Even more than 50 years after the first contraceptives were approved, the contraceptive pill is still the most commonly used contraceptive in Western industrial nations. In Europe, about four out of ten women between the ages of 15 and 45 use one or the other form of the pill. This contraceptive is used particularly frequently by young women under the age of 30.
The contraceptive pill is one of the hormonal contraceptives. The
contraceptive pill works by preventing the egg from maturing every
month and thus ovulation. Whereas pills used to be highly dosed,
today's modern preparations contain the hormones in the lowest still
effective dosage. The lower dosage has also significantly reduced the
side effects of the pill.
pill is a very effective method of contraception. If you wish to have
children later, the pill can be discontinued without any problems.
After discontinuation, the pill has no effect on fertility.
all pill preparations have in common is that they contain sex
hormones - albeit in different compositions and dosages. A basic
distinction is made between the following types of pill:
Combination preparations (the "classic" contraceptive pill)
"classic" pill contains the hormones estrogen and
progestin. An estrogen dosage of less than 0.05 milligrams per tablet
is also referred to as a micro pill (not to be confused with the
today, however, hardly any preparations with higher dosages are
prescribed - the majority of preparations contain between 0.02 and
0.03 milligrams - the term micro pill no longer has any great
the progestin components, various active ingredients are used (e.g.
levornogestrel, desogestrel, drospirenone), which differ in their
potency. Therefore they are contained in the individual preparations
partly in very different dosages. But the progestins also differ in
the possible side effects, which is why it makes sense to switch to
another preparation in the event of any side effects.
hormonal contraceptives that contain a combination of estrogen and
progestin are the contraceptive patch and the vaginal ring.
overview of the mechanisms of action of the contraceptive pill:
supply of estrogen and progestin influences the hormonal regulatory
circuits between the brain and ovaries. Normally, one ovum matures in
the ovary per menstrual cycle, resulting in ovulation and thus
fertility. Hormonal contraception prevents this (ovulation
the same time, the lining of the uterus is built up less strongly
during the cycle, which is why menstruation in women taking pills is
usually weaker and shorter than natural menstruation.
pill is therefore particularly suitable for women who suffer from
menstrual pain. Good cycle control is mainly due to the effect of
progestogen contained in the pill also prevents fertilisation by
making the mucus plug at the entrance to the uterus more viscous.
This impairs the function and mobility of sperm and makes it
difficult or impossible for them to penetrate the uterus and
pill is an effective method of contraception with a Practical Pearl
Index of about 8. The most frequent reasons for failure of the pill
are application errors, in particular forgetting to take it,
diarrhoea or no prescription. If taken correctly, only about 0.3 of
every 100 women become pregnant within one year (Theoretical Pearl
Index of 0.3).
Pearl Index is the usual form for assessing the effectiveness of
contraceptive methods. It indicates how many out of 100 women who use
the contraceptive for a year become unintentionally pregnant.
only the Theoretical Pearl Index is given because it is lower and
looks better. However, this index is not very meaningful, because
sexuality takes place in real life and there are also mistakes in its
the use of the pill, pregnancies can occur, especially if mistakes
have been made in taking the pill or if certain additional
medications have been taken.
the one hand it can happen that the woman forgets to take a pill
daily, e.g. because of great stress or she has not obtained a
prescription and the last pack is used up.
when taking medication, always pay attention to possible
interactions. In particular, antibiotics or drugs that influence the
liver metabolism (e.g. antiepileptics) can limit the effectiveness of
hormonal contraceptives. Additional contraceptive measures should be
taken during this time.
or intestinal problems can also reduce the effectiveness of the pill.
If vomiting occurs within four hours of taking the pill, it is likely
that the hormones have not yet been fully absorbed. Efficacy cannot
be guaranteed. Even in diarrhoeal diseases, which are often
accompanied by a change in the intestinal flora, the uptake of
hormones from the intestine can be reduced and contraceptive
protection therefore reduced.
the pill is an effective method of contraception, but it does not
protect against sexually transmitted diseases.
pill is basically suitable for almost all women who are fertile but
currently do not want to have a child - from young women to
menopausal women. However, for all forms of hormonal contraception, a
careful physical and gynaecological examination and anamnesis must be
carried out before the prescription. The specialist can then assess
whether a pill is suitable in the individual case and which
preparation may be preferred.
to the influence on the cycle, some pill preparations are
particularly suitable for women with the same condition:
formation of cysts in the ovaries or the clinical picture of
endometriosis can also often be positively influenced.
progestins contained in the pills also have a regulatory influence on
the male sex hormones (androgens). Disturbances in the androgen
balance can lead to oily or impure skin, acne or hair loss. In these
cases, the pill can improve the symptoms and is often used
minipill is the pill of choice for women who cannot tolerate
pills should not be taken while breast-feeding, the minipill is also
suitable for breastfeeding women.
pill has been researched for over 50 years and is very well tolerated
by most women. However, like all medicines, it can also lead to
undesirable side effects. These include:
of the most feared side effects is thrombosis or stroke. The risk for
these diseases is very low, but can increase with the use of the
pill, especially if there are other risk factors for cardiovascular
diseases such as smoking, obesity, bed-rest, long journeys by plane,
atherosclerosis or fat metabolism disorders.
combined pill, ring or patch is therefore generally not suitable for
women with an increased risk of thrombosis, i.e. in cases of blood
clotting disorders, thromboses that have already occurred or
diabetes. The pill may also not be used for certain tumour diseases
(e.g. breast cancer). Heavy smokers have an increased risk of
thrombosis due to smoking, which is further increased by the pill.
clarification of the individual risk profile before the first
prescription is just as important as regular follow-up checks.
costs of contraception are not covered by health insurance in Europe,
the individual preparations cost around 10 to 15 euros per month.
Some preparations are also available in bulk packs (e.g. for three or
six months), which are usually cheaper.
In most other Western European countries, the cost of contraception is taken for granted, at least for young people and women with low incomes.
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