What You Should Know About Birth Control Pills

Birth control pills are used by around 16% of women aged 15 to 49 in Canada, helping with pregnancy prevention and menstrual cycle management.  

For those looking to start a birth control pill prescription, key considerations to keep in mind include the different types of birth control pills and the potential benefits, risks, and side effects.

This article discusses everything you need to know about birth control pills, as well as the different types and brands available to choose from.  

Continue reading to learn how Felix can help you find the right birth control for you.

What are birth control pills?  

Birth control pills are a type of oral contraceptive taken every day that help to prevent pregnancy.  

In addition to contraceptive uses, birth control pills can also be used to help manage and regulate a person’s menstruation cycle.

How do birth control pills work?  

How birth control pills work depends on what type of pill a person is taking. 

Most birth control pills contain hormones that work to prevent the release of eggs from the ovaries (i.e. stop ovulation). However, there are also non-hormonal versions of birth control as well. 

The two main hormones used in birth control pills are estrogen and progesterone. Some birth control pills are labelled as progestin-only, meaning they only contain the synthetic form of progesterone.

How effective are birth control pills?  

When discussing the effectiveness of birth control pills, healthcare practitioners differentiate effectiveness according to how a person uses them. 

Perfect use is defined as taking a birth control pill at the same time every day. With perfect use, birth control pills have a 99.7% effectiveness rate, meaning the failure rate of birth control is just 3 out of every 1,000 people.

However, most people do not maintain perfect use at all times.

Instead, most women taking birth control pills are defined as having typical use, meaning a dose may be occasionally taken at a different time during the day or forgotten. 

With typical use, birth control pills have a 91% effectiveness rate. This equates to a failure rate of 90 out of every 1,000 people.  

Types of birth control pills  

In terms of how many types of birth control pills are available in Canada, there are two main types — combination pills and progestin-only pills.  

Within these categories are smaller sub-categories that healthcare practitioners can choose from for their patients. Which type of pill a person is prescribed depends on various factors, including pre-existing health conditions and overall health goals. 

There are also several non-hormonal birth control methods as well.  

These methods may be preferable for certain patients with health conditions that are incompatible with hormonal birth control pills or whose health goals do not align with hormonal birth control pills.   

Let’s take a more in-depth look at what each type of birth control has to offer:

Combination pills  

Combination birth control pills are the most common type of birth control pills. They contain two hormones: estrogen and progesterone.  

Due to the presence of estrogen in combination pills, this type of birth control pill is not recommended for people who:

• Are older than 35 and smoke
•  Experience migraine with aura
• Have a history of blood clots
• Currently have or have a history of breast cancer

This type of birth control pill offers two different sub-types:

1. Monophasic pills: Monophasic pill packs contain 21 pills that all contain the same amount of hormones. After all 21 pills are taken, the patient then takes a 7-day break during which their period can occur.  

2. Multi-phasic pills: Multi-phasic pill packs contain two to three different colours of pills, totalling 21 pills per pack. Each colour of pill contains a different level of hormones. These pills may be preferable for patients with a higher risk of certain health conditions, like ovarian cysts. Like monophasic pills, multi-phasic pills are taken for 21 days straight, followed by a 7-day break.  

In addition to being either monophasic or multi-phasic, combination pills can also come in 21-pill or 28-pill packs. The 28-pill packs include seven placebo pills taken during the 7-day break. 

People who use 28-pill packs often prefer them because these packs help them to remember to take the pill at the same time every day.

The 7-day break is also not always necessary, though if you skip over this break, you will not experience a regular period. Delaying your period is preferable for some people, though it does make it harder to detect a potential pregnancy.

How combination pills work

A key characteristic of combination pills is their mechanism of action, which inhibits ovulation and thickens the cervical mucus. This makes it both more difficult for an egg to be released from the ovaries and more difficult for sperm to reach the egg. 

There are some differences in how the pills work depending on whether you are prescribed monophasic or multi-phasic pills.  

How monophasic pills work 

With a monophasic pill pack, your body is provided with the same concentration of hormones for 21 days. There is no difference in the hormone levels depending on the week, and all pills are the same colour to indicate they have the same amount of hormones.  

How multi-phasic pills work 

With multi-phasic pill packs, your body is provided with various hormones.  

Multi-phasic pills can be either biphasic or triphasic. Biphasic means two different doses are present in the pill pack, while triphasic means there are three.

The way these pills typically work is that in the earlier weeks, you are provided with a lower dose of hormones. This dose is increased halfway through the cycle for biphasic pills and increased every seven days for the triphasic pills. 

Both monophasic and multi-phasic pill packs can contain seven placebo pills if they are 28-day packs.

Continuous and extended cycle pills  

Continuous cycle pills refer to birth control pills that are intended to be taken without the 7-day break. These packs typically contain no placebo pills, and patients using these pills will not experience a regular monthly period.  

Extended cycle pills skip the 7-day cycle for two or more cycles and then have a planned 7-day break. As a result, patients who take extended cycle pills will generally only have three to four periods per year rather than twelve.

Benefits of combination pills  

Patients can experience many benefits from combination hormonal birth control pills, including:

•  More regulated, lighter, and shorter menstrual periods
• Reduced menstrual cramps
• Reduced risk of endometrial, ovarian, and colon cancer
• Improvements to acne
•  Reduced growth of unwanted body and facial hair

Additionally, combination pills can also be used to treat the symptoms of certain disorders associated with menstrual cycles, such as endometriosis and polycystic ovarian syndrome.

