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Contraceptive pills

Birth control pills, also known as oral hormonal contraception, are one of the most popular and widely used methods of preventing unplanned pregnancy in the world. These are drugs taken orally, containing synthetic hormones that affect the natural hormonal cycle of a woman, preventing conception. In Poland, as in many other countries, contraceptive pills are available only on a doctor’s prescription, which emphasizes the need for medical consultation before using them, especially in the case of combined contraceptive pills.

How do birth control pills work? Mechanism of protection against pregnancy

The effectiveness of birth control pills is based on a complex mechanism of action, using synthetic equivalents of natural female sex hormones – estrogens and/or progestogens. The most commonly used estrogen is ethinylestradiol or estradiol, while among progestogens there are many substances such as levonorgestrel, drospirenone, dienogest or gestodene. These synthetic hormones affect the female body on several levels, providing multidirectional protection against pregnancy.

Main Mechanism of Action: Inhibition of ovulation

The basic mechanism of action, especially in the case of combined pills, is to block ovulation, i.e. the process of releasing a mature egg from the ovary. Synthetic hormones (estrogen and progestin) inhibit the secretion of hormones by the pituitary gland: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH is responsible for stimulating the maturation of ovarian follicles, and LH induces ovulation. Blocking the secretion of these hormones prevents the ovarian follicles from maturing (including the Graafian follicle) and ovulation does not occur. Without the released egg, fertilization by sperm becomes impossible, which emphasizes the effectiveness of birth control pills in preventing pregnancy.

Additional mechanisms:

In addition to inhibiting ovulation, birth control pills also use other mechanisms that further increase their effectiveness:

1. Cervical mucus thickening: Progestins contained in the pills (both one- and two-component) affect the consistency of the mucus produced by the cervical glands. The mucus becomes thicker, stickier and less permeable to sperm. This acts as a physical barrier that makes it difficult or impossible for sperm to pass through the cervix and into the fallopian tubes, where fertilization could occur. This is the main mechanism of action of single-component tablets.
2. Changes in the endometrium: Hormones (both estrogens and progestogens) affect the structure of the endometrium. The endometrium becomes thinner, less developed and less susceptible to implantation. Even if fertilization occurs, these changes make implantation difficult or impossible, which is an additional protection against pregnancy. These changes also mean that withdrawal bleeding is typically less heavy and shorter than a natural menstrual period.
3. Inhibition of fallopian tube peristalsis: Progestins can also reduce the motility of the fallopian tubes, which further hinders the transport of the egg and sperm.

This multidirectional mechanism of action makes contraceptive pills, when used correctly, one of the most effective reversible methods of preventing pregnancy. Each of these mechanisms is another barrier to the fertilization and implantation process, which in total translates into a very low risk of unplanned pregnancy. The different roles of hormones (estrogen mainly inhibits FSH and stabilizes the endometrium, progestin thickens mucus, inhibits LH and changes the endometrium ) explain why combined pills are so effective and how single-component pills, which rely mainly on the action of progestogen, work.

Types of contraceptive pills: one- vs two-component

There are many types of contraceptive pills available on the market, which differ primarily in their hormonal composition. The basic division distinguishes between two-component and single-component pills. The choice of the right preparation depends on the individual needs, the woman’s health condition and possible contraindications and should be made together with a gynecologist.

Combined tablets (DTA/COC)

These are the most commonly used birth control pills. They contain two types of synthetic hormones: estrogen (most often ethinylestradiol, less often estradiol) and progestin. Their main mechanism of action is to inhibit ovulation.

Combined pills are additionally divided according to the hormone dosage schedule in the cycle:

• Single-phase: Each active tablet in the pack contains the same fixed dose of oestrogen and progestogen. They are simple to use and are often prescribed as the first choice, especially in young women. They are characterized by hormonal stability.
• Two-phase commit: They contain tablets with two different hormonal compositions, usually with a variable dose of progestogen (sometimes also estrogen) in two phases of the cycle. They are designed to better mimic natural hormonal fluctuations. However, they require stricter adherence to the intake regimen, as a delay can more easily reduce effectiveness. The tablets in the blister often vary in colour depending on the phase.
• Three-phase: There are three types of tablets in the package, with different doses of estrogen and progestogen, taken in a specific order. They have the most complex scheme, also designed to mimic the natural cycle. They require very strict adherence to the regimen and are less commonly used, sometimes in perimenopausal women or women who do not tolerate other forms well. The tablets also vary in colour.
• (Four-phase tablets are also mentioned)

Single-component tablets (POPs/mini-pills)

These pills contain only one type of hormone – progestin, in a low dose.

• Mechanism of action: They work mainly by thickening the cervical mucus, which makes it difficult for sperm to reach the egg, and by changing the endometrium, making it unfriendly to implantation. Ovulation inhibition is less constant than with combined pills and occurs in about 50-60% of cycles, depending on the type of progestogen.
• Use: They are taken daily, with no breaks between packs (a blister usually contains 28 tablets). They require very strict adherence to the time of administration – a delay of even a few hours (usually >3 hours, although newer preparations may have a window of 12 hours) can significantly reduce their effectiveness.
• For whom: They are a good choice for women who have contraindications to the use of estrogens. This applies to, m.in, breastfeeding women (estrogens can inhibit lactation), smokers over 35 years of age, women with a history of thromboembolism, certain heart diseases, hypertension or migraines with aura. They may also be suitable for teenage girls due to their milder hormonal profile and safety.

The variety of pills available (combined vs single-component, different phases in combined pills) is not accidental. It reflects the need to individually adjust the method of contraception to the woman’s health, lifestyle and preferences. For example, single-ingredient pills provide a key alternative for women who cannot use estrogen. Multiphasic pills, on the other hand, try to mimic the natural cycle, which for some women may mean better tolerance, but at the expense of having to use it more precisely. This need for strict adherence to the time of administration in the case of mini-pills and multiphasic tablets compared to the greater flexibility of monophasic combined pills (often a permissible delay of 12 hours) shows a compromise between the specificity of the formula (e.g. lower dose of hormones, variable doses) and the ease of use and “forgiveness” of minor mistakes by the user. The final choice should always be made after consultation with a doctor.

The effectiveness of birth control pills: what does the Pearl Index say?

The effectiveness of the contraceptive method is a key factor in its choice. The Pearl index (PI) is commonly used to assess the effectiveness of various methods, including birth control pills.

What is the Pearl Index?

The Pearl Index measures the number of unplanned pregnancies that occurred in 100 women using a given method of contraception for one year. The lower the value of the Pearl index, the more effective the method is considered to be. For example, a PI of 1 means that statistically 1 in 100 women using the method for a year will become pregnant. For comparison, in the absence of any contraception, the Pearl index is as high as 80-90, which shows how high the risk of unprotected pregnancy is.

