What's in my Birth Control Pill?

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“The pill” is one of the most common types of birth control used by female college students, but what is actually in those small little pills? You may know that they contain hormones, but how does “the pill” actually work? Find the answers to all of your questions below.

“The pill” refers to birth control pills that contain synthetic estrogen and progestin, two types of hormones. They are also called combined oral contraceptives (COCs), and these types of pills are very safe and effective.

COCs usually come in packages of 21 or 28 pills. Seasonale and Seasonique are called extended use COCs. They contain 84 pills so that you only have four periods a year. The pill should be taken at about the same time everyday, and most women take them when they get up in the morning or before going to sleep. Not taking the pill at the same time everyday can cause bleeding in between periods and contribute to an unintended pregnancy.

The estrogen part of the pill is either ethinyl estradiol or mestranol. The amount of estrogen in the pill can vary. The lowest dose of estrogen currently available is 20 mcg/day. Your pharmacist or gynecologist can tell you how much estrogen is in the pill you are taking. There are also nine different progestins currently available. The type and amount of estrogen and the type of progestin are what creates the difference between the many birth control pills currently available. Generic COCs are as effective as brandname combined oral contraceptives.

The hormones in “the pill” work to prevent pregnancy by stopping ovulation (releasing an egg), by causing changes in the uterine lining, and by creating thick cervical mucus to slow the travel of sperm.

The side effects that you may experience from taking “the pill” can be related to either the estrogen portion or the progestin portion of the pill. Because there are many combinations of estrogen and progestin, your doctor can change the amount of estrogen in your pill or the birth control pill you are on to decrease side effects. Effects of estrogen include changes in lipid and carbohydrate metabolism, breast tenderness, increased breast size, fluid retention, cyclic weight gain, headaches, high blood pressure, nausea, nervousness and irritability, and a risk for blood clots. Effects of progestin include acne, oily skin, breast tenderness, increased breast size, decreased libido, decreased high-density lipoprotein (HDL), (good) cholesterol levels, depression, fatigue, increased appetite, weight gain, increased low-density lipoprotein (LDL), (bad) cholesterol levels, and itching.

“The pill” also has some benefits in addition to being a contraception method. COCs can relieve “uncomfortable menstrual symptoms and premenstrual syndrome: cramps diminish, flow decreases, and the cycle becomes more regular.” COCs are also linked to “a reduction in the incidence of ovarian cancer, endometrial cancer, colorectal cancer, menstrual migraines, and iron deficiency anemia.”

You should contact your healthcare provider right away if you experience any of the following symptoms: depression, breast lumps, becoming jaundiced (yellowing of the skin and eyes), “severe abdominal pain, severe chest pain or shortness of breath, severe headaches, dizziness, changes in vision (vision loss or blurring), speech problems, or severe leg pain.”

Another type of birth control pill available is known as the minipill, and it contains only progestin. The minipill is primarily used by women who cannot take the estrogen component of COCs because they have a history of blood clots, high blood pressure, or estrogen-related side effects. The progestin only pills can cause irregular bleeding patterns, or for you to not get your period at all. In addition, they are a little less effective than COCs, which contain estrogen. It is extremely important that the minipill is taken at the same time everyday.



Davidson, M., London, M., & Ladewig, P. (2012). Old’s Maternal-Newborn Nursing & Women’s Health: Across the Lifespan 9th ed. Boston, MA: Pearson.




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