However, cases of pregnancy while taking contraceptive pills do occur. The main reasons are associated with improper use of drugs or neglect of instructions for use:

• missed doses or expired medication;
• combination with medications that reduce the contraceptive effect;
• inability to absorb the drug, for example, in case of poisoning and vomiting;
• irrational choice of oral contraceptives (contraceptive pills may have different schemes and methods of action).

If an unwanted pregnancy occurs, then taking oral contraceptives (OCs) should be stopped. Not all, but some drugs can have a negative effect on the fetus from the first days of life.

Why oral contraceptives are not suitable for everyone

First, you need to understand what is going on in the female body, namely the hormonal background. Each woman has her own and depends on many factors. The concentration of hormones is influenced by: age, weight, number of pregnancies, abortions and births, the presence of chronic diseases associated with the thyroid and pancreas, pituitary gland and adrenal glands, regularity of intimate relationships and other factors.

Therefore, each patient needs its own composition. which is almost impossible to implement in practice. Of course, there are average standards - they are used as the basis for different drugs. Combined contraceptives may contain different hormone components, their weight and concentration vary.

For example, the mini-pill contains only progestin. The first generations of combined tablets contain large dosages of both types of hormones. If you prescribe such a “bouquet” to a young, nulliparous, fragile girl, then the side effects of oral contraceptives are guaranteed. And for a 30-year-old woman, this composition can be of great benefit, protecting her from pregnancy and disorders and tumors caused by hormonal imbalances.

To choose the right hormonal contraceptives, it is not enough to know the composition of the contraceptives. The instructions only tell you about contraindications and warn about side effects, without giving recommendations for use. A gynecologist can choose the right contraceptive drug, and only after receiving the results of tests for sex hormones.

Groups of contraceptives for women

The pharmacological market currently offers a wide range of drugs to prevent pregnancy. All of them are divided into the following groups:

1. Combined oral contraceptives are based on hormones similar to the action of estrogens, these are progestogen and ethinyl estradiol. There are two-, three- and monophasic drugs.
2. ​Mini-drink. Contains exclusively progestogen. The principle of action is a local effect on the peripheral zones of the reproductive organs. As a result of taking such drugs, there is a change in the biochemical and morphological parameters of the endometrium, so the development of the fertilized egg does not occur. In most women, the ovulation process is suppressed. Effective representatives: Microlut, Laktinet, Exluton, Charozetta.

COCs are divided into 3 groups based on the active substance content in the tablets:

1. ​Monophasic - contain a low level of hormones. Therefore, they are recommended for use by young girls who have not given birth before. And for people who are encountering contraceptives for the first time, such medications will be the most suitable.
2. ​Biphasic - prescribed to young and middle-aged women, especially relevant in the postpartum period. These pills should be taken by those who experience discharge while taking microdosed contraceptives. These drugs have an antiandrogenic effect, therefore they have a positive effect on the skin and prevent unwanted hair growth. These include: Regulon, Marvelon, Siluet.
3. Triphasic - characterized by a high content of female hormones. They are prescribed for some gynecological diseases and to restore hormonal levels. Representatives: Trikvilar, Ovidon, Trizeston.

Side effects when taking a hormonal drug: dangerous and safe contraception

Many women are afraid to take such medications, having read horror stories about the side effects. But before drawing conclusions, you need to understand what the concept of “side effect” means and what can be expected if any are described in the instructions for the drug.

The first thing you need to know is that side effects are described for any medicine, but their mention does not mean that such effects occur in absolutely everyone who starts taking the pills. And even if they exist, they are not in the full spectrum. Statistics show that side effects really bother no more than 10% of patients. And again, each person has no more than 1-2 types of violations.

Side effects of oral contraceptives can again be absolutely safe or, on the contrary, lead to serious changes in the body. All side effects are divided into:

• Short-term
  - such problems are inevitable, they are associated with addiction to the hormonal drug. This may include: breast swelling, nausea, etc. In just a couple of weeks, not a trace remains of them.
• Warnings
  - you need to pay attention to them. These are any, even the mildest, side effects that do not go away within 2 months, bleeding between critical days, abdominal pain, changes in the shape and volume of the abdomen, significant changes in weight and sexual behavior. With such symptoms you need to go to a gynecologist.
• Dangerous side effects of birth control pills require abandoning this method of contraception. This includes all types of severe complications associated with changes in the composition and properties of the blood, for example, increased sugar, sudden changes in blood pressure, deterioration of vision, poor health, etc., affecting a woman’s life.

