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Which Pill to Start
Pick any standard, low-dose birth control pill that is readily
available.
Most women (90%) will do well on any low-dose BCP. A few will do well
only on certain BCPs, but there is no way to predict in advance which pill will work best
for any individual woman.
Historically, as the hormone dose of birth control pills was lowered,
the risk of serious complications such as blood clots was also reduced. For that reason,
starting a low-dose pill (30-35 mcg of estrogen) is preferable to starting medium dose (50
mcg) or high dose BCPs. Lowering the dose below the 30-35 mcg dose has not, however, led
to any additional clinical benefits but has made some of the very-low-dose pills more
"unforgiving" than the standard low-dose BCPs.
Starting the Pill
Sunday Start:
- Take the first pill on the first Sunday following the beginning of the menstrual
flow.
- This means that if a period starts on a Tuesday, you should wait all the way through
the week until Sunday, and then start taking the BCPs. If the period starts on a Saturday,
then the first BCP would be taken the next day, Sunday. If the period starts on a Sunday,
take the BCPs the same day. This method is called a "Sunday Start" and has a
number of advantages. Because a fresh pill pack is always started on Sunday, it is easier
for some people to remember. Using a "Sunday Start" means that the pill-induced
periods will usually begin early in the week (Monday or Tuesday) and will be over before
the weekend. Many women find this timing convenient and desirable.
5th Day Start:
- An alternative method ("5th Day") is to always start the BCP pack on day #5
of the menstrual cycle. Day #1 is the first day of flow. This method is very effective but
requires counting and recalculations each month.
Just start them:
- Another popular method is to simply start the pill as soon as the patient receives it, regardless of where she is in her menstrual cycle. In this case, the advantages of prompt contraception are considered to outweigh any irregular bleeding this may prompt.
During the first month, it is common for women to experience some degree of breast tenderness, bloating, and nausea. This is mostly due to the estrogen in the pill, in addition to the woman's own naturally-produced estrogen. Later, after the pill has suppressed the woman's ovarian function, her circulating estrogen levels will drop back to normal or often are a little lower than before she started the pill. At this time, her estrogen-excess symptoms will resolve.
This resolution, however, depends primarily on the pill suppresing the woman's ovarian function, and occasionally that doesn't happen. She's still protected against pregnancy (because of the other contraceptive effects of the pill), but if her pill doesn't suppress ovarian function, she will continue to have heavy or heavier periods, bloating, and breast tenderness from time to time. I see this more often with the newer BCPs (wth newer progestins and shorter progestin half lives), and more often among women who are inconsistent in their pill taking. These women will often do better if they are switched to an older low-dose BCP with a long half-life progestin, such as levonorgestrel. |
