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| |    Birth Control Pills: They've Come a Long Way, Baby by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. The birth control pill first became available to American women in 1960. In those early years, a number of problems, such as blood clots, gave the Pill a bad reputation. But now, four decades later, birth control pills have lower hormone levels and considerably fewer side effects. And research suggests that, in general, the Pill's health benefits outweigh its health risks, making it a good birth control choice for many women. (For up-to-date information about today's pills, see "Myths and Truths about The Pill") What is the Pill? Standard combination oral contraceptives contain both estrogen and progestin in the pills assigned to the first 21 days of each pack. Monophasic pills have the same dose of hormones in every pill, while triphasic pills (which usually have the number 7 or the prefix "tri" in the name) vary the amount of hormone each week. There are no significant differences between the effectiveness and side effects of monophasic and triphasic pills--just personal preference on the part of you or your physician. Most 28-day packs include placebos--pills that don't actually contain any hormones--for the last week. However, some packs now have fewer than seven days' worth of placebos or have added a small amount of estrogen to the last week of pills. This absence, or decrease, in the hormone dose for the last week allows a menstrual period to occur. Your practitioner can tell you more about the specific pill she is prescribing for you. How does the Pill work? The progestin in the Pill prevents ovulation for most women, most of the time. In addition, it makes the cervical mucus impenetrable to sperm and makes the uterine lining too thin to promote implantation of a fertilized egg. The estrogen in the pill also plays a role in preventing ovulation, as well as stabilizing the uterine lining to prevent breakthrough bleeding. In general, the first 21 pills in a pack contain hormones. From day 22 to 28, the hormone levels drop, allowing for menstruation to take place. If you have the type of package that only includes 21 pills, you are supposed to stop taking pills for a week before starting the next pack. It's important to remember to start the next pack on day 29, as the worst pill to miss--in terms of pregnancy risk--is the first pill of a new pack. How effective is it? If you take the Pill exactly according to direction--that is, at the same time every day without missing a single day--it provides 99.9% protection from pregnancy regardless of the brand or dose of combination estrogen-progestin pill. In other words, if 1,000 women are taking the pill perfectly, only one of them will get pregnant in a year of use, making it one of the best methods of contraception around. However, humans are not perfect, and many women do not take the Pill consistently. Typical use of the Pill provides protection more in the neighborhood of 97 percent, meaning that 3 out of 100 women will be pregnant after a year of use. This risk seems to be much higher in teenagers, with as many as 15 percent getting pregnant per year, offering another compelling reason for why sexually active younger women should use condoms in addition to birth control pills. Advantages:
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