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The pill: types & uses

Almost all types of pill that are currently on the market contain a combination of estrogen and progestin - so are Combination preparations. Are less common Monopreparations (Mini pill, progestin pill) that contain only progestin. You can find out more about the latter below.

Combination preparation: hormones for 21 days

With almost all combination preparations, one hormone pill is taken daily for 21 days. This is followed by a seven-day hormone-free interval, which triggers menstruation-like bleeding (hormone withdrawal bleeding). Then the woman starts again with a new monthly supply from before.

With some combination preparations, each monthly pack only contains the 21 hormone-containing pills. The woman pauses taking it for the last seven days of the cycle.

However, there are also combination preparations with 28 pills per month - the last seven pills are hormone-free and only there so that the woman does not have to interrupt the usual daily intake rhythm. These preparations also correspond to the "21 and 7" intake schedule.

There is also a combination preparation that follows a "24 and 4" intake rhythm: Each monthly pack contains 24 pills containing hormones and four pills free of active substances.

Combination pill: single-phase or multi-stage preparation

Combination preparations can be further subdivided depending on the exact hormone composition and dosage of the pills in a monthly package. A distinction is essentially made:

  • Single-phase preparation: Here all 21 (or 24) active ingredient-containing pills in a monthly supply contain the same amounts of estrogen and progestin. The order in which you take the pills does not matter.
  • Two-step preparation: The proportion of estrogen in each pill is largely the same. In contrast, the progestin content is low in the first 11 pills and significantly increased in the remaining ten pills. Because of this different composition, a two-step pill must be taken in the specified order.
  • Three-step preparation: This further development of the two-stage preparation should be even better adapted to the natural hormone fluctuations of women. The estrogen and progestin content of the pills vary over three levels. Here, too, it is imperative to take the individual pills in the given order in the blister pack.

In the past there were also two-phase preparations. Here the pills of the first phase only contained estrogen, those of the second phase a combination of estrogen and progestin. These preparations have now been replaced by step preparations.

Combination pill: Usually a micro pill

In the past, the pill was dosed quite high, which was associated with a higher risk of side effects. So the hormone content was gradually reduced - the aim was to have the lowest possible dose of pills that would still provide adequate protection against pregnancy. Most combination products now only contain a maximum of 50 micrograms of estrogen per pill and are thus referred to as a micropill.

You can read more about the use and safety of this form of hormonal contraception in the article Micropill.

The "natural" pill

As mentioned above, most combination products contain the synthetically produced ethinylestradiol as the estrogen. For a few years now, however, there have also been preparations that have a "natural" estrogen component instead - estradiol or its variant, estradiol valerate. However, both compounds are also made synthetically. The addition "natural" has a different background:

  • The synthetic estradiol used has the same structure as the estradiol that occurs naturally in the body.
  • The synthetic estradiol valerate used is converted into the natural hormone estradiol in the body.

By using such a "natural" estrogen component, the pill in question should be better tolerated than common preparations with ethinylestradiol. Incidentally, such pills contain either nomogestrol acetate (Nomac) or dienogest as a progestin.

The "natural" estrogen (estradiol or estradiol valerate) of such pills is broken down more quickly in the body than the ethinylestradiol in other combination pills. Therefore it has to be dosed higher (1 to 3 mg per pill). For comparison: the micropill (the standard of classic combination pills) contains a maximum of 0.05 mg of estrogen (ethinylestradiol).

The mini pill (progestin pill)

In contrast to the combination pill, the mini pill is an estrogen-free pill, i.e. a pure progestin preparation. The progestin used is either levonorgestrel or desogestrel.

The minipill is taken continuously, i.e. without a hormone-free interval every month, as is usual with the classic combination pill. Especially with the minipill with levonorgestrel, it is important that you always swallow it at approximately the same time of day - the time difference must not be more than three hours. With the desogestrel pill (mini pill with desogestrel), on the other hand, you can deviate from the usual intake time by up to 12 hours without endangering the contraceptive protection.

You can read more about the use and safety of the estrogen-free pill in the article Minipill.

Which pill to take

The birth control pill is a prescription drug and must therefore not be given without a prescription. Your gynecologist can recommend the preparation that is best suited for you personally and is likely to be the most well tolerated. To do this, he must carefully check your state of health and ask about bleeding disorders, hair and skin problems and gynecological diseases such as severe menstrual cramps.

