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Want to know about the Pill? Here is everything you need to know Watch

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    I have seen a few threads about the pill and whilst it is quite repetitive and people have different levels of knowledge, I thought Id use my professional knowledge to help you ladies on TSR out (for reference, I am a male pharmacist but deal with quite a lot of contraceptive patients taking different types of pills).

    In this thread, there will be different subthreads on the following topics:

    What is the pill?

    What is is used for?

    How does it work?

    Side-effects / cautions

    What to look out for (when / what to avoid)

    Advice taking it

    Alternate contraceptives

    Difference between the pill and the morning after pill (trust me, this is important).


    So yh, please enjoy the thread and remember, no hating / trolling / discriminating against others.
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    What is the pill?

    The pill is a tablet containing modified versions of the female hormones oestrogen, progestogen or a combination of both. Whilst everyone talks about the pill, there are actually quite a few different versions containing different products.

    Here is a list of a few of them:

    Oestrogen contraceptives: microgynon, ovranette, marvellon, Mestranol.

    Progestrogen contraceptives: cerazette, cerelle, desogestrel, Feanolla, Noriday

    Combined Oral Contraceptive: Loestrin, Kliofem, Kleovance, Brevinor, allelini, gedarel, Marvelon, Monlea, aiduran, femodene, femodete (list goes on)
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    What is it used for?

    The pill is predominantly used for avoiding getting pregnant and has a high success rate of over 90-98% (depending on literature used). Generally speaking 1 tablet is taken each day however depending on the type of pill you take, you either need to take a 7 day break or use it continuously.

    In addition to the above, it can be of help to women with endometriosis and some people can take progestogen tablets to reduce period bleeding (although more on that later).
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    How does it work?

    As I mentioned earlier, there are 2 types of pill: , Progestogen and combined pills.

    the combined pill contains a combination of an oestrogen and a progestogen, whereas progestogen ones are by themeselves.

    Oestrogen containing pills essentially reduce development of eggs inside your body

    Progestogen pills prevent eggs being released into your womb (ovulation)

    Because of the way the work, progestogens needs to be taken continuously as it acts later in your cycle, whereas eggs mature earlier in the cycle thus oestrogen-containing pills (combined pill) can be taken for the first 21 days of your cycle followed by a 7 day break.
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    Side-effects / cautions:

    This varies due to the type of pill but here are the ones to look out for:

    Combined Pill: breast tenderness, breakthrough bleeding (period-like bleeding), weight gain, nausea, vomiting, headache, loss of libido and potentially mood swings / feeling down.

    Progestogen: Similar to above however breakthrough bleeding can vary from 40% of people to complete lack of bleeding.

    With the combined pill, there is a small risk of getting breast cancer whilst taking it / 10 years after (oestrogen is a female hormone which causes cell growth and increased oestrogen has been linked to breast, endometrial and ovarian cancer), however the risk of getting it below the age of 35 is quite low. Therefore it is worth considering an alternate type if you have familial history of breast cancer / you are at risk (more about alternates later).

    Also make sure your doctor takes your blood pressure before starting it as it can increase your risk of a stroke (<1 in 100,000 chance).
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    What to look out for (when / what to avoid):

    If you have breast/ ovarian / endometrial cancer, avoid it.

    additionally avoid using the combined pill if you have 2 or more of the following: familial history of heart disease, diabetes, high blood pressure, smoking, stage 2 obese (BMI >35) and experience migraines.

    Also avoid if you have had arterial disease, a stroke, lupus, red patches on your skin (not acne), a clotting disorder (clot in your lungs / legs) or were itchy during pregnancy. Also avoid it in liver disease and within 6 months of giving birth / if breastfeeding.
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    Advice for taking the pill:

    The tablet has to be taken once a day at the same time each day you take the tablet.

    Depending on the pill, you either take it for 21 days (combined) or 28 days (progestogen only) from day 1 of your cycle. As the NHS only allows for 6 months supply at a time, the maximum of either you can get on a prescription is 126 or 168 tablets (it assumes 1 cycle / calender month is 28 days).

    Assuming you are on a combined pill and your cycle is 28 days, after day 21 of your cycle (1 whole strip of tablets), you do not take the pill for 7 days. afterwards you resume from day 1 of a 28 day cycle (it assumes that all women have 28 day menstrual cycles).

    If you miss the tablet, make sure you take it within 3 hours of when you would normally take it and resume as you would normally the following day.

    If you have missed a tablet and it has been for more than 3 hours (12 if your on cerazette), make sure you take it the following day and use a barrier (condom / femidom) if your having sex to reduce the risk.

    If you have missed your pill for more than 2 days, take a pill as soon as you remember, take as normal and use a condom for 7 days. It is also worth considering speaking to a health professional with family planning accreditation (not all pharmacists and GPs have this) as they can help with more advice regarding this. It may be worth considering a morning after pill but Ill discuss more about this later as it is more controversial than you think.

    If you havent taken your pill within the last 7 days, dont take the 7 day break during your next cycle (combined pill).

    Diarrhoea and vomitting can affect the way the pill works. If you have vomitted within 2 hours of taking the pill, take a second pill. Also make sure to use additional protection when having sex (condom / femidom, spermicide etc) if diarrhoea or vomitting continues, use additional protections for 7-9 days or until 2 days after it has stopped.

    Whilst the pill can be used to stop bleeding, the reality is that it is a low dose and is 60% effective at this. there is a high strength pill which can be prescribed / brought from certain pharmacies (5mg norethisterone) but this only delays periods for up to 14 days.