Ideal Efficiency vs. Typical Efficiency

When assessing the effectiveness of contraceptive methods, especially those dependent on the regularity of use by the user, it is crucial to distinguish between two values of the Pearl index:

1. Ideal Use: It reflects the effectiveness of the method when used perfectly, according to all recommendations (e.g. taking the tablet at the same time every day, no omissions, no interactions).
2. Typical Use Effectiveness: It shows the real effectiveness of the method in everyday life, taking into account the mistakes of users (e.g. forgetting to take a pill, delays in taking it, vomiting, diarrhoea, interactions with other drugs). This value is usually higher (meaning lower efficiency) than for ideal conditions.

Pearl Index for Contraceptive Pills:

• Combined tablets: They are considered to be one of the most effective methods of reversible contraception.
  • Ideal use: The PI is typically between 0.1 and 0.3. This means less than 1 pregnancy per 100 women per year with perfect use.
  • Typical use: The PI is higher and ranges from about 2 to 8 (depending on the source and the population studied). This means that in fact, between 2 and 8 out of 100 women who use this method for a year can become pregnant.
• Single-component tablets (mini-pills): They also show high efficacy, although they are sometimes considered slightly less effective in typical use than combined pills, mainly due to a smaller margin of error in the regularity of intake.
  • Ideal use: The PI is about 0.3 to 0.5.
  • Typical use: The PI ranges from about 0.4 to 5 (or even 7 according to some sources).

The significant difference between ideal and typical efficacy (e.g. PI 0.1 vs 7.6 for combined pills ) clearly shows that the main cause of contraceptive failures in practice is not the unreliability of the method itself when used correctly, but factors related to the user and external circumstances. Errors in use, such as skipping pills , absorption problems (vomiting, diarrhea) or interactions with other substances , are the main reasons why the real effectiveness is lower than theoretical. Therefore, education about the correct use and potential pitfalls is absolutely crucial to achieving the highest possible protection.

Although both groups of pills are highly effective, the slightly wider range and potentially higher upper limit of PI for typical use of mini-pills compared to combined tablets (e.g. ) may reflect their lower tolerance to errors in the intake regimen, which is consistent with the requirement for stricter adherence to the time of use.

How to use birth control pills correctly?

In order for birth control pills to be effective, it is crucial to use them correctly and regularly. Follow your doctor’s instructions and the information in the package leaflet carefully.

Getting started (first packing)

• Optimal start: It is best to start taking the first pill on the first day of the menstrual cycle, i.e. on the day the bleeding starts. This way of starting provides contraceptive protection from the first pill.
• Alternate Start: It is also possible to start taking the tablets between the 2nd and 5th day of the cycle. In this case, however, it is necessary to use an additional method of contraception (e.g. a condom) for the first 7 days of taking the pills, as the protection is not immediate. Starting on a different day of the cycle also requires 7 days of additional protection. In the case of single-component tablets (mini-pills), this period may be shorter (e.g. 2 days), but you should check the leaflet of the specific preparation.
• Special situations: The rules for starting contraception may be different for women changing their contraceptive method, after childbirth or miscarriage. Always consult your doctor.

Daily pill routine

• Regularity: Take one tablet each day, at approximately the same time. Maintaining a constant level of hormones in the blood is crucial for effectiveness. Even a delay of a few hours can reduce the effectiveness, especially in the case of mini-pills.
• Time of day: The choice of time of day (morning or evening) is not essential for effectiveness, regularity is important. It is worth choosing a time that best suits your daily schedule and is easy to remember (e.g. when brushing your teeth, before bedtime).
• Order: Take the tablets in the order shown on the blister (often marked with arrows or days of the week). This is especially important for multiphasic pills, but it also helps to track the regularity of intake for monophasic pills.
• Memory Support: To avoid missing a pill, you can set a daily reminder on your phone, use special mobile apps, or combine taking a pill with another regular activity during the day. It is also worth marking the start and end days of the packaging and breaks in the calendar.

Dosage regimens

There are several regimens for taking the pills, depending on the type of preparation:

• Scheme 21+7 (for combined tablets): It involves taking one active pill (containing hormones) every day for 21 days, followed by a 7-day break during which you do not take the pills. During this break, there is usually withdrawal bleeding, resembling menstruation. You start taking the tablets from the new pack on the eighth day, regardless of whether the bleeding has stopped. Some of the preparations in this regimen contain 21 active pills and 7 placebo tablets (without hormones) to keep the daily pill intake.
• Scheme 24+4 (for combined tablets): It consists of taking 24 active tablets followed by 4 placebo tablets. This regimen reduces the hormone-free period to 4 days. This has several potential advantages: it can reduce symptoms associated with hormone withdrawal (headaches, stomach aches, mood swings, so-called PMS-like symptoms), cause shorter and less heavy withdrawal bleeding, and facilitate regularity, because the pills are taken every day without a break in counting the days. Shortening the hormonal gap can also theoretically increase contraceptive effectiveness by reducing the risk of ovulation “escaping”.
• Continuous regimen (for single-component tablets and some combined tablets): Mono-component tablets (mini-pills) are taken continuously, every day, without any breaks between packs (the blister contains 28 active tablets). Also combined tablets can be used continuously or prolonged (e.g. for several cycles without a break, 84+7 regimen), omitting breaks for withdrawal bleeding. This use avoids bleeding, which can be beneficial for women with painful periods, endometriosis, or just for convenience. Continuous use should be consulted with a doctor. It is usually recommended not to skip the break for more than 3 consecutive cycles due to the risk of mid-cycle spotting.

The availability of different dosage regimens (21+7, 24+4, continuous) testifies to the evolution of the approach to hormonal contraception. It offers women more flexibility and the ability to adapt the method not only to their contraceptive needs, but also to manage their cycle symptoms. The 24+4 and continuous regimens challenge the historical assumption that monthly withdrawal bleeding is medically necessary while using contraception , giving women more control over their cycle.

The pressure to take the pills at the same time every day is not accidental. This is crucial for maintaining stable blood hormone levels, which is essential for continuously inhibiting ovulation and maintaining changes in cervical mucus. Fluctuations in hormone levels, caused by irregular intake, can weaken these mechanisms and increase the risk of pregnancy , especially with pills with a lower dose or shorter half-life, like mini-pills.

Missing the contraceptive pill – what to do?

Skipping the contraceptive pill is a common mistake and can lead to a decrease in the effectiveness of protection against pregnancy. The procedure in this situation depends on several factors: the type of tablets you are taking (mono- or combined), the number of tablets you missed, and the week of the cycle in which you missed. The most important thing is to always check the exact instructions in the package insert of the specific preparation.

