In the previous article on contraceptives, “To Be or Not to Be—That is the Contraceptive,” the methods of preventing pregnancy were listed and described. But none of them has changed the world the way the oral contraceptive—or “birth control pill” (BCP)—has.


The Combination Pill and the Progesteron-only Pill (POP)

Ingredients—one scoop or two

Two types of pill have been marketed. The more popular version is called the “combination pill,” because it has both an estrogen and a progesterone, the main female hormones involved in the menstrual cycle and ovulation. For women who cannot take estrogen, the progesterone-only pill (POP) was developed.


Party on! Adventures in promiscuity and sexual experimentation

To say “the pill” was a revolution is an understatement. It was introduced first in the 1960s, and along with daring and provocative music, changing concepts of morality, and the hippie mind set, it fueled the free love movement with high octane. Back then, all one had to worry about in “hooking up” with someone with an unknown past was gonorrhea or syphilis—or pregnancy. Like gonorrhea and syphilis, the BCP meant that now there was a pill for pregnancy, too. The sexual revolution exploded. There were not roadblocks.

Then came HIV, AIDS, the chlamydia epidemic, hepatitis B and C, and the cancer- and wart-causing HPV, which hit the brakes—hard—on this revolution. Except for chlamydia, there were no pills for the rest of these party-poopers. And on top of that came reports of young women suddenly dropping dead from pulmonary emboli (blood clots to the lungs).

The party was certainly over, but the world had still changed dramatically, since women now could take charge of their own reproduction. (How it changed for the condom manufacturers, too!)


Whatever did we do before birth control pills?

In the previous millennium, before oral contraceptives, the most popular and effective method of birth control was breastfeeding. The milk letdown hormone, Prolactin, tends to inhibit the production of hormones that stimulate the ovary to mature and release eggs for fertilization. It wasn’t foolproof, but it was the most popular way to space out births within a family. A good way to see if breastfeeding was working well as a contraceptive was when the menstrual cycle lost its monthly rhythm. The women who had to worry about pregnancy were the ones who still menstruated monthly while breastfeeding. Abstinence was the fall back when this happened.

How does the birth control pill work?

The BCP likewise inhibits the hormones that stimulate the ovary, but it does this in a slightly different way. It doesn’t make the body think it’s breastfeeding, but that it’s already pregnant. The estrogen and progesterone hormones in BCPs do that. And since pregnancy has always been foolproof in preventing ovulation, imitating pregnancy made a better way to prevent pregnancy than mimicking breastfeeding.

Combination Pills

The estrogen and progesterone in the birth control pill are at levels that prevent the stimulation of more estrogen, because it’s already there from the pill, taking advantage of the body’s clever negative-feedback system. Additionally, the longer the pills are taken, the thinner the lining (endometrium) of the womb, less conducive to pregnancy.

POP (Progesteron-only pill, An alternative to estrogen

For women who cannot take estrogen at all, e.g., women with a history of blood clots, the progesterone-only pill (“POP”) is useful, although its failure rate, while still being very low, is slightly higher than the combination pills.


The quest for the perfect pill

The pulmonary embolus deaths were concerning, and the pharmaceutical companies began to play lowering the amount of hormone against the likelihood of pill failure by doing so. Less hormone meant less chance of blood clots bur more chance of a rogue ovulation that could result in pregnancy. Thankfully, the two zones—lower hormone for less clotting, and higher hormone for guaranteed contraception—don’t overlap to any extent.

How safe are birth control pills?

Today, the BCPs are safer than ever, making blood clots almost a negligible consideration when choosing a contraceptive method. In fact, when accidental pregnancy is factored in to the other methods chosen to avoid the BCP, the statistics pan out to show that taking BCPs are safer than not taking them because of the increased reliability of condoms, abstinence, etc. Today’s combination pills have been whittled down to 4-5 times less the amount of estrogen compared to the first pills that were marketed in the 1960s.


Refining The Pill

The quest for the perfect pill has resulted in several perfect pills for certain subsets of women. With both an estrogen and a progesterone component, depending on the hormonal needs, pills can be selected for whether they are more estrogenic or more progesterone-dominant. For instance, if keeping the lining of the womb stable that would otherwise result in irregular spotting throughout the month, an increased-estrogen balanced pill might work best; a lower-progesterone pill, while providing the contraception needed, could be reduced if there were headaches or fatigue.