Usually, if contraception is prescribed by a doctor, only short-term side effects occur, because the gynecologist takes into account and clarifies all possible contraindications in advance. When you take hormonal medications on your own, you can expect anything, so you need to monitor your health especially carefully.

Mini-pills - progestin tablets

Mini-pills or, as they are otherwise called, “minimal pills,” are drugs containing a minimal amount of a synthetic substitute for the female sex hormone progestin (gestagen). Hormones belonging to this class are produced in the ovaries and other organs and are designed to support conception and pregnancy. In total, mini-pills can include 2 types of synthetic gestagens - linestrenol or desogestrel. The hormone content in “minimal pills” varies from 300 to 500 mcg.

In terms of their functionality, mini-pills can replace combined oral contraceptives - their effectiveness is 95%. Such contraceptives are prescribed to women who, for a number of reasons, cannot take hormonal pills with normal concentrations of hormones. Although progestin-only drugs (mini-pills) are less effective than classic hormonal contraceptives, they are still popular due to their gentle effect on the body. The group of progestin contraceptives includes: Mikronor, Ovret, Charozetta, Primolut-Nor, Exluton, Continuin.

Many women ask their gynecologist how mini-pills differ from combined contraceptive pills and what is the reason for their reduced activity. The difference is in the mechanism of action. Mini-pills realize their contraceptive effect by changing the consistency of mucus in the cervix. It becomes thick and prevents sperm from entering the uterus. If at least one of them managed to get to the egg, another action of the mini-pill appears. The fertilized egg cannot attach to the walls of the uterus. Combination pregnancy pills suppress ovulation.

How to take the mini-pill correctly

The effectiveness of any drug directly depends on the correct method of its use. The mini-pill must be taken every day and at approximately the same time. It turns out that you need to take 365 tablets per year without breaks, regardless of menstruation.

If for some reason it was not possible to take the pill on time, you need to do it as soon as possible. If vomiting begins after taking the drug, therefore the drug does not start to work, a new tablet will need to be taken the next day. In this case, you will additionally have to use other methods of protection for 2-3 days.

The most optimal time period for taking the pill is 18-19 hours. The contraceptive effect reaches its maximum 3-4 hours after using the drug. In general, most sexual intercourse occurs late in the evening or at night. It is at this time that the mini-pills will work best. But this fact does not mean that during the day they will be ineffective. The birth control pill lasts for a day and will perform its functions in any case.

Mild side effects of birth control pills due to addiction

Oral contraceptives may cause mild discomfort:

• Nausea, panting in the lower abdomen, diarrhea
  - these symptoms disappear after about a month, with the start of the second cycle of taking birth control pills. If symptoms persist, this indicates that hormone levels are too high and other medications are needed. To easily survive the adaptation period, take a tablet from the blister at night - by the morning everything in the body will settle down.
• Breast tenderness
  – mild breast pain and tenderness may occur. A cotton support bra will reduce discomfort. If engorgement manifests itself unevenly, enlargement of individual lobes, pellets are felt, discharge from the nipples is observed, or swelling of the breast lasts throughout the entire cycle, you should urgently consult a gynecologist and have an ultrasound of the mammary glands.
• Menstruation failure
  . Associated with changing the cycle and bringing it back to normal. Within a couple of months, menstruation should begin every day.
• Bloody discharge between periods
  - light spotting that quickly disappears is considered normal. Discharge of an unusual color, foamy or lasting more than 3 days is a signal that you should immediately consult a doctor.
• Mood swings
  – oral contraceptives may worsen existing depression. Normally, this process should not exceed the normal period of PMS. If moodiness, depressed mood, etc. last longer than a week, most likely these hormonal medications will have to be replaced.
• Discomfort from lenses
  - some women need to pay special attention to this symptom. This is not a reason to change pills, as this will not work. You will either have to get used to it, or replace the lenses with glasses, or give up oral hormones in favor of installing an intrauterine device.
• Increased skin oiliness, acne
  . These are temporary troubles; they go away on their own after a couple of months.
• Libido changes .
  The effect is also temporary.
• Dryness in the vagina
  . This disorder can be not only a side effect, but a symptom of thrush and other STIs, therefore, it is better to visit a gynecologist and take a smear to check the cleanliness of the vagina.

If the side effects cause significant discomfort, you should consider replacing birth control pills with another contraception.