What to do if you miss a TWO-COMPONENT tablet:

• Delay LESS than 12 hours:
  • Take the forgotten tablet as soon as possible.
  • Take the next tablet at the usual time.
  • Contraceptive effectiveness is maintained, there is no need for additional protection.
• Delay MORE than 12 hours (or missing a whole one tablet):
  • Take the last missed tablet as soon as possible, even if it means taking two tablets on the same day. Previously missed tablets (if there were more of them) should not be taken.
  • Continue to take the remaining tablets in the pack at the usual time.
  • You should use an additional method of contraception (e.g. a condom) for the next 7 days.
  • Additional rules depending on the week of skipping:
    • Week 1 (Days 1-7): Proceed as above (take the missed tablet, continue packing, use additional protection for 7 days). The risk of pregnancy is increased in this case, especially if intercourse took place in the week before the omission (or during the break). Consideration should be given to emergency contraception (the morning-after pill). It is advisable to consult a doctor before starting to take contraceptive pills.
    • Week 2 (Days 8-14): Proceed as above (take the missed tablet, continue packing, use additional protection for 7 days). If you have taken your pills correctly in the 7 days before you miss, you will probably have contraceptive protection, but extra protection is often recommended to be sure.
    • Week 3 (days 15-21 in the 21+7 scheme or days 15-24 in the 24+4 scheme): There are two options to proceed to stay protected:
      1. Take the missed tablet as soon as possible, finish taking the active tablets from the current pack, then skip the 7-day break (or skip the placebo pills) and start taking the tablets from the new pack straight away. In this case, withdrawal bleeding will not occur or spotting may occur when taking the second pack.
      2. Immediately stop taking the tablets from the current pack and start a 7-day break (counting the day you missed a pill as the first day of the break). The break cannot last longer than 7 days. After the break, start a new packing. The choice of options depends on the recommendations in the leaflet; Option 1 is often preferred if there have been mistakes in taking the pills before. If you have taken your tablets correctly within 7 days before you miss, option 2 does not require additional protection. If there were errors, when choosing option 1, additional protection should be used for 7 days.
• If you forget MORE THAN ONE active tablet:
  • The risk of pregnancy is significantly increased.
  • Take the last missed tablet as soon as possible. Any other forgotten tablets should be discarded.
  • Continue to take the tablets from the current pack at the usual time.
  • You should use an additional method of contraception for at least 7 consecutive days.
  • Consult your doctor. In the event of intercourse during the period of missed pills, emergency contraception should be considered.

What to do if you forget a SINGLE-COMPONENT tablet (Mini-pill):

• The time window for delay is much shorter than with combined pills. It is usually only 3 hours from the fixed time of intake. Some newer preparations (e.g. with desogestrel) may allow a delay of up to 12 hours – be sure to check the leaflet!
• Delay WITHIN the allowed time window (e.g. <3h):
  • Take the forgotten tablet as soon as possible.
  • Take the next tablet at the usual time.
  • Contraceptive protection is maintained.
• Opóźnienie POZA dozwolonym oknem czasowym (np. >3h):
  • Take the missed tablet as soon as possible, even if it means taking two tablets close together.
  • Take the next tablets at the usual time.
  • Contraceptive effectiveness may be reduced. You should use an additional method of contraception (e.g. a condom) for the next 2 days or 7 days – check the leaflet of your preparation! For desogestrel tablets (if 12 hours delay >), 7 days of additional protection is recommended.
  • If you have had unprotected sex before or after missing a pill, emergency contraception should be considered.

Emergency contraception (“morning-after pill”)

For emergencies, such as missing a pill and having unprotected sex, emergency contraception is available, which may contain progesterone. There are preparations containing levonorgestrel (e.g. Escapelle, Livopill – effective up to 72 hours after intercourse) and ulipristal acetate (e.g. ellaOne – effective up to 120 hours after intercourse). They work mainly by delaying or inhibiting ovulation. These pills are available only on prescription. Keep in mind that ellaOne may interact with permanent hormonal contraception, so after taking it, you may need to use additional methods until the end of the cycle and consult your doctor.

The complexity of the rules of conduct in the event of a missed pill, especially depending on the week of cycle with combined pills, illustrates the importance of the human factor in the effectiveness of this method. The need to remember and correctly apply these rules in a stressful situation (realizing the mistake) is one of the main reasons for the difference between the ideal and typical effectiveness of oral contraception. Long-acting methods, such as implants or intrauterine devices, eliminate this problem, as they do not require daily memory and discipline from the user.

The recommendation to use additional protection for 7 days after most cases of missing a combined pill is due to the time it takes the body to regain stable hormone levels, which will ensure effective blocking of ovulation and/or adequate thickening of mucus after a temporary drop in hormone levels. This 7-day period ensures continuous protection until the pill’s contraceptive mechanisms are fully restored.

What reduces the effectiveness of birth control pills?

In addition to missing a pill, there are a number of other factors that can weaken the effect of hormonal contraception and increase the risk of an unplanned pregnancy. Women using the pill should be aware of these potential interactions and situations.

Drug Interactions

Some medicines may interact with the hormones in the contraceptive pill, mainly by accelerating their metabolism in the liver (induction of liver enzymes) or impaired absorption from the gastrointestinal tract. Always tell your doctor prescribing other medicines about the use of hormonal contraception.

Medications that may reduce the effectiveness of contraception include:

• Antibiotics:
  • Rifampicin and rifabutin (used to treat tuberculosis): They have a proven effect of weakening the effectiveness of contraception through strong induction of liver enzymes. It is necessary to use an additional method of contraception during therapy and for some time after its completion.
  • Other antibiotics (e.g. penicillins – amoxicillin; tetracyclines – doxycycline; macrolides – clarithromycin; cephalosporins; quinolones – ciprofloxacin; metronidazole): Evidence for their direct effect on the effectiveness of contraception (other than rifamycins) is limited and often contradictory. The theoretical mechanism may be a disruption of the intestinal bacterial flora, which affects the absorption or circulation of hepatointestinal hormones. Many experts, due to the lack of sufficient research and potential risks, recommend the use of an additional method of contraception (e.g. a condom) during antibiotic therapy and for 7 days after its completion. This caution stems from scientific uncertainty and the desire to minimize the risk of contraceptive failure.
• Antiepileptic drugs: Phenytoin, carbamazepine, barbiturates (e.g. phenobarbital), primidone, topiramate, oxcarbazepine, felbamate, cenobamate. They act mainly as inducers of liver enzymes.
• Antifungal: Griseofulvin. Interactions with other antifungal drugs (e.g. ketoconazole, fluconazole, itraconazole) are more complex – some may even increase hormone levels.
• Antiviral medicines (used to treat HIV/HCV): Protease inhibitors (e.g., ritonavir, nelfinavir) and non-nucleoside reverse transcriptase inhibitors (e.g., nevirapine, efavirenz). Some newer medicines used to treat hepatitis C (e.g. paritaprevir, ombitasvir, dasabuvir) may also interact.
• Antidepressants: Some can potentially interact, but the data is less clear. It is always a good idea to inform your doctor.
• Acetaminophen: Taking high doses (above 3 g per day) can potentially affect hormone metabolism.
• Modafinil (a drug used to treat narcolepsy): It is an inducer of liver enzymes. It requires additional protection during therapy and for 2 months after its completion.
• Laxatives: When used in excess or in a short period of time after taking tablets, they can speed up intestinal transit and prevent full absorption of hormones. Drugs that accelerate intestinal peristalsis (e.g. metoclopramide) have a similar effect.
• Orlistat (a medicine used to treat obesity): It can cause diarrhea and impair absorption.
• Ulipristal acetate (ingredient in some morning-after tablets, e.g. ellaOne): It can weaken the effect of regular hormonal contraception.