    Certain drugs reduce the effect of the pill. when taking these drugs, use additional protection: epilepsy medicine / neuropathic pain medicines, St. John's Wort and rifampicin. Ideally you should switch to using contraceptive injection or an IUD during and for 4 weeks after taking these drugs but reality is most GPs cant be asked (especially certain one who love saying they have studied medicine for X years, been practicing for Y, so who the #@{} are you to tell me what to do).

    Antacids can have an affect on contraceptives so if you have heart burn, ask for something called a PPI or H2RA from a GP / Pharmacy.

    If you are taking doxycyline (usually for acne but can be for infections) or ampicillin for more than 2 weeks, eat more yoghurt! the reason is because antibiotics can reduce the amount of good bacteria in your tummy (which in turn can affect the way the pill works due to increased diarrhoea and maybe due to good bacteria helping the way the pill works), thus you need more yoghurt to help your tummy when on long-term anitbiotics.

    Whilst the pill is good for preventing pregnancy, it doesn't protect against STDs. For that, you need to use barriers such as condoms or femidoms.
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    Alternate contraceptives

    Whilst the pill has many uses, it is commonly associated with contraception. Thing is, as a patient, you (or your parents if your under the age of 16 / not gillick competent (term is tl;dr)) have the choice of what you want to use. If your unhappy with something, just ask your doctor to prescribe something else.

    As I mentioned earlier, barrier methods can be used and these have the added benefit of protecting against STDs. That being said however, some men may find it uncomfortable using condoms, so it is a about finding a compromise with your partner / whoever you sleep with. Also femidoms can be hard to find in most pharmacies so you would have to do a lot of searching.

    In addition to barrier methods, you can have other ways of having the effect of the pill without having to swallow anything.

    EVRA patches contain combined contraceptives and you only have to apply 1 patch a week for 3 weeks, followed by a 7 day break. This is especially good if you dont want to swallow a tablet a day. the problem is however is that it is quite expensive for the NHS / pharmacies so a lot of doctors will be hesitant against prescribing it unless you have real issues remembering when to take the tablet. Also because it is stronger than the standard pill, you can get increased breast tenderness and bleeding.

    You can also get it administered to your arm as an injection or a device implanted in your fatty tissue in your arm. the injections last for 8-12 weeks and the implant works for 3 years (with the implant however, the effects are reversible when removed and can be removed when you want). downside is that you can get discomfort in your upper arm whilst it is in there and the doctor / nurse has to be specially trained to do it (which can take ages to find with the NHS).

    the final options are intra-vaginal and intra-uterine devices, which they insert via your private way.

    intra-vaginal devices are usually rings you have to insert once a month (for first 21 days of cycle, followed by a 7 day break, then resume as normal). with these ones, there is a risk of it falling out and it is a bit TL; DR to explain what to do.

    Intra-unterine devices are literally copper& plastic or drug and plastic coils (non-springy springs) which are inserted into you by a trained doctor / nurse. these can stay in you for up to 5 years at a time. These devices can be painful to insert and remove however
    there is also an increased risk of an infection "down there" within the first 20 days of it being inserted, particularly is you have an STD or a "water infection" so be careful.

    the drug one can affect your bleeding for 3-6 months, after which it is reduced. But it does have more side effects.

    Ultimately however, it is down to you what you want and the pill is usually the main one used by most people.
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    Difference between the pill and the morning after pill (trust me, this is important)

    Alot of people think the pill and morning after pill are the same, used the same, etc. but there is a few things you need to consider before thinking about the morning-after pill.

    The morning after pill is an emergency contraceptive (levonelle or ursogestrel - levonelle or ella 1) which can be used within 3-5 days of having unprotected sex to avoid pregnancy. Whilst this seems ok, the method behind it can lead to headaches on moral / religious / potentially ethical views.

    The way it works is it makes your uterine lining shed, which in turn can lead to bleeding. What should be mentioned however is that if you have been impregnated, then the zygote (impregnated egg / proto-baby) tends to stay on your uterine lining thus it can cause an abortion if you have been impregnated.

    Now it can be prescribed by a doctor or purchased via a pharmacy but there are complications with this. In the case of prescriptions, doctors can choose to not prescribe it and they should signpost your to another doctor, a sexual health clinic or a pharmacy which can.

    With pharmacies, they cannot outright sell it as there are sales restrictions on it (essentially because it can cause an abortion, you need to have a clinical consultation with a pharmacist before doing so). Like doctors, pharmacists can choose to not sell it and should legally signpost you to someone who can supply it to you. Additionally pharmacists have to be accredited to give morning after pill and a lot of pharmacists do not.

    Where there are complications however is with out of hours care / weekends / holidays as it is predminantly locum doctors and pharmacists who are working on weekends. Whilst a surgery / pharmacy may have professionals who do the service (ie regular staff) because locums are not regular staff, they would not be able to do all the services the regular staff do and may not be aware of alternate providers in your local area.

    At the end of the day, only use the morning after pill if you have had unprotected sex without taking other contraceptives. Before purchasing it, make sure you contact local GP surgeries / pharmacies, ask to speak with the GP or the pharmacist and ask if they can do the morning after pill.

    If you are unable to get the morning after pill within 3-5 days of completely unprotected sex or in general, speak to a family planning or sexual health clinic asap as they can provide more detail than standard pharmacists / doctors. Alternatively look for professionals with accreditation in family planning as they can provide similar advice (if speaking to a GP surgery or a pharmacy, ask if the pharmacist has family planning / female sexual health accreditation).
 
 
 
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