Potential risks and side effects of combination pills  

The most significant risk associated with combination pills is an undetected pregnancy. 

Since many types of combination pills can reduce the number of periods you have each year when taken continuously, if you become pregnant, you may not realize it for several weeks to months since you are not expecting a regular period.  

As far as side effects go, common side effects of combination pills can include:

• Mood swings 
• Nausea 
• Headaches 
• Tender breasts 
• Reduced libido

These side effects should be minor and should lessen in intensity after taking the pills consistently for two weeks to a month. Contact your healthcare practitioner immediately if you experience any severe or worsening side effects while on combination pills.

There are also some rare serious side effects associated with combination pills, including blood clots. Your best action plan is to discuss these risks with your healthcare practitioner and decide if combination pills are the right choice for you.

Additionally, as mentioned earlier, people who are over 35 and smoke, experience migraines with aura, or have a history of blood clots or breast cancer are not recommended to take combination pills due to potential complications from estrogen. The risk of blood clots can also increase if a person smokes.

People with additional medical conditions, like lupus, are not recommended to take combination pills either. 

Anyone taking combination pills is at a slight risk of developing high blood pressure (hypertension) and should have their blood pressure checked before getting a prescription and while using the pills. 

Progestin-only birth control pills 

Progestin-only birth control pills — also called the mini-pill — are oral contraceptives that only contain the hormone progestin. Progestin is the synthetic version of progesterone.

These birth control pills have the same effectiveness as combination pills (91% with typical use and 99.7% with perfect use). They come in packs of 28 pills and are taken continuously with no hormone-free interval. 

How progestin-only pills work  

Progestin-only pills work in the same way as combination pills by inhibiting ovulation by preventing an egg from being released from the ovaries and thickening the cervical mucus to prevent sperm from reaching an egg. 

The main difference between these pills and combination pills is that progestin-only pills do not contain estrogen. This can be preferable for people with certain health conditions, such as people who:

•  Have a history of or are at risk of developing blood 
• Experience migraine with aura
• Are 35 years or older and smoke 

Benefits of progestin-only pills 

Along with the typical benefits associated with combination pills, progestin-only pills have the added benefit of not containing estrogen. 

Progestin-only birth control pills can be particularly beneficial for women who cannot take estrogen for medical reasons, who are breastfeeding, or who are over 35 and smoke. 

Potential risks and side effects of progestin-only pills 

Aside from the potential risk of an undetected pregnancy, progestin-only pills are generally not recommended for women who:

• Are diagnosed with certain medical conditions, like lupus 
• Women who currently have breast cancer 
• Women who have had breast cancer in the past (if progesterone receptor is positive)

Common side effects experienced with progestin-only pills include:

• Changes to bleeding 
• Spotting 
• Headaches 
• Nausea 
• Breast tenderness 

As with combination pills, contact your healthcare practitioner immediately if you experience severe or worsening side effects while on progestin-only pills.

Non-hormonal birth control methods 

For women who cannot or do not wish to take hormonal birth control methods, there are several non-hormonal options that a healthcare practitioner could prescribe. 

These include:

• Copper IUDs: A copper intrauterine device (copper IUD) can be both hormonal and non-hormonal. These devices are inserted into the uterus and can last up to 10 years.  

• Male External Condoms: Male external condoms are made from either latex or non-latex materials. These condoms are worn on a penis and prevent sperm and semen from entering a woman’s body. External condoms can also help to protect against sexually transmitted diseases and infections.  
• Female Internal Condoms: Female internal condoms are fitted inside the vagina before penetration occurs. They are made from a polyurethane material and should be removed immediately following sexual intercourse.  
• Diaphragms and Spermicide: A diaphragm is a barrier method of contraception placed inside the vagina and used alongside spermicide.

Choosing the right birth control pill for you 

Choosing the right birth control pill or other contraceptive option for you comes down to an honest discussion between you and your healthcare practitioner. 

It’s always important to remember that the pill helps prevent pregnancy but does not provide protection against sexually transmitted diseases or infections. As such, using condoms is recommended for everyone.

To determine what method is right for you, you should always provide the following information:

• Your medical history and pre-existing health conditions 
• Your personal health goals 
• Your familial medical history, especially in regards to uterus, cervical, colon, or breast cancer

Questions to ask your healthcare practitioner 

If you are unsure how to approach your healthcare practitioner about your birth control pill options, the best first step is to simply ask questions. 

Here are three important questions to ask regarding birth control pills:

What are the side effects of taking birth control pills?  

Though we have covered the common side effects of birth control pills in this article, speaking about the potential side effects of specific types of pills or brands with your healthcare practitioner is always a good idea. 

Make sure to mention any pre-existing health conditions you experience currently or have experienced in the past, including migraines. People who experience migraines with aura may not be well-suited for certain types of birth control.

Do I need to contact a healthcare practitioner to get birth control pills? 

You should always contact a healthcare practitioner before beginning any new medication. To access any medications discussed in this article, you will need to speak with a healthcare practitioner and receive a formal prescription.

What are generic birth control pills?   

For some women, generic birth control pills can be a more affordable option than name-brand pills. 

The only difference between generic and name-brand pills is the branding — both pills work in the same way and can produce the same benefits and side effects.

Key Takeaways 

Birth control pills can be an excellent prescription for many reasons, from contraception to period management. Talking to a healthcare practitioner is the best way to get a prescription that meets your needs. 

Get started with Felix today to discuss what birth control options may be suitable for you.