Herbs and Dietary Supplements

Certain herbs and supplements can also affect the effectiveness of the pills:

• St. John’s wort (Hypericum perforatum): It is a strong inducer of liver enzymes and significantly reduces the effectiveness of hormonal contraception. Preparations containing St. John’s wort (teas, tablets) should be avoided while using contraception.
• Other herbs: Chinese angelica (Dong Quai), black cohosh (Black Cohosh), licorice, senna, buckthorn, psyllium – may interact by affecting hormones, laxative effects or other mechanisms. Be careful and consult the use of herbs with your doctor. Horsetail, nettle, mint and chamomile seem to be safe.
• Vitamin C: Taking very high doses (above 1000 mg per day) has the potential to affect estrogen metabolism, although the mechanism and clinical significance are not fully clear. Vitamin C should be included both from supplements and from the diet (juices, fruits).
• Activated carbon (medicinal) / Diosmectite (e.g. Smecta): They can adsorb (bind) hormones in the digestive tract, preventing them from being absorbed. There should be at least a 2-4 hour interval between taking these preparations and the contraceptive pill.
• Chromium/Iron: Some preparations with chromium or iron have the potential to reduce the absorption of tablet ingredients. It is recommended to keep a time interval.

Gastrointestinal problems

• Vomiting or severe diarrhoea: If they occur within 3-4 hours of taking the tablet, there is a risk that the hormones have not had time to be absorbed. Proceed as if you missed a tablet, take an extra tablet from a spare blister pack (if possible) and use the extra precautionary care for 7 days. Severe diarrhea is usually defined as at least 3 loose, watery stools per day. A single loose stool 4 hours after taking the tablet does not affect its effectiveness.

Alcohol

• Alcohol itself does not interact directly with hormones and does not reduce the effectiveness of the pills.
• However, excessive alcohol consumption can lead to vomiting (which prevents you from absorbing the tablet) or forgetting to take your tablet at the same time. In addition, combining alcohol and birth control pills can put an additional strain on the liver.

Body Weight (BMI)

• There are some concerns and studies suggesting that women who are severely overweight or obese (BMI > 25 kg/m² or > 30 kg/m²) may be slightly reduced in the effectiveness of standard doses of hormones in birth control pills. This may be due to changes in the metabolism or distribution of hormones in the body. In such cases, the doctor may consider using preparations with a higher dose of hormones.
• However, other studies, especially on newer, low-dose preparations, have not shown a significant effect of body weight on contraceptive effectiveness. Guidelines of scientific societies (e.g. PTGiP) classify obesity (BMI > 35) as a contraindication to the use of combined tablets (risk category 4) mainly due to a significantly increased risk of thromboembolic complications, and not necessarily due to a lack of effectiveness. This issue requires further examination and individual evaluation by a doctor.

Foods

• Grapefruit and grapefruit juice: They can inhibit the action of certain liver enzymes (CYP3A4) responsible for hormone metabolism. Paradoxically, this can lead to an increase in the concentration of hormones in the blood and an increase in side effects, rather than a decrease in effectiveness. Still, due to the complexity of the interactions, it is often recommended to avoid grapefruit consumption or to keep a 2-4 hour interval from taking a tablet. Other citrus juices can have a similar effect. The safest way is to wash down the tablet with water.
• Foods rich in vitamin C may support health while taking birth control pills. As mentioned, a very high intake of vitamin C (above 1000 mg/day) can theoretically interact.

Such a long list of potential interactions and factors that weaken the effects of the pills emphasizes that maintaining their full effectiveness requires more than just remembering to take a pill every day. It is necessary to be aware of your own health, diet, medications taken (even over-the-counter) and supplements. Open and regular communication with your doctor or pharmacist about any changes in your health or the preparations you are taking becomes crucial.

Side effects of birth control pills: from mild to severe

Like any medicine, birth control pills can cause side effects. Many of them are mild and temporary, disappearing spontaneously after the first few months of use (the period of adaptation of the body). However, some side effects can be serious and require immediate medical attention. The response to hormones is individual and depends on many factors, including the type of preparation, the dose of hormones, the woman’s age, health and lifestyle.

Common and Mild Side Effects (usually at the beginning of use):

• Nausea, vomiting: More often associated with the estrogen component, they may disappear after a few weeks. Taking the pill with food or before bed can help.
• Headaches, migraines: They can appear or intensify, but in some women, the pills can even relieve migraines. Migraine with aura is a contraindication to the use of combined pills.
• Tenderness, pain, breast enlargement: The result of hormones. It usually goes away after a few cycles.
• Mood changes: Mood swings, irritability, nervousness, depressed mood and even depressive symptoms. The risk may be higher in women with a history of mood disorders.
• Spotting and mid-cycle bleeding: Irregular bleeding or spotting between withdrawal bleeding. More common in the first 3 months of use and with single-component tablets or with a very low dose of hormones. They usually disappear on their own.
• Changes in libido: A decrease in sex drive is most commonly reported, but reactions can vary.
• Skin lesions: In some women, acne and seborrhea may appear or intensify, although pills (especially those with antiandrogenic properties) often improve the condition of the skin.
• Water retention: It can lead to a feeling of swelling, bloating and a slight weight gain (usually 1-2 kg). More commonly associated with estrogen, combined birth control pills affect the menstrual cycle.
• Changes in vaginal secretions, increased susceptibility to vaginal yeast infection (candidiasis).
• Hypersensitivity to light, difficulty wearing contact lenses.

