Boobs, Blood and Blemishes: Nurse Alex Demystifies the Birth Control Pill

How does the Pill work? Once upon time, I figured that the hormones I was taking somehow sort of targeted and exploded my eggs, kind of like in Angry Birds. Not so!
Publish date:
November 20, 2012
birth control, the pill, women's health, nurse alex

Before I was Nurse Alex, I was an 18-year-old at my doctor’s office, about to go on The Pill for the first time.

Doctor: So, you want the Pill. No problem. Here’s a new brand, it should work pretty well for you.

Me: Okay, great. Thanks. Um. So I just take it every day?

Doctor: Yes, take it at the same time every day. If you forget, well, just read the box. I think then you take two. Anyway, you shouldn’t have any side effects. I just have to warn you that you will be at higher risk for a stroke.

Me: Like, an elderly person type stroke?

Doctor: Yes. It’s rare though. It probably won’t happen to you. Enjoy!

Fast forward to one month later when my normally average B-cup boobs had quickly ballooned to a generous C. Meanwhile, I was simultaneously ravenous and nauseous. “Whaatttt isssss happeninggggg,” I thought to myself nervously.

This experience is quite common among many ladies trying the Pill for the first time. In the realm of reproductive health, horror stories and myths run rampant, and it’s hard to find, access and use reliable women’s health information. Did you guys read this article? Or this article? The main themes that came out of the comments sections of both are how frustrating women find navigating the important world of birth control and side effects, and issues with talking to their health care providers about sexual health.

As women, we are expected to become experts in our own reproductive health, yet for various reasons (including poor sexual health education) we often lack the necessary information to do so. But knowledge (like perfectly applied red lipstick) equals power, amirite?

So I’d like to discuss one of the most controversial topics on xoJane lately: the hormonal oral contraceptive pill, also known as the Pill or the BCP!

The Pill can be a wonderful thing. It revolutionized women’s health when it was invented in the 1960s as it gave women control over their fertility. These days the Pill is more than just birth control: Though it does allow highly effective contraceptive control (up to 99.7% efficacy with perfect use), it can also clear up acne, lighten heavy monthly flow, stabilize pre-menstrual mood swings and drastically reduce menstrual pain and cramping. But it must be said: The Pill is NOT for everyone. It can have seriously disruptive side effects and some people simply can’t tolerate it. That’s fine, too. There exists a veritable smorgasbord of other non-hormonal birth control options as well.

Why would someone go on the Pill? Most obviously, the Pill provides extremely effective protection against pregnancy, which means that we can fornicate happily without worrying about ending up on what I think would be great new MTV reality shows: "Still Afraid of the Dark and Pregnant," "Why Can’t I Ever Find My Keys and Pregnant," and "My Dad Still Does My Taxes and Pregnant." (Actually, I’m pretty sure my dad will always have to do my taxes. Why so complicated?)

Other people do not use the BCP for its pregnancy effects, and instead take it for its desirable side effects: It tends to clear up acne and can reduce severe monthly cramps and headaches. The Pill does NOT protect against STIs, so even pill-takers still need to use barrier protection such as condoms.

How does the Pill work? Once upon time, I figured that the hormones I was taking somehow sort of targeted and exploded my eggs, kind of like in Angry Birds. Not so!

Essentially, taking the BCP maintains a steady level of the hormones estrogen and progesterone in your bloodstream. Ovulation happens to be triggered by a surge of two different hormones (LH and FSH) that stimulate the development and release of the egg. Taking a steady amount of estrogen and progesterone decreases the release of LH and FSH, blocking the hormone surge, and consequently ovulation does not occur. Therefore, even if sperm do make the Olympic journey up your vagina and cross the cervical finish line, there is no egg waiting to offer a fertilization high-five.

Basically, for about three weeks you take the pill every day around the same time (shout-out to my cell phone alarm for the help on this one) to maintain a steady level of hormones in your bloodstream. Then, for one week, you either stop taking the pill or take a placebo, which allows you to have a “false period,” named as such because it is more a withdrawal response to the cessation of hormones than actual uterine shedding. (Side note: calling it a false period is a little like calling Kraft Single’s fake cheese. I mean, it’s still BLOOD right? I still have to spend 15 freaking dollars on tampons each month, right?)

