Contraceptive pills are a common hormonal method of contraception, primarily achieved by regulating estrogen and progestin levels within the female body. These oral medications can be classified into monophasic (same hormone levels throughout the cycle) and multiphasic (varying hormone levels across the cycle), with different formulations chosen based on patient needs. Besides contraception, some pills are also used to treat gynecological issues such as irregular menstruation, dysmenorrhea, and endometriosis, making them versatile medical tools.
The core mechanism involves suppressing ovulation and thickening cervical mucus to prevent sperm penetration, while also altering the endometrial environment to prevent implantation of fertilized eggs. This treatment requires daily, timely intake to ensure high contraceptive efficacy, with clinical studies showing failure rates below 1% when used correctly.
Contraceptive pills are mainly divided into "combination" and "progestin-only" types. Combination pills contain synthetic estrogen and progestin, which inhibit gonadotropin secretion to prevent ovum maturation. Progestin-only pills do not contain estrogen and primarily affect cervical mucus viscosity and endometrial environment. Newer formulations may include additional ingredients to reduce side effects, such as low-dose estrogen formulations.
The mechanisms involve three phases: first, suppression of follicle growth; second, slowing tubal motility to delay fertilization; third, changes to the endometrial receptivity. Some medications are designed for a 28-day cycle, with 7 days of placebo pills to mimic the natural menstrual cycle.
Main indications include: 1) high-efficiency contraception 2) regulation of irregular menstruation 3) relief of premenstrual syndrome 4) pain control for endometriosis. According to the Ministry of Health and Welfare regulations, suitable candidates are women over 18 years old with no contraindications after medical evaluation.
Special indications include treatment of primary dysmenorrhea and menorrhagia (excessive menstrual bleeding). In Taiwan, some medications are also approved for improving hyperandrogenism symptoms in polycystic ovary syndrome (PCOS), requiring hormonal monitoring by a physician.
The standard method is to take one pill at the same time daily, starting from day 1 of the cycle, continuously for 21-28 days depending on the formulation. Cycle-type pills must be strictly followed according to the color-coded instructions; if missed more than 12 hours, additional precautions are necessary. Some cycle-adjusting pills may require continuous 28-day use without a break.
Dosage adjustments depend on age and health status; women over 35 who smoke are recommended to use low-estrogen formulations. Physicians may adjust formulations based on individual response, such as changing from a 28-pill cycle to a 21 active pills plus 7 placebo pills design.
Main benefits include:
Additional advantages include improvement of acne, reduction of premenstrual syndrome severity, and providing regular withdrawal bleeding. Long-term use can reduce symptoms related to uterine fibroids, and some medications have been shown to lower ovarian cancer risk.
Common mild side effects include:
Serious side effect warnings include:
Absolute contraindications include:
Relative contraindications include: women over 35 who smoke more than 10 cigarettes daily, diabetes with vascular complications, uncontrolled hyperlipidemia, etc. Use is generally not recommended during the first 6 weeks postpartum; reassessment is needed after uterine recovery.
Concurrent use with antiepileptic drugs (e.g., carbamazepine) may reduce efficacy, requiring additional contraceptive measures. Rifampicin, an anti-tuberculosis drug, can accelerate drug metabolism, necessitating the use of injectable contraceptives. Some herbal components like Angelica may affect hormone metabolism; inform your physician of all supplements used.
Use of gastrointestinal absorption inhibitors (e.g., antacids) may reduce absorption; it is recommended to take them at least 2 hours apart. Do not use St. John’s Wort supplements during medication, as this herb can induce drug metabolism and reduce effectiveness.
Multicenter clinical trials show that with correct use, the failure rate is below 0.3% annually. In menstrual regulation, randomized controlled trials confirm a reduction in menstrual blood loss by 30-50%, and a 60% reduction in dysmenorrhea severity. WHO data indicates that users for over a year have a 20% reduced risk of endometrial cancer.
Drug effectiveness is highly related to adherence; taking pills at the same time daily can keep failure rates below 0.1%. Long-term follow-up studies show that fertility fully recovers within months after stopping, with no permanent effects.
Main alternatives include:
Non-hormonal options like condoms can also prevent sexually transmitted infections, while natural family planning requires careful basal body temperature and cervical mucus observation. Doctors will provide personalized advice based on age, reproductive plans, and health history.
It is recommended to perform baseline health checks, including blood pressure measurement, blood coagulation screening, and Pap smear. If there is a history of endometriosis or breast disease, risk assessment by a physician is necessary. The doctor will adjust the medication plan based on age, smoking habits, and family history of thrombosis.
What should I do if I experience breast tenderness or mood swings while taking the pill?Mild discomfort usually resolves within 3-6 months; dietary adjustments such as reducing salt intake can help reduce water retention. If symptoms persist or worsen, consult a doctor for possible adjustment of hormonal components or dosage. Do not stop medication on your own; seek medical evaluation immediately and avoid using over-the-counter painkillers without consultation.
Is it necessary to use other contraceptive methods while on the pill?For those on a 21-day regimen, cycle-based discontinuation is needed; during the off-week, no additional measures are required. If using continuous pills or if more than 12 hours are missed, using condoms is recommended to ensure contraceptive effectiveness. Discussing medication adherence with your partner is important.
How long after stopping the pill can fertility be fully restored?Most women resume normal ovulation cycles within 1-3 months after stopping; fertility is generally unaffected. If pregnancy does not occur within 6 months, fertility evaluation such as hysterosalpingography is recommended. Smokers and women over 35 should pay special attention.
Does long-term use affect future bone density?Estrogen-containing contraceptives may temporarily affect calcium absorption, but studies show that bone density recovers after stopping use for over 3 years. It is recommended to intake 1000-1200 mg of calcium and vitamin D daily and engage in weight-bearing exercises. Women over 40 should have bone density scans every 5 years.
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