Rare but Serious Side Effects (requiring urgent medical consultation):

• Choroba zakrzepowo-zatorowa (ŻChZZ/VTE) jest szczególnie istotna w kontekście przyjmowania tabletek antykoncepcyjnych. Jest to najpoważniejsze, choć rzadkie, powikłanie związane głównie z tabletkami dwuskładnikowymi (zawierającymi estrogeny). Obejmuje zakrzepicę żył głębokich (DVT), najczęściej w nogach, oraz zatorowość płucną (PE), która może być śmiertelna. Ryzyko jest podwyższone kilkukrotnie w porównaniu do kobiet nie stosujących antykoncepcji, ale bezwzględna liczba przypadków jest niska u młodych, zdrowych kobiet. Ryzyko znacznie wzrasta przy obecności dodatkowych czynników, takich jak: wiek powyżej 35-40 lat, palenie papierosów, otyłość (BMI > 30-35), osobista lub rodzinna historia zakrzepicy, długotrwałe unieruchomienie, niektóre operacje, wrodzone zaburzenia krzepnięcia (trombofilia). Ryzyko jest najwyższe w pierwszym roku stosowania.
  • DVT alarm symptoms: Pain, swelling, redness, increased warmth of one leg (usually the calf).
  • PE alarm symptoms: Sudden shortness of breath, chest pain (especially when breathing), cough (sometimes with hemoptysis), rapid heartbeat.
• Arterial thrombosis (heart attack, stroke) may be associated with taking birth control pills. The risk is also slightly increased, especially in women with risk factors (smoking, hypertension, diabetes, migraine with aura, hyperlipidemia).
  • Stroke alarm symptoms: Sudden, severe headache, visual disturbances, speech disturbances, paresis or numbness of half of the body, balance disorders.
  • Alarm symptoms of a heart attack: Severe chest pain or tightness (may radiate to the shoulder, neck, jaw), shortness of breath, nausea, sweating, anxiety.
• Hypertension: The pills can cause an increase in blood pressure. Regular pressure measurements are necessary.
• Liver diseases: Very rarely, benign liver tumours (adenomas) or other problems may occur.
• Gallstones: The risk may be slightly increased.
• Cancers: As mentioned in the benefits section, the pills reduce the risk of ovarian and endometrial cancers. However, some studies suggest a small increase in the risk of breast cancer and cervical cancer with long-term use. The relationship with cervical cancer may be indirect (related to risk factors for HPV infection). Regular preventive examinations (cytology, breast examination) are necessary.
• Ovarian cyst: Single-component pills may slightly increase the risk of ovarian functional cysts.

The benefit-risk assessment of hormonal contraception is highly individualised. Although serious complications such as thrombosis are absolutely rare in young, healthy non-smoking women, the relative increase in risk is significant. That is why it is so crucial to carefully collect the medical history and assess individual risk factors (smoking, obesity, age, family history, other diseases) before prescribing pills, especially combined pills.

Many common, mild side effects (spotting, nausea, headaches, mood swings, breast tenderness) are temporary and often disappear after the first 1-3 months of use, as the body adapts to the new hormonal state. However, if these symptoms are very severe or persist for a longer time, it is advisable to consult a doctor in order to possibly change the preparation to another one with a different composition or dose of hormones.

Post-contraceptive benefits: what else do pills do?

In addition to its primary function of preventing pregnancy, birth control pills (especially combined pills) offer a number of additional health benefits that can significantly improve the quality of life for many women.

• Menstrual cycle regulation: The pills provide regular, predictable withdrawal bleeding, which is helpful for women with irregular periods.
• Reduction of the abundance and soreness of menstruation: Withdrawal bleeding is typically shorter, less heavy, and less painful than natural menstruation. Reducing blood loss reduces the risk of iron deficiency anaemia.
• Relief of premenstrual syndrome (PMS) symptoms: Stabilizing hormone levels helps reduce mood swings, irritability, headaches, breast tenderness, and bloating associated with PMS.
• Improvement of skin condition: Many combined tablets, especially those containing progestins with antiandrogenic activity (e.g. drospirenone, cyproterone acetate, dienogest, chlormadinone acetate), effectively treat hormonal acne and reduce seborrhea. However, it should be remembered that single-ingredient pills can exacerbate skin problems in some women.
• Treatment of hirsutism: Reduction of excessive male pattern hair (e.g. face, chest) in women with hormonal disorders such as polycystic ovary syndrome (PCOS).
• Reducing the risk of certain malignancies: This is one of the most important long-term benefits. The use of combined pills significantly reduces the risk of ovarian cancer and endometrial cancer. The protective effect is long-lasting and lasts for many years after you stop using the pills. The mechanism is probably based on the inhibition of ovulation (which reduces the “wear” of the ovary) and the action of progestogen inhibiting endometrial growth. Some studies also indicate a reduced risk of colorectal cancer.
• Reducing the risk of ovarian functional cysts: Inhibiting ovulation prevents the formation of these types of benign changes.
• Treatment of endometriosis and adenomyosis: Contraceptive pills (especially when used continuously) can inhibit the growth of endometriosis foci and alleviate the associated pain.
• Treatment of polycystic ovary syndrome (PCOS) symptoms: They help regulate menstrual cycles and alleviate the symptoms of hyperandrogenism (acne, hirsutism).

These significant post-contraceptive benefits, especially long-term protection against ovarian and endometrial cancer, are an important part of the benefit-risk balance of hormonal contraception. They are often underestimated in public discussions, which focus mainly on the risks associated with taking birth control pills. Reducing the incidence of these serious cancers is a significant public health advantage.

In addition, the use of birth control pills to treat conditions such as acne, PMS, painful menstruation or PCOS shows their wide therapeutic use in gynecology. For many women, the ability to simultaneously prevent pregnancy and alleviate bothersome disease symptoms significantly improves the quality of life. This dual function – contraceptive and therapeutic – makes the pill a valuable tool in women’s health care.

Contraindications: Who should not use birth control pills?

Hormonal contraception, despite its many advantages, is not suitable for every woman. There are a number of contraindications, i.e. health conditions or risk factors that exclude or limit the possibility of safe use of contraceptive pills, especially those containing estrogens (two-component). Before starting to use hormonal contraception, it is absolutely necessary to consult a doctor who will conduct a thorough medical history, examination and assess individual risks.

The World Health Organization (WHO) and scientific societies, such as the Polish Society of Gynaecologists and Obstetricians (PTGiP), have developed criteria for medical qualification for the use of contraceptive methods, dividing contraindications into risk categories. Category 4 means an absolute contraindication (the risk is unacceptable) and category 3 means a relative contraindication (the risk usually outweighs the benefits, the use requires special caution and close medical supervision).