Not all BCPs are made equal. Each has its own unique set of pros and cons.

The combination pill: This is the most common type, and contains both estrogen and progesterone. There are a few different types of combo pills:

  • Monophasic: Each of the active pills contains the same amount of estrogen and progesterone. Usually women try this pill first. These pills are classified by their estrogen levels (kind of like soft drinks): low dose, regular dose, and high dose.
  • Multiphasic: The amount of estrogen, progesterone or both varies in phases in the active pills. In the biphasic BCP, the level of progesterone is altered about halfway during the cycle. Triphasic BCPs contain three different doses of hormones in the three weeks of active pills. Depending on the brand, either the progesterone or estrogen level varies, or both. This pill was developed to lessen the side effects of the monophasic pill and many women (including me) who experienced undesirable side effects on the monophasic pill can take this one. As a fun aside, these ones are quite colorful and pleasing to look at. I like to think of this pill in terms of seasons: Spring! Summer! Fall! And the winter of my menstruation.

The mini pill: All BCPs are actually quite small, so I’m not sure what’s up with the name here. This pill contains only progesterone. It is usually taken by women who can’t take estrogen due to risk of blood clots. Breastfeeding mothers who already have natural pregnancy protection and just need extra security can also use it.

This chart is a pretty useful guide to the brands of pills available and most common side effects. You may need to try several different pills in order to find the one that’s right for you.

Let’s talk side effects. The most serious side effect of the combination BCP is the risk of blood clots, which can then lead to life-threatening complications such as stroke or a pulmonary embolism, which is a clot in the lungs. My doctor was correct though; this complication is extremely rare. However, women over 35 as well as those who smoke already have a higher risk of developing blood clots, and so should be aware of this and perhaps avoid taking the combination pill, or at least talk it over seriously with a doctor.

More common and less serious side effects include breast tenderness, spotting between periods, decreased monthly flow, decreased acne, alleviation of symptoms of polycystic ovarian syndrome and pelvic inflammatory disease, increase in migraine headaches, decrease in menstrual-related headaches, and increase in vaginal lubrication.

Interestingly, several studies have shown that there is no significant link between the low-dose combination pill and weight gain. (Ahem, science, I beg to differ) Depression has been shown to occasionally worsen in some women, especially those with existing mental health issues and those taking the progesterone-only pill. However, some women who report pre-menstrual irritability and moodiness have found that the Pill actually stabilizes their moods. Decreased libido is another oft-cited side effect of the Pill, although several studies have found no change in sexual satisfaction.

In terms of side effects, it is important to remember that every single medication has side effects and we need to weigh the pros and cons of everything we decide to take. For me, the undesirable side effects I experienced on the BCP were the boob boom and weight gain. (Side note: I was also eating an alarming number of “study M&Ms” at the time, so I’m sure the Pill isn’t entirely to blame). However, I saw a dramatic decrease in my previously crime-scene quantity period flow and it alleviated my debilitating cramps, plus my skin cleared up, and OH YEAH NO PREGNANCY. BOOM! For me the benefits largely outweighed (pun intended?) the drawbacks.

I hope this cleared up some of the BCP myths and maybe helped give you some important information to discuss with your doctor if you are unhappy with your pill, thinking about going on the pill, wanting to stop taking the Pill or simply curious. I am a huge women’s health nerd (is it obvious?) and would be happy to write about other health topics as well!

What would you guys like to discuss? Other forms of birth control? Troubleshooting for your vagina? How to get the most from your health care providers? Poop? Seriously, I don’t mind poop that much. It’s only number 4 on “Alex’s Top 10 Grossest Bodily Fluids.”

Alex is a full-time nurse and public health freak. She also volunteers for an organization that works to empower single mothers to access health care resources and advocate for the health of themselves and their children.