Oral contraceptives, commonly known as ‘the Pill’, are among the medicines women use most frequently. Although most well known as a convenient form of birth control, this type of medication is also often prescribed to help women with a variety of other health issues. A General Practitioner and pharmacist share their perspectives on what every woman should know.
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“The Pill is not only for birth control. It can also be used for prevention or treatment of acne, reducing menstrual pain and symptoms of pre-menstrual syndrome, as well as regulating a woman’s menstrual periods,” says pharmacist Prudence Masemola of Medipost Pharmacy, South Africa’s largest national courier pharmacy.
“Oral contraceptives are prescribed to help control physiological hormonal mechanisms in the body, which is why the Pill can be effective for menstrual cycle control, severe painful or heavy periods known as dysmenorrhoea, polycystic ovarian syndrome and endometriosis. It is important to note that these conditions must be managed by a medical practitioner,” says Dr Sharmistha Heeralal, a consultant on the Contro partner doctor network.
Medipost Pharmacy dispenses and delivers medication nationwide across South Africa, including medicines prescribed by Contro’s team of partner doctors.
Masemola adds that most oral contraceptive pills are packaged with a daily calendar to help women keep track of their medication in relation to their monthly cycle. This includes placebo pills, often in a different colour, for a few consecutive days each month to allow the body to release menstrual flow.
“For special occasions, such as a holiday or sports event, women can safely skip their period by not taking the placebo pills and continuing with the active pills instead. Although this should not be done too regularly, it is a very convenient option for those times when you have activities planned that would otherwise be hampered by menstruation,” she says.
Many options for family planning
When it comes to birth control, there are many options available to couples other than oral contraceptives. “Condoms offer the additional benefit of protection against sexually transmitted infections (STIs). Abstaining from sex is the only fully reliable option for preventing pregnancy and transmission of STIs, including HIV,” Masemola says.
“Injectable contraceptives, which are administered at two- or three-monthly intervals depending on which type is prescribed, only contain progesterone alternatives. This is in contrast to the contraceptive pill, which involves both oestrogen and progesterone hormones, and prevents pregnancy more effectively because it includes an additional barrier to falling pregnant,” adds Dr Heeralal.
For longer-term birth control, women can also consider having an intra-uterine device (IUD) fitted, which remains in the uterus, or an implant device, which is inserted into the upper arm and releases small amounts of progesterone to prevent pregnancy. Both of these options can provide up to five years of protection.
“Once the individual feels their family is complete, the couple could consider more permanent surgical options. For women, a procedure called tubal ligation seals the fallopian tubes to prevent pregnancy. A less invasive procedure available to men, known as a vasectomy, prevents the release of sperm to avoid unwanted pregnancy,” Dr Heeralal notes.
Possible side-effects and warnings
“As with any medication, everyone’s experience differs and there are possible side-effects although many will not feel any symptoms at all. The most commonly experienced are nausea, some gastrointestinal disturbances, headaches, weight gain, inter-cyclical spotting or ‘breakthrough bleeding’, pre-menstrual symptoms such as breast tenderness, and missed menstrual periods. Most side effects pass after the first two weeks, however if symptoms persist, the woman should contact her prescribing doctor,” the GP says.
“Any woman who is considering oral contraceptives should also be aware that there is a very small risk of serious side effects relating to conditions caused by blood clots, known as thromboembolic diseases, including potentially increased risk of stroke. Medicine package leaflets contain details of potential risks,” Masemola says.
Pregnancy must be ruled out before a woman starts taking the pill. Women who have a history of thromboembolic disorders, such as deep vein thrombosis or pulmonary embolisms, undiagnosed abnormal genital bleeding, or suffer frequent headaches should make sure their treating doctor is aware of these factors, as this could mean the pill is not the right choice for them. The same applies to women with known or suspected breast or ovarian cancer and oestrogen-related disorders, or a family history of these conditions.
Prescription and compliance
Oral contraceptives are classified as schedule three medicines in South Africa, which means that they are only available with a doctor’s prescription. “It must be noted that compliance is a key factor to this method of contraception being effective. The pill needs to be taken every day, around the same time in order for it to be optimally effective,” Dr Heeralal says.
Contro network doctors can prescribe sexual health medication, including the contraceptive pill, patch and vaginal ring, online via virtual consultations. Opting to have your medicines, such as oral contraceptives, delivered by Medipost Pharmacy means there is no need to visit a pharmacy and wait in queues.
As part of the Contro service, scripts are automatically renewed without the need to consult a doctor in person each time. The partnership with Medipost Pharmacy ensures continuous and hassle-free reliable delivery of your medicines each month at no additional cost, so it is easy to adhere to treatment. As always, patient privacy is paramount so there is no indication on the outer packaging of what the medicine parcels contain, and confidentiality is guaranteed.
“Remember that once you decide to stop taking oral contraceptives, it can sometimes take a few months for your monthly cycle to return to normal and allowing for conception to take place. If pregnancy is not desired, alternative contraceptive methods should be started when you stop taking the pill,” Masemola concludes.