Absolute Contraindications to the Use of Combined Tablets (WHO/PTGiP Category 4):

• Pregnancy or suspected pregnancy.
• Thromboembolism (venous or arterial):
  • Current or history of deep vein thrombosis (DVT) or pulmonary embolism (PE).
  • A history of stroke, myocardial infarction, ischemic heart disease, angina.
  • Known thrombophilia (congenital or acquired coagulation disorders), e.g. deficiency of antithrombin III, protein C, protein S, Leiden mutation of factor V, presence of antiphospholipid antibodies.
  • Multiple risk factors for thromboembolism at the same time.
• Cardiovascular diseases:
  • Poorly controlled or severe hypertension (e.g. >160/100 mmHg).
  • Diabetes with vascular complications (nephropathy, retinopathy, neuropathy) or lasting more than 20 years.
  • Most valvular heart defects, cardiomyopathies, cardiac arrhythmias (e.g. atrial fibrillation), pulmonary hypertension.
• Hormone-dependent cancers:
  • Current or history of breast cancer.
  • Other estrogen-dependent cancers (e.g. endometrial cancer).
  • Pituitary tumors.
• Severe liver disease:
  • Active hepatitis, cirrhosis, severe hepatic failure.
  • Liver tumors (benign or malignant).
  • A history of cholestatic jaundice during pregnancy or during previous use of hormonal contraception may affect the decision to take contraceptive pills.
• Migraine with aura: Regardless of age.
• Smoking: In women aged 35 years and older (especially those who >smoke 15 cigarettes a day).
• Unexplained vaginal bleeding: Until the cause is determined.
• Breastfeeding period: During the first 6 weeks after delivery.
• Long-term immobilization: For example, single-component contraceptive pills contain progesterone. after major surgical operations, injuries to the lower limbs. Contraception should be discontinued 4 weeks before elective surgery and resumed 2 weeks after full mobility has been restored.
• Obesity: BMI > 35 kg/m² (according to PTGiP).
• Other rarer conditions: E.g., severe systemic lupus erythematosus, severe hypertriglyceridemia with a history of pancreatitis, porphyria, eye diseases of vascular origin.

Relative Contraindications to the Use of Combined Tablets (WHO/PTGiP Category 3):

In these situations, the risks of the tablets are elevated and usually outweigh the benefits, but use may be considered under close medical supervision if other methods are unavailable or unacceptable. Examples:

• Age >35 years and smoking <15 cigarettes a day.
• Pharmacologically controlled hypertension or values of 140-159/90-99 mmHg.
• Obesity (BMI 30-34.9 kg/m²).
• Migraine without aura in women >35 years old.
• Diabetes without vascular complications.
• Thromboembolism in first-degree relatives.
• Symptomatic gallstones.
• Taking certain medications (e.g. lamotrigine).
• Breastfeeding period between 6 weeks and 6 months after delivery.

Contraindications to the Use of Single-Component Tablets (Mini-Pills):

Mini-pills have far fewer contraindications than combined pills because they do not contain estrogen. The main contraindications are:

• Current breast cancer.
• Severe, decompensated liver disease (e.g., cirrhosis, liver tumors).
• Unexplained vaginal bleeding.
• Caution is advised in women with a history of ectopic pregnancy or ovarian cysts.

Such an extensive list of contraindications, especially for combined pills, clearly proves that hormonal contraception is a medical intervention with potential risks that must be carefully assessed individually for each patient. It is not a universal method and requires professional medical evaluation. Risk categorisation system (e.g. health effects associated with regular use of birth control pills). WHO/PTGiP ) allows doctors to make more nuanced decisions, allowing contraception to be used even with certain risk factors (category 3), but provided close monitoring and awareness of potential risks. This highlights the danger of choosing or getting pills on your own without medical consultation.

Myths and Facts About the Contraceptive Pill

Many myths and misunderstandings have arisen around birth control pills that can cause unnecessary fear or lead to wrong decisions. It is important to separate medical facts from common, often untrue beliefs.

Myth 1: Birth control pills cause significant weight gain.

• Fact: The effectiveness of combined contraceptive pills is high when used correctly. Large-scale scientific studies generally confirm the effectiveness of birth control pills in preventing pregnancy. do not confirm that modern, low-dose contraceptive pills are the direct cause of significant weight gain in most women. Some women may experience slight fluctuations in weight (usually 1-2 kg), which is often related to water retention in the body (estrogen effect) or a possible increase in appetite. These effects are often temporary and individual. Lifestyle, diet and physical activity continue to play a key role in maintaining a healthy body weight. If the weight gain is significant or worrying, you should consult a doctor for a possible change in the preparation.

Myth 2: Birth control pills cause permanent infertility.

• Fact: This is one of the most common and harmful myths. Hormonal contraception causes temporary and completely reversible infertility, only during the period of its use. After stopping the pills, fertility usually returns to normal quickly – in many women, ovulation occurs in the first cycle after discontinuation, and most are able to get pregnant within a few months (e.g. 50% within 3 months, over 80% within a year). Problems with getting pregnant after stopping the pill are most often due to other reasons, such as a natural decline in fertility related to the woman’s age, pre-existing health problems (e.g. PCOS, endometriosis, which the pills may have masked) or problems with the partner’s fertility. The pills do not “destroy” fertility. Interestingly, immediately after stopping the pills, there may be a temporary increase in fertility and a slightly higher chance of multiple pregnancy.

Myth 3: You need to take regular breaks from taking pills to “cleanse your body”.

• Fact: From a medical point of view, there is no need to take periodic breaks (e.g. every few months or years) in the use of hormonal contraception in order to “rest” or “cleanse” the body. The hormones in the pills do not accumulate in the body and are metabolized quickly after discontinuation. Such unjustified breaks do not bring any health benefits, on the contrary – they increase the risk of unplanned pregnancy and may cause the recurrence of side effects after resumption of therapy. Hormonal contraception can be safely used for many years without interruptions, unless there are medical contraindications. Breaks are only recommended in certain medical situations or at the request of the patient (e.g. planning a pregnancy). Also, a 7-day break in the 21+7 regimen is not necessary for health and can be skipped (continuous use), which can be beneficial.

Myth 4: Birth control pills always cause cancer.

• Fact: The relationship between hormonal contraception and cancer is complex and ambiguous. Combined pills significantly reduce the risk of ovarian cancer and endometrial (endometrium) cancer . This protective effect is long-lasting. On the other hand, some studies indicate a slight increase in the risk of breast cancer and cervical cancer with long-term use. However, the risk of cervical cancer is strongly associated with HPV infection, and the role of pills may be indirect. The overall balance of the effect on cancer risk requires taking into account both the benefits (reduction of the risk of ovarian and endometrial cancer) and the potential slight increase in the risk of other cancers associated with taking the contraceptive pill. Regular preventive examinations (cytology, breast examination) are crucial for all women, regardless of the use of contraception.

Myth 5: Hormonal contraception protects against sexually transmitted diseases (STIs).

• Fact: This is absolutely untrue. Birth control pills do not offer any protection against sexually transmitted infections such as HIV, chlamydia, syphilis, gonorrhea, HPV or herpes. The only effective method of protection against STI is the use of barrier methods of contraception, primarily condoms, but it is also worth considering taking birth control pills.

Myth 6: Bleeding during a 7-day break is a normal menstrual period.