Monophasic, Biphasic and Triphasic pills, what are they?

Besides whether a pill is estrogen-dominant or progesterone-dominant, pills have also been formulated as having the same amount in each hormone throughout the month’s pack, having a two-phase dosing strategy, and even a three-stage dose to mimic what goes on in the normal menstrual cycle. These are termed monophasic, biphasic, and triphasic, respectfully. In actual practice, this amount of tinkering has probably been unnecessary, but each of these seem to have found a niche for particular groups of women.

What it really comes down to is, “what works best, use.” A temporary period of trial and error will usually find the right pill for each woman.


FAQs on BCPs

How does one know what is the right pill for her?

Usually trial and error. Each family doctor or gynecologist has a few favorites of each of the estrogen-dominant pills, progesterone-dominant pills, low-dose pills, or medium-dose pills, as well as monophasic or otherwise. Based on one’s individual needs, one will be tried, and giving it a few months to see how things go, can either be changed or kept.


What kinds of problems can the wrong pill cause?

Headaches, nausea, swelling, and mood changes can occur, which usually fade away after a few packs of pills. The most common reason a woman will change to a different pill is something called “breakthrough bleeding.” Once beginning the pill, there is a bit of a fight between the hormone content in the pill and one’s own hormones. If the pill doesn’t contain enough hormone to override one’s own, irregular bleeding can occur—inconvenient spotting up to prohibitive heavy bleeding. This is fixable, however, usually with another brand and consideration between a progesterone-dominant and an estrogen-dominant pill, or between a monophasic or a multiphasic pill. Again, trial and error.


When is the right pill the wrong pill?

A woman on the pill endures the reality that the pill stays the same, but she changes. The right pill for her now may be the wrong one for her later, and vice versa. This allows revisiting a previous “wrong” pill after the pill she’s been taken becomes a “good pill gone bad.”


What are some of the popular pills available?

Among the monophasics are Yasmin, Ortho brands, Demulen, Lo/Ovral, Loestrin, and others.

Among the biphasics are Aranelle, Necon 10/11, and Ortho-Novum 10/11.

Among the triphasics are Tri-cyclen, Ortho Tricyclen, Tri-Levlen, Trivora, Trinessa, and Triphasil


When is the best time to begin the BCP?

Usually the first Sunday after the next period, which is simply to make sure there isn’t a pregnancy.


Are there NON-contraceptive uses for the BCP?

Yes, many. Overriding one’s own hormonal cycle that has proved troublesome can comfortably mask its miseries and is discussed in a follow-up article.


What are other ways the pill can be used?

While maintaining reliable contraception, the pills can be manipulated to artificially manipulate one’s cycles, even eliminating periods altogether. This is safe and a legitimate use of the pill and is discussed in a follow-up article.


What’s the best way to stop the pill if there are problems or if pregnancy is desired?

The best way is to let the current pill pack end, then wait. If discontinuing a current pill due to side effects, but oral contraception is still desired, a different brand can begin right on time (right after the discontinued brand ends), or alternately, let the problematic brand end and take no more, allowing the natural cycle to resume, which will happen in about 1-3 months.


If discontinuing the pill is for the pursuit of pregnancy, stop them at the end of the current pack, allow that period to occur, and await natural cycles, which should re-establish themselves in 1-3 months.

Birth Control Pills and Women Empowerment


Historically, the BCP has, well…changed history. Not an abortive, it bypasses all of the political and ethical melodrama. Now into its 6th decade of use, 60 years of tweaking has allowed the oral contraceptive to give women safe control over their family planning, engendering careers for another half of the population, previously saddled with child-rearing whether they wanted it or not. Child-rearing, however, is not a dirty phrase, but a beautiful one, and thanks to BCPs, one a woman can choose when her time is right.


This article is part of a series on Birth Control Pills.

Articles To come:

Birth Control Pills Do So Much More Than Control Birth (BCPs Part II)

Contraceptive Tricks—Eliminating Periods Altogether (BCPs Part III)


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