Pros and cons of taking mini pills

There are no ideal contraceptives, they all have both pros and cons.

Benefits of the mini drink

• Quick effect - when taken regularly, the tablets begin to act within 3-4 hours.
• No side effects and a mild effect on the body as a whole. Even in nursing women, lactation does not decrease and the taste of milk does not change.
• Do not affect blood clotting.
• Regular use allows you to feel protected at any time. There is no need to take the pill immediately before sexual intercourse.
• Mini-drinks do not reduce libido, do not increase emotionality, and do not stimulate nervousness.
• Progestin-only birth control may be used before surgery.
• After stopping taking the mini-pill, the ability to conceive is restored within a month.
• Menstruation passes without severe pain.

Disadvantages of progestin contraceptives:

• A slight weight gain is possible.
• Taking your pills daily requires punctuality.
• The effectiveness of the mini-pill is slightly lower than that of combined oral contraceptives.
• Not suitable for all women.
• They do not have a pronounced therapeutic effect, while combined contraceptives are prescribed both for prophylactic purposes and as medications.

Side effects and contraindications

Possible side effects (occurs in 1-7% of women)::

• Chronic thrush is getting worse.
• The menstrual cycle changes.
• The sensitivity of the mammary glands increases.
• The skin's sensitivity to ultraviolet radiation increases; sunbathing is undesirable.

Mini-pills are contraindicated for use if a woman has:

• Epilepsy.
• Bleeding of unknown origin.
• Malignant tumors.
• Hepatitis.
• Kidney pathologies.

While taking the mini-drink, you should contact your doctor immediately if you notice signs such as:

• A long delay in menstruation is a possible pregnancy.
• Bleeding, heavy menstruation (hygiene products are changed every hour) - hormonal imbalance.
• Pain in the pelvic area (a sign of ectopic pregnancy).

If conception occurs as a result of violation of the frequency of taking the drug, then you need to stop taking the mini-pill. If you decide to leave the pregnancy, then no problems will arise - such pills do not affect the formation of the fetus.

Side effects that should alert you

The following side effects should not be ignored in any case:

• Menstrual irregularities, bleeding, spotting, recurring after 2 cycles of taking the pills.
• Headache that does not go away on its own without analgesics.
• Primary or chronic thrush.
• Swelling of the legs, faces, indicating metabolic and kidney problems.
• Permanent decrease in libido.
• Hair loss.

These symptoms indicate an excess of sex hormones, so these pills need to be replaced.

Can you trust hormonal contraception?

The content of the article

Many women think that birth control pills are a new invention, so they don’t trust them. In fact, people first started talking about hormonal contraception 100 years ago at the beginning of the 20th century. The first experiments on hormones were carried out by the Austrian doctor Haberland. Due to this, artificial female sex hormones progesterone and estrogen were obtained already in the 30s of the last century. And in 1960, the American Pincus created the first hormonal contraceptive pill, it was called “Enovid”.

The first drug contained huge doses of hormones and was not reliable, so development of “pills for getting pregnant” continued. As a result, the dosages of hormones were reduced, the proportions were worked out, and the reliability of contraceptives increased. Now hormonal contraception is the most reliable method of preventing unwanted pregnancy - its effectiveness reaches 99.9%.

In addition to protection, many drugs have a therapeutic effect, restoring hormonal balance. Therefore, gynecologists prescribe them for many diseases of the female genital area and for severe metabolic disorders. Properly selected hormonal drugs significantly improve a woman’s appearance - oily skin and hair go away, pimples and blackheads disappear.

When are birth control pills contraindicated?

When prescribing birth control pills, the gynecologist must take into account contraindications. Since hormones regulate many processes in the body, taking oral contraceptives may strengthen or weaken some of them.

In this case, the following may occur:

• Acute chest pain.
• Dyspnea.
• High blood pressure (BP).
• Blood clots.
• Depression.
• Headache - migraine.
• Itching of the skin, genitals.
• Hearing and vision impairments.

At risk are women approaching the age of forty, smokers, and those suffering from chronic diseases of the kidneys, liver, and thyroid gland. Long-term use of COCs without replacement can also cause health problems.

Diagnosis before selecting contraceptives

The patient’s complaints about changes in health status become indications for a full diagnosis. In addition to general laboratory tests, the gynecologist prescribes a study on blood biochemistry and hormonal composition of the blood, determination of hemostasis (blood formation), and also proceeds to instrumental diagnostics:

• Ultrasound of the pelvic organs;
• Colposcopy;
• Survey mammography.