• Fact: Bleeding that occurs during a break in taking active pills (or when taking placebo pills) is not a physiological menstrual period, but a so-called withdrawal bleeding. It is caused by a decrease in the level of hormones in the blood after their external supply is stopped. It is usually less heavy, shorter and less painful than natural menstruation. Lack of ovulation while using the pills means that it is not a natural cycle.

Myth 7: Birth control pills always lower libido, which is not true, especially in the case of single-component birth control pills.

• Fact: A decrease in libido is one of the possible reported side effects of hormonal contraception in some women. This may be related to the effects of hormones on testosterone levels or mood. However, this is not a rule – many women do not experience changes in libido, and some even report an improvement (e.g. due to less fear of pregnancy). The reaction is individual. If a decrease in libido is a problem, it is worth talking to your doctor about the possibility of changing the preparation to a different one.

Myth 8: After stopping the pills, you have to wait a few months before trying to get pregnant.

• Fact: This is another common myth. There are no medical contraindications to trying for a baby immediately after stopping contraceptive pills. Fertility can return very quickly, even in the first cycle after discontinuing use. Although in some women the full regularity of the cycle may return after a few months, there is no evidence that waiting improves the chances of a healthy pregnancy.

Established myths often result from outdated information about older generations of pills, misunderstanding of the physiology of the cycle and the effects of hormones, or confusing correlation with causation (e.g. attributing fertility problems to pills, which in fact result from age). Confronting these myths with reliable medical knowledge is crucial for making informed decisions and reducing unfounded fears.

Discontinuation of birth control pills: what next?

The decision to stop using contraceptive pills may result from various reasons: the desire to get pregnant, the planned change of contraceptive method, the appearance of medical contraindications, the occurrence of troublesome side effects or simply a personal decision of the woman.

How to stop taking the pills?

It is usually recommended to finish the current pack of active pills to avoid irregular bleeding and to help predict the date of the next natural cycle. Once you have finished the active tablets (or the entire placebo pill blister), you simply do not start another pack. If the decision to stop is made during the cycle or for medical reasons, it is worth consulting a doctor.

Possible effects of discontinuation of the pills

After stopping taking the pills, the body gradually returns to its natural hormonal rhythm. This process is individual and may be associated with some temporary symptoms.

• Return of the natural menstrual cycle: The first bleeding after the end of the pack is still withdrawal bleeding. Subsequent bleeding will be natural menstruation, preceded by ovulation. It may take from one to even several (e.g. 3-6) months for regular cycles to return. Temporary irregularities or even amenorrhea for a period of time are possible. If menstruation does not occur for more than 3-6 months, a medical consultation is advisable to rule out pregnancy or other causes.
• Return of symptoms from before contraception: If the pills have been used to relieve symptoms such as painful or heavy periods, irregular cycles, acne or PMS symptoms, these symptoms may return after stopping the pills.
• Skin and hair lesions: There may be a return or worsening of skin problems (acne, seborrhea) and increased oiliness or hair loss when the natural hormonal balance (including androgen levels) is restored.
• Mood changes: During the period of adaptation of the body, mood swings may occur.
• Changes in libido: If libido was lowered while taking the pills, an increase in libido is often observed after discontinuing them. The natural lubrication of the vagina can also improve.
• Weight changes: There may be a slight weight loss associated with the loss of previously retained water. However, this is not fat loss.
• Changes in the breasts: There may be a decrease in breast volume and the resolution of tenderness associated with water retention.

The return of fertility

As already mentioned, fertility returns relatively quickly after stopping the contraceptive pill. Ovulation can occur as early as the first cycle after stopping taking the pills, which means that pregnancy is possible immediately. Statistics show that about half of women get pregnant within the first 3 months of trying after stopping the pills, and the majority (over 80%) within a year. The time it takes to get pregnant is comparable to the time it takes for women who have never used hormonal contraception, after adjusting for age.

Planning a Pregnancy After Stopping Pills

If the goal of stopping the pills is to get pregnant, it is worth taking some preparatory steps:

• Consultation with a doctor: Discussing plans with a gynecologist.
• Folic acid supplementation: Starting supplementation at least one month before the planned conception and continuing it in early pregnancy to prevent neural tube defects in the fetus.
• Research: Performing basic follow-up tests (e.g. blood count, general urine test, cytology, gynaecological ultrasound).
• Healthy lifestyle: Introduction of a balanced diet, regular physical activity, giving up stimulants (alcohol, cigarettes).

Most of the symptoms associated with withdrawal from the pills are temporary and disappear as the natural hormonal cycle stabilizes. However, if worrying symptoms appear or the cycle does not return to normal for a long time, you should consult a doctor.

Comparison with Other Hormonal Contraceptive Methods

Birth control pills are only one of many available methods of hormonal contraception. They differ in the method of administration, frequency of use, and sometimes also in hormonal composition and the profile of effectiveness and side effects. The choice of method should be tailored to the individual needs and preferences of the woman, after consultation with a doctor.

Here is a brief comparison of the pills with other popular hormonal methods:

• Contraceptive patches are an alternative to single-component contraceptive pills.
  • Description: A transcutaneous system that releases estrogen and progestin. The patch is applied to the skin (e.g. abdomen, buttock, arm) once a week for 3 weeks, followed by a 7-day break for bleeding.
  • Advantages: Convenience of use (change only once a week), bypassing the gastrointestinal tract (effectiveness independent of vomiting/diarrhea).
  • Disadvantages: There may be a visible risk of detachment (although rare), possible skin reactions at the site of adhesion, effectiveness may be lower in women weighing > 90 kg.
  • Effectiveness (PI): High, typically about 0.9 (ideally 0.6-0.7, typically 0.7-1.2 according to ), comparable or slightly lower in typical use than tablets.
• Vaginal rings (rings):
  • Description: An elastic estrogen and progestogen-releasing ring, placed alone in the vagina for 3 weeks, followed by a 7-day break.
  • Advantages: Convenience (application once every 3 weeks), constant release of hormones, bypassing the gastrointestinal tract, discretion (imperceptible when properly inserted).
  • Disadvantages: Need for self-application and removal, rarely discomfort or prolapse, possible local side effects (infections, vaginal discharge).
  • Effectiveness (PI): High, about 0.65 (ideally 0.3, typically 0.7 according to ), comparable to tablets.
• Contraceptive injections:
  • Description: Intramuscular injection of progestogen (e.g. medroxyprogesterone), repeated every 12-13 weeks (approx. 3 months).
  • Advantages: Very high effectiveness, convenience (rare application), lack of estrogen (suitable for contraindications), discretion, can be used during lactation and in overweight women. They do not increase the risk of thrombosis.
  • Disadvantages: Need to see a doctor/nurse for an injection, possible irregular or no bleeding, potential weight gain, delayed return of fertility after stopping use (this may last for several months).
  • Effectiveness (PI): Very high, about 0.3 (ideally 0.2, typically 4 acc), higher in typical use than tablets.
• Subcutaneous implants:
  • Description: A small, flexible rod containing a progestin (e.g. etonogestrel), implanted by a doctor under the skin of the arm for up to 3 years.
  • Advantages: The highest effectiveness among reversible methods, very high convenience (long-term action), lack of estrogen, discretion, quick return of fertility after removal. Suitable for lactating and overweight women.
  • Disadvantages: Need for minor surgery (implantation and removal), high initial cost, frequent irregular bleeding or spotting (main reason for dropout), other possible side effects (headaches, acne, mood changes).
  • Effectiveness (PI): Very high, close to sterilization, approx. 0.01-0.06.
• Hormonal IUDs (intrauterine systems – IUS):
  • Description: A small, T-shaped device placed by a doctor in the womb that releases a local progestin (levonorgestrel) for 3 to 5-8 years (depending on the type).
  • Advantages: Very high effectiveness, long-term action, convenience, minimal systemic effect of hormones, significant reduction in the abundance and pain of menstruation (sometimes their disappearance), therapeutic effect (e.g. in endometriosis, endometrial hyperplasia). Suitable for breastfeeding, overweight women and those with estrogen contraindications.
  • Disadvantages: Need for insertion and removal by a doctor, initial cost, possible irregular spotting (especially at the beginning), rare risk of uterine perforation during insertion or expulsion (prolapse) of the IUD.
  • Effectiveness (PI): Very high, about 0.1-0.3 (depending on the dose of the hormone).

