Some women experience minor "nuisance" side effects while using the Pill. Of course, depending on your level of discomfort, a nuisance can become serious enough to warrant switching to a different OC or discontinuing the Pill altogether. Additionally, some minor side effects could actually be masking a condition that needs medical attention. Never hesitate to mention a side effect to your physician. Among the minor side effects the Pill sometimes produces are acne, breakthrough bleeding or spotting, breast tenderness, depression, headaches, nausea and weight gain.
Acne: Pill users may notice an improvement, a worsening, or no change in their acne. In some women, the progestin component of the Pill improves the acne; in others it works like the male sex hormone, androgen, and makes it worse. (Women produce androgen in small amounts.) Dietary, allergic, hygienic, or familial factors can also increase acne. A bad case could be a sign of an ovarian or adrenal tumor, although chances of this are minimal.
You have several options if you break out with acne while on the Pill. Recently, new lower dose pills containing so-called "new progestins," were introduced to the American market. These pills have been used in Europe and other parts of the world for over 30 years with great success. Although many claims are made about them, so far their only real benefit appears to be their lower androgenic properties. Ask your doctor about these pills containing progestins called norgestimate (Ortho-Cyclen, Ortho Tri-Cyclen) and desogestrel (Ortho-Cept, Mircette, Desogen). Ortho Tri-Cyclen is now officially approved by the Food and Drug Administration for the treatment of moderate acne. A third new progestin called gestodene, which could actually be the best of the three because it can be used at the lowest dose, could become available in the U.S. sometime in the future.
The new pills are more expensive than the older high-dose pills, so you'll have to decide if improving your acne is worth the added expense. You might choose to switch to another of the older pills instead. You can also consider taking antibiotics, changing your diet, or using a special cleanser.
Breakthrough bleeding or spotting: Intermittent minor menstrual bleeding could mean that your pill isn't strong enough, or it could signal a pelvic infection, endometriosis, or ectopic pregnancy. Once your doctor has ruled out these more serious possibilities, he or she will either switch you to a different pill (probably one with a higher dose of progestin or one of the new progestin pills) or counsel you to try to tolerate the bleeding and spotting for a little while longer, especially if you just started on the Pill. Breakthrough bleeding and spotting diminish rapidly over the first four months of pill use.
Most physicians do not recommend stopping the Pill because of this side effect. If you have any doubts, however, call your doctor.
Breast tenderness: If your breasts hurt, your doctor will first rule out pregnancy and breast cancer. He or she may then prescribe a different, lower dose pill.
You may also want to try wearing a different bra with better support. Also try to avoid vigorous exercise when you have the most discomfort.
Depression: It's difficult to prove a direct link between depression and the Pill. A woman who's chosen the Pill may still have strong moral or medical concerns about it. Starting on the Pill may also coincide with increased sexual activity, which may cause deep psychological conflicts for the user. This inner turmoil can easily seem like depression. It is important to decide whether there could be other reasons for your feelings, and to note whether your depression started or became worse when you began taking the Pill.
If you rule out depression from sources other than the Pill, there are several Pill-related remedies your doctor can try. Most likely the culprit is the progestin in the Pill, so your physician might try prescribing a pill with less of that hormone. Pill-related depression can be the result of fluid retention or a lack of vitamin B6, among other causes. Talk with your doctor about the best plan of action. If your depression seems severe, he or she may suggest you discontinue the Pill and talk with a specialist.
Headaches: Although OCs sometimes initiate headaches or make them more severe, headaches can also be a warning of impending strokes or other circulatory disorders. Pay close attention to headaches that are different or more severe than those you had before starting on the Pill.
Estrogen seems to be the culprit in Pill-related headaches, so you might find relief by changing to a lower dose pill, or switching to a progestin-only method like Norplant implants or Depo-Provera. If you usually get headaches only during the week you're not taking pillsthe placebo weekyou might have what's called an estrogen withdrawal headache. To determine whether this is the case, consider using an estrogen supplement. For example, during your withdrawal week, you can try wearing a transdermal patch that releases estrogen through the skin.
Another approach to estrogen withdrawal headaches is simply to put off withdrawal from the Pill. Essentially, you postpone the headache by extending the amount of time you take active pills. A recent year-long study of 300 women showed that those who opted for an extended regimentaking active pills for 9 weeks instead of 3 and then taking a withdrawal weekhad fewer headaches. Continuing the active pills for the extra time caused no serious side effects and no decline in effectiveness.
It may seem unnatural to take pills for longer than the standard 3 weeks, but remember that the entire pill cycle is essentially unnatural. As one family planning expert puts it, "The day was made by God, the week was made by man."
Nausea: Although it could signal pregnancy, early miscarriage, or some nonreproductive disorder, when nausea is related to the Pill, it's the estrogen component that's at fault. For a new Pill user, nausea usually subsides after the first few cycles or remains a nuisance only on the first day of each new cycle.
In addition to switching to a pill with a lower estrogen dose or to a progestin-only method, another possible remedy is taking your pill after a meal. Swallowing a pill before going to sleep has also helped some women.
If the nausea is so bad that you vomit within 1 hour of taking a pill, take another pill from an extra pack. Also, if you missed a pill and are trying to catch up, take the next 2 pills at least 12 hours apart. (For more information see the nearby box on "What To Do When You Miss a Pill.")
Weight gain: Some doctors refuse to acknowledge that the Pill can cause excessive weight gain. Although your doctor might switch you to a different pill, it could be because you believe it will help rather than because he or she thinks it will.
Weight gain that occurs after you start using the Pill may be caused by fluid retention or estrogen-induced fat deposits in the thighs, hips, and breasts. It may also be the result of reduced physical activity or increased intake of food. (The androgenic effects from the progestins in the Pill can cause an increase in appetite.)
Switching to lower dose pills or to pills with less progestin content can help, but increasing exercise and reducing caloric intake is often the best solution.
| Drugs that Defeat the Pill Have you ever known someone who became pregnant while taking the Pill, but who swore she took a tablet every day? The culprit could have been a drug interaction. Certain drugs, notably anticonvulsant medications and some antibiotics, stimulate enzymes which absorb estrogen and progestins. This means less of the hormones from your OCs are available to prevent pregnancy. These drugs can also act on the Norplant system. If you need to take these medications for only a few weeks, your doctor will probably advise you to use a backup contraceptive, such as condoms or spermicides. Long-term therapy may require you to switch from hormones. Here are some of the medications which can reduce the effectiveness of OCs and implants:
Source: Outlook, Volume 9, Number 1, April 1991. Program for Appropriate Technology in Health (PATH), Seattle, WA. |