It is important for the doctor to differentiate the pathology from other diseases. Typically described adverse reactions are signs of inflammatory processes, benign and malignant neoplasms of the genitourinary system, diseases of the blood, gastrointestinal tract, cardiovascular system, and brain. Other highly specialized specialists are involved in the work of the gynecologist.

Where to choose oral contraceptives in St. Petersburg, prices

In St. Petersburg there is a specialized gynecologist-urological clinic Diana. Here you can get tested for sex hormones and any type of infection, undergo all types of ultrasound (the latest machine with Doppler), choose birth control pills or safely terminate a pregnancy.

Here you can also select and install an IUD, remove any tumors using the most modern radio methods without pain or complications, or undergo other procedures.

The cost of visiting a gynecologist is 1000 rubles. Comprehensive pelvic ultrasound - 1000 rubles. Appointment based on the results of tests taken at the clinic - 500 rubles.

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Copper intrauterine devices (IUDs)

This method is also used in emergency cases and is a drug that must be injected into the uterus within 5 days after sexual intercourse. For some reason, women call copper-containing contraceptives pills, although in fact this device does not look like a pill at all.

The action is based on a change in the composition of the mucous membrane, which leads to damage to the egg and sperm. The effectiveness of this method of emergency contraception is 99%, but only if the timing and technique of administration are observed. The only contraindication to the use of copper-containing contraceptives is pregnancy, so you must first undergo a pelvic ultrasound.

Do hormonal drugs have a therapeutic effect?

Birth control pills can indeed be prescribed not only for the contraceptive effect [5]. Due to the mechanisms of their action, hormones reduce the symptoms of premenstrual syndrome and premenstrual dysphoric disorder. COCs have worked well for problems such as hirsutism (increased male pattern hair growth), acne and in some cases alopecia. If a woman has endometriosis or cysts on the ovaries, the gynecologist may also suggest taking hormonal medications to alleviate the patient’s condition.

“The morning after pill” - what you need to know about this method of contraception

We continue to understand why an entire generation of women considers emergency contraception pills to be a terrible evil and fears them like fire.

In the first part of the article, we told you how often you can take these medications without harm to your health, whether these medications are hormonal, and how effective they are.

Do you need a prescription?

In the Russian Federation, yes, a prescription is necessary, although the severity of domestic laws is compensated by the optionality of their implementation.

The point of emergency contraception is to take action urgently. A visit to the doctor is not always possible urgently, so medical associations encourage the over-the-counter sale of drugs.

Levonorgestrel tablets have over-the-counter status in 23 European countries. The exceptions are Malta, which does not sell emergency contraceptives, and several countries that require a prescription (Hungary, Germany, Greece, Italy, Liechtenstein, Poland and Croatia) [7] . In the USA, tablets with levonorgestrel are also freely sold in pharmacies, but in some states you will have to confirm your age over 17 years.

Can teenagers take these pills?

Adolescents can use any method of emergency contraception [8, 9] . Moreover, this is the target audience of the method. It is teenagers who most often find themselves in the situation of “and they woke up in the morning,” while pregnancy is high-risk and extremely undesirable.

The use of levonorgestrel tablets does not require a doctor's examination, tests, or pregnancy test [10] .

Moreover, it is seriously discussed and recommended by the latest guides to tell young women about the possibilities of emergency contraception at the appointment and give a prescription “just in case,” because the effectiveness depends on how much time has passed from the “event” to the pill.

A visit to the doctor is necessary primarily to discuss STI issues and timely switch to planned methods of contraception, because planned contraception is more effective. In addition, the “morrow morning pill” will not protect against HIV infection - this is important to remember.

In the modern world, special online services are being invented that help patients gain simple and convenient access to emergency contraception. In the USA it is PRJKT RUBY or Nurx. And we continue to scare patients with “danger” and “hormonality”.

How much time do I have?

The main news of 2021 is that experts believe that a woman has 120 hours to take emergency measures. That's 5 whole days!

True, there is serious evidence of 120-hour effectiveness only for ulipristal, which is not certified in the Russian Federation for emergency contraception. Experts thought about it and decided that women all over the world still try to take levonorgestrel-containing pills after 72 hours have already elapsed, and some effectiveness certainly extends to 96 hours. And where there are 96, there are already 120 [11].