The table below summarizes the key features of selected hormonal contraceptive methods (based on ):

Method	Effectiveness (PI typical)	Reversibility	The safety of taking contraceptive pills regularly should always be consulted with a doctor.	Acceptance	Other benefits	Disadvantages	Indicative cost (per cycle/unit)
Combined tablet	High (0.1-8)	Yes	High blood pressure can be the result of taking birth control pills.	A large number of women use combined contraceptive pills.	Reducing the risk of ovarian and endometrial cancer; healing properties (cycle, PMS, acne)	The need to take it every day; side effects; no protection against STI	ca. 8-50 PLN / package
Single-component tablet	High (0.5-5)	Yes	High	Large	Can be used with estrogen contraindications (lactation, VTE risk)	The need for very regular intake; possible irregular spotting; no protection against STI	ca. 20-40 PLN / package (28 tabl.)
Slices	High (0.9)	Yes	High	Large	Convenient to use (once a week)	Visibility; risk of detachment; skin reactions; lower efficiency at >90kg possible; no protection against STI	ca. 50 PLN / package (3 pcs.)
Vaginal rings	High (0.65)	Yes	High	Large	Convenience of use (once every 3 weeks); discretion	Need to apply/remove it yourself; possible local side effects; no protection against STI	ca. 50-70 PLN / piece
Injections	Extra high (0.3)	Yes (delayed)	High	Large	Convenience (once every 3 months); lack of estrogen; does not increase the risk of thrombosis; can be used if you are overweight	Need for a medical visit; delayed return of fertility; possible irregular bleeding, weight gain; no protection against STI	ca. PLN 45 / injection
Implants	Very high (0.01-0.06)	Yes	High	Large	Highest effectiveness; comfort (up to 3 years); lack of estrogen; can be used in overweight, lactation; rapid return of fertility after removal	Implantation/removal procedure; initial cost; frequent irregular bleeding; no protection against STI	ca. 1200 PLN (implant + procedure)
Hormonal IUD	Very high (0.09-0.33) effectiveness of combined contraceptive pills.	Yes	High	Large	High effectiveness; comfort (3-8 years); lack of estrogen; local action; reduction of bleeding; can be used in overweight, lactation	Insertion/removal by a doctor; initial cost; possible initial spotting; rare risk of perforation/expulsion; no protection against STI	ca. PLN 600-1200 (insert + insert)

The choice of hormonal contraception method is an individual decision that should take into account the effectiveness, safety profile, potential side effects, convenience of use, costs, and the woman’s lifestyle and reproductive plans.

The importance of a medical consultation

The decision to start, change or stop using contraceptive pills should always be made after consultation with a gynecologist. This is crucial for several reasons:

1. Assessment of health status and contraindications: The doctor will conduct a detailed medical history regarding your health condition, past illnesses, family history (especially in terms of thromboembolism, cancer), lifestyle (smoking, body weight) and medications taken. This will allow you to identify possible contraindications to the use of hormonal contraception, especially one containing estrogens, and assess the individual risk. Gynaecological examination and blood pressure measurement are standard elements of such a visit.
2. Selection of the appropriate method and preparation: Based on the information gathered, your doctor will help you choose the most appropriate method of contraception (one- or two-component pills, or perhaps another hormonal or non-hormonal form) and a specific preparation, taking into account individual needs (e.g. acne treatment, cycle regulation) and tolerance. Different progestogens have slightly different properties, which allows for some personalization of therapy.
3. Instructions on how to use it correctly: Your doctor will explain how to take the tablets correctly, the dosage schedule, what to do if you miss a dose, and potential interactions.
4. Monitoring and management of side effects: Regular follow-up visits allow you to monitor the patient’s well-being, assess drug tolerance and early detection of possible side effects. In the event of bothersome side effects, the doctor may recommend changing the preparation or method of contraception.
5. Availability of the drug: Contraceptive pills are prescription-only drugs that can be issued by a doctor after consultation (also in the form of a teleconsultation or an online prescription in justified cases of continuation of treatment).

Starting or changing hormonal contraception on your own without consulting a doctor is dangerous and can lead to serious health consequences, especially if there are undiagnosed contraindications.

Summary

Contraceptive pills are an effective and popular method of preventing pregnancy, while offering a number of post-contraceptive benefits, such as regulating the menstrual cycle, relieving painful menstruation and PMS symptoms, improving skin condition, and even reducing the risk of certain cancers (ovarian and endometrial cancer). They work through a complex mechanism of inhibition of ovulation, thickening of cervical mucus and changes in the endometrium.

There are different types of pills (one- and two-component, with different dosage regimens), which allows the method to be individually tailored to the needs and health of the woman. The key to high effectiveness is their regular and correct use, according to the doctor’s recommendations and the information contained in the leaflet. Be aware of factors that may reduce efficacy (missed tablet, vomiting/diarrhoea, drug and herbal interactions) and potential side effects, ranging from mild and temporary to rare but serious (such as thromboembolism).

There are many myths surrounding hormonal contraception, e.g. regarding permanent infertility or the need to take breaks – it is important to rely on medical facts. After stopping the pills, fertility usually returns to normal quickly.

Due to the potential risk and the need for individual selection, the decision to use contraceptive pills must be made consciously, after consultation with a gynaecologist, who will assess the health condition, rule out contraindications and help choose the safest and most appropriate option.