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“214 million women want to avoid pregnancy but are not using a modern contraceptive method”, says a WHO article on Contraception.
Unfortunately, despite the availability of so many types of contraceptives in the market, women are either not aware of these options or are confused regarding their usage & schedule.
In fact, one of the emerging confusions is between the usage of COCs (Combined Oral Contraceptive Pills) & ECPs (Emergency Contraceptive Pills).
They all fall under one category i.e oral contraceptive pills, which are basically tablets that are taken to prevent unwanted pregnancy. One should keep in mind that these pills don’t protect from STDs. So, it’s always advised to use a barrier contraceptive like condoms along with it.
Combined Oral Contraceptive Pills (COCs)
COCs are oral pills that contain the two main female hormones, estrogen & progesterone, hence called “combined”.
Each pack contains either 21 or 28 pills, where each pill is taken per day for a month.
When to start COCs?
For a woman in reproductive age (15-45years), after being examined & consulted by the doctor, the first tablet of the pack is taken on the 1st day of her menses. One tablet is taken daily at the same time, without interruption for 21 or 28 days, depending on the number of pills the pack contains.
If one forgets to take a pill on a certain day, the forgotten pill can be taken (as soon as she remembers it) on the next day along with the pill for that day i.e 2 pills.
It’s understandable taking a pill everyday can be tedious but a daily reminder on your phone will help 🙂
Following up with the doctor is recommended after 2 months & after 6 months of taking the medication.
- Pills known as “Mini- pills”, that contain only progesterone, available in the market. But should only be taken after being consulted by their doctor.
- Combined Injectable Contraceptives
- Combined contraceptive patch
- Combined contraceptive vaginal ring (CVR)
Who Shouldn’t take COCs:
According the World Health Organisation:
- COCs are not recommended (unless other methods aren’t available) in women with the following conditions:
- Have a history of breast cancer
- Have unexplained vaginal bleeding
- Significant gallbladder disease
- <3 weeks post delivery
- Has high blood pressure
- On medication for seizures
- COCs should not be used for the following:
- If a woman is pregnant
- Is breastfeeding (<6 weeks post delivery)
- Has history of heart disease or problems
- Has blood clotting disorders
- Is a smoker with age >35 years
- Has diabetes for more than 20 years
- Has headaches/ migraines
- Has high blood pressure
- Has breast cancer
- Has liver tumours
- Has to undergo major surgery
[Always consult a doctor before you start your COCs. Do not self administer them, especially if you have pre-existing medical conditions. You do not have to be scared or ashamed of getting help from a doctor. Talk to us to know more. We can help you. Click on the Whatsapp chat button now: ]
Side Effects are commonly very minimal, which include:
- Decreased appetite (less common)
- Slight bleeding from the vagina (less common)
One should stop taking the pills immediately if they experience the following:
- Visual disturbances
- Yellowish discoloration of skin & eyes (jaundice)
- When one gets pregnant
- Increasing blood pressure
- Planned operations
- 0.3 pregnancies per 100 women per year with consistent and correct use
- 7 pregnancies per 100 women per year as commonly used
The Dept of Family Welfare, in the Ministry of Health & Family Welfare, Govt of India has made two types of COCs available under the brand names of Mala-D & Mala-N, both having 28 pills/pack.
Mala-D is available for 3 rupees only!
Mala-N is the same as Mala-D but free of cost, which is available at government health facilities like primary health centers, urban family health centers etc
Emergency Contraceptive Pills (ECPs)
Also known as “morning after pill”, emergency contraceptive pills are similar to COCs; the only difference is that only one pill is taken, containing a very high dose of estrogen & progesterone; that’s why it should only be taken in case of emergency!
This pill can either have a combination of two hormones like estrogen & progesterone or contain only one hormone like progesterone. It is also combined with medications like ulipristal acetate, that help in contraception.
ECPs are indicated in the following:
- Unplanned, unprotected intercourse
- Used a condom that may have leaked or broken
- Missed multiple COC pills
- Failed incorrect withdrawal method (ejaculated in vagina or external genital area)
- Incorrectly used a diaphragm, or the diaphragm or cervical cap has broken or got dislodged, or was removed early
- Rape or incest victims
- Sexually active adolescents in need of contraception
- Those currently not using a method of contraception
- Exposure or usage of medicines, drugs that can be harmful to the growing baby during pregnancy
ECPs should never be taken when pregnancy has been detected & is confirmed.
When to take ECPs?
- It should be taken as early as possible; most effective when taken within the first 12-24 hours of having unprotected sex
- It can be taken within 5 days of having unprotected sex
Women with the following conditions should get counselled by their doctor before taking ECPs:
- Women who are breastfeeding
- History of ectopic pregnancy
- History of heart disease or problems
- History of migraines
- History of liver disease
- Women who are medications for Tuberculosis, seizures, hypertension etc
[ Just because ECP is an Over-The-Counter drug, doesn’t mean anyone and everyone can use it. If you have pre-existing medical conditions, you must consult a doctor to get advice on using ECP. You can talk to us and we will ensure that you get help from a doctor who understands your position. Click on this Whatsapp chat button: ]
- Nausea (seen in 20% of women using COCs)
- Vomiting (seen in 5% of the women using COCs)
- Abnormal bleeding
- Abdominal cramps
- Pain in breast
- Irregularities in periods
- < 1 pregnancies per 100 women per year with correct use for ulipristal acetate ECPs
- 1 pregnancies per 100 women per year with correct use for progestin-only ECPs
- 2 pregnancies per 100 women per year with correct use for combined estrogen and progestin ECPs
- Intrauterine Devices (IUDs)
An article on emergency contraception published by WHO in 2018 states:
“Some women, however, use ECPs repeatedly for any of the reasons stated above, or as their main method of contraception. In such situations, further counselling needs to be given on what other and more regular contraceptive options may be more appropriate and more effective’’; also stating that frequent use of ECPs result in increased side effects.
It’s imperative to get counselled by your doctor & increase the access & awareness of the choices of contraceptive pills that’s available. It’s natural for one to be apprehensive about the side effects but it should be understood that the benefits of these medications outweigh the side effects. And by acting responsibly, we not only preserve & protect our choices & health, but the health of our community too.
[If you have any other questions or doubts about periods, pregnancy, abortion, or your sexuality, please talk to us. We will immediately help you. Talk to us by clicking on this Whatsapp chat button: ]
About the Author: Teertha Barnwal
A doctor, a medical intern at MGM Medical College, Navi Mumbai. Enjoys writing, singing & adventuring. Meditates & believes that life is the biggest adventure.
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