Until recently, it was believed that the effectiveness of levonorgestrel was highly time dependent (95% within the first 24 hours, 85% from 24 to 48 hours, and 58% from 48 to 72 hours) [12,13].

However, experts analyzed data from four large studies and found little difference between effectiveness in the first four days, with little or no effectiveness on the fifth day [11].

Because the evidence is conflicting, a reasonable recommendation is to try to take the pill as soon as possible after sex.

Mifepristone is available as emergency contraception in the Russian Federation, Armenia, China, Moldova, Ukraine and Vietnam. Although the label promises to prevent pregnancy within 72 hours of intercourse, experts believe it can also work for up to 5 days [14] .

Another good news is that mifepristone is better at preventing pregnancy than levonorgestrel [15, 16]

What should you remember?

Medical science does not stand still. This means that the time of “eternal” knowledge and “exact” truth has passed.

It's time for both doctors and patients to learn to be more flexible and reconsider their usual views.

What once seemed scary and harmful, upon closer examination, turns out to be simply not very effective.

Think about this before you shout about how “terribly evil” emergency contraceptive pills are.

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1. Festin MP, Bahamondes L, Nguyen et al. A prospective, open-label, single arm, multicentre study to evaluate the efficacy, safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg // Hum Reprod. Mar 2021; 31(3): 530–40. doi: 10.1093/humrep/dev341. Epub 2021 Jan 31. 2. Halpern V, Raymond EG, Lopez LM. et al. Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy. // Cochrane Database Syst Rev. 2014 Sep 26; (9): CD007595. 3. Kapp N, Abitbol JL, MatheÌ H, Scherrer B, Guillard H, Gainer E, Ulmann A. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraception. Feb 2015; 91(2). 4. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011; 84: 363. 5. Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Contraception. 2017; 6. Praditpan P, Hamouie A, Basaraba CN, Nandakumar R, Cremers S, Davis AR, et al. Pharmacokinetics of levonorgestrel and ulipristal acetate emergency contraception in women with normal and obese body mass index. Contraception. 2021. 7. https://www.ema.europa.eu/en/news/ema-recommends-availability-ellaone-emergency-contraceptive-without-prescription 8. Harper CC, Rocca CH, Darney PD. Tolerance of levonorgestrel emergency contraception in adolescents.// Am J Obstet Gynecol. 2004 Oct; 191(4):1158–63. 9. Raine TR, Ricciotti N, Sokoloff A. et al. An over-the-counter simulation study of a single-tablet emergency contraceptive in young females.// Obstet Gynecol. 2012 Apr; 119(4):772–9. 10. ACOG. Practice Bulletin No. 152: Emergency Contraception.// Obstet Gynecol. 2015 Sep; 126(3):e1–11. 11. Piaggio G, Kapp N, von Hertzen H. Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: a combined analysis of four WHO trials. Contraception. 2011. 12. Creinin MD, Schlaff W, Archer DF, et al. Progesterone receptor modulator for emergency contraception: a randomized controlled trial. Obstetrics & Gynecology. 2006. 13. Piaggio G, von Hertzen H, Grimes DA, Van Look PF. Timing of emergency contraception with levonorgestrel or the Yuzpe regimen. Task Force on Postovulatory Methods of Fertility Regulation. The Lancet. 1999; 353 (9154): 721. 14. von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. The Lancet 2002; 360 (9348). 15. Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E, Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev 2008(2):CD001324. 16. Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database of Systematic Reviews. 2021.

Oksana Bogdashevskaya

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The opinion of the author may not coincide with the opinion of the editors

Absolute contraindications for the use of hormonal pills

The main indication for the use of birth control pills is reliable contraception. Sometimes they are used in preparation for an IVF program to prevent hormonal imbalance.

COCs are contraindicated in the following conditions:

• tendency to thrombosis or previous thrombotic diseases;
• coronary heart disease, previous heart attack or stroke;
• frequent migraines;
• arterial hypertension;
• liver cirrhosis cysts and tumors;
• diabetes mellitus with a history of disease of more than 20 years or established angiopathy;
• smoking up to 15 cigarettes a day, especially after 35 years;
• oncopathology of the mammary gland;
• pregnancy.

Do not use medications in case of individual intolerance to the components, hormone-sensitive tumors, vaginal bleeding of unknown origin.

Diane-35, according to recent studies, is not recommended as a contraceptive drug due to its effect on the androgen spectrum. It is used as a remedy.