The doctor will also clarify whether you have possible risk factors for side effects of the hormonal contraceptive. These include, for example, high blood pressure, thrombophilia (increased tendency for blood clots), liver diseases, eating disorders, obesity and metabolic disorders.

Your doctor will also take your nicotine consumption into account when choosing a contraceptive. The reason: The combination of pill and smoking greatly increases the risk of blood clots. If you smoke and are 35 years of age or older, your gynecologist will probably advise you not to use hormonal contraceptives as a rule, as increasing age increases the risk of blood clots. Then non-hormonal contraceptive methods (such as condoms or copper IUDs) are more advisable.

Your gynecologist should explain your individual risk factors and the possible side effects of the hormonal contraceptive to you in detail. You can then decide together with him whether and which pill is the "right" one for you.

Change the pill

Even if you have been taking the contraceptive pill for a long time, your gynecologist should regularly check your state of health and your risk profile before he gives you a new prescription for the pill. Always inform your gynecologist about current complaints or new diseases (such as thrombosis). You may then need to switch pills to avoid unnecessary health risks.

Start the pill

If you want to start taking the pill, it should be at the right time in your menstrual cycle. It is best to start using oral contraception on the first day of your menstrual period. Then you are immediately protected against pregnancy.

If, on the other hand, you only start taking the pill on one of the days following your menstruation (2nd, 3rd day, etc.), the contraceptive does not start immediately. Then you will have to use other methods of contraception for a few days, for example with a condom.

You can find out more about the right way to start oral contraception and the different intake schedules in the Pill - Ingestion article.

Forgot pill

The pill is a very safe form of contraception - provided it is used correctly and not forgotten every now and then. It depends on the preparation whether and for how long you can still take a forgotten pill without losing your contraceptive protection.

In the case of multi-stage combination preparations, the section of the cycle in which you forgot to take one or more pills also plays a role.

You can find out more about the consequences of forgetting to take a pill and what you should do in such a case in the article Forget Pill.

Pill and vacation: what to look out for

Women who use birth control pills have to reckon with various imponderables when they are on vacation. Among other things, time differences, forgetfulness or gastrointestinal complaints can impair the protection against conception.

Like all important medicines, the pill belongs in hand luggage when traveling by air. In the event that your stay is extended unexpectedly or your current pack is lost, you should also take a reserve pack with you.

Forget your pill at home

Memorize the active ingredients and dosage of your pill. If you have difficulties with this, you should make a note of the composition and place it with your travel documents before departure. Because your product can have a completely different name in another country.

Vomiting and diarrhea

Some people are plagued by gastrointestinal complaints, especially on vacation. The following rules of thumb apply to women using birth control pills:

  • If you vomited or had diarrhea within three hours of taking the pill, take another pill within twelve hours.
  • If the symptoms persist, take the rest of the pills as usual, but protect yourself by using condoms.

time shift

An adjustment is only necessary if the local time in the holiday country deviates more than twelve hours (pill or new minipill) or more than three hours (minipill) from the German time:

In this case, take an additional tablet (from the reserve pack) 12 hours after the last dose - or at the latest when you arrive at your holiday destination. This is, so to speak, an "interim pill". The next dose is taken another 12 hours later. You can then continue in the usual 24-hour rhythm.

Think carefully about this intake rhythm in advance and ask your gynecologist if you have any questions.

When you return from vacation, you can continue to take the pill at the usual time, as a shortened 24-hour cycle has no effect on the protection against conceiving.

Vacation love

The pill does not protect against AIDS or other sexually transmitted diseases. Therefore, use condoms when you get intimate with holiday acquaintances.

Take the pill

For a few years now, starting in the USA and now also in Europe, the constant use of the pill has been established. With this intake schedule, also known as the long cycle, women take the pill for longer than 21 days. The hormones in these pills are dosed lower than in a conventional pill preparation, which provides a hormone-free break, and can be taken continuously.

Overall, the administered dose of the hormones is higher when women take the pill than when they keep the hormone-free period. It can therefore also lead to side effects. If you want to take the pill, talk to your doctor beforehand.

Pill break

Contraception with the combination pill (with estrogen and progestin) normally provides for a hormone-free interval every month. It usually takes seven days, during which you do not swallow any or only one hormone-free pill, before you start with a new blister pack.

What is this scheduled pill break all about? Can a woman get pregnant during this hormone-free interval? Can you omit or shorten the pill break?

You can read the answers to these and other questions on the subject in the article Pill Break.