The pill: Myths and facts

Since it became available in Canada over 50 years ago, the pill remains one of the most popular forms of birth control. Close to half of women in Canada use the pill for birth control or to regulate their menstrual cycle. Still, many misconceptions lurk behind the contraceptive. Staff obstetrician and gynecologist at The Hospital for Sick Children (SickKids), Dr. Nicolette Caccia, helps separate the fallacies from the facts.

Myth: It's not safe to use birth control pills to manipulate your cycle

"It's absolutely 100 per cent safe,” says Dr. Caccia. Doctors have been using the pill this way for decades. It also does not affect fertility. Birth control works by mimicking the regular 28 day menstrual cycle. The pills taken for the first 21 days are 'active', meaning they contain reproductive hormones. In contrast, the pills taken during the last seven days do not contain any hormones (placebos). The lack of hormones in the pill causes the uterine lining to shed. It is during this time when vaginal bleeding occurs – similar to a regular menstrual period.

Some women may take the active pill for longer times. They sometimes experience spotting or bleeding. In this case Dr Caccia recommends stopping the pill for 3 to 4 days. This gives time for the uterine lining to shed. After a few days, restart the pill.

"Yes - when you miss a pill you take one as soon as you can,” advises Dr. Caccia. Each type of contraceptive has what Dr Caccia calls a "window of forgiveness": the grace period in which the body still has a low risk of becoming pregnant. The pill has a very narrow window of forgiveness. That is why it is important to consistently take the pill every day and as close to the same time as possible.

Your teen can learn more about what to do if she misses a pill by clicking through the interactive guide in Sexuality and U.

Fact: Some antibiotics reduce the pill's effectiveness

Some do, but most don’t. “When you get antibiotics, tell your doctor you are on the birth control pill,” advises Dr. Caccia. If it does interfere, one option is to switch other contraceptives that work similarly to the pill. These include:

The vaginal ring and patch do not interact with oral medications to the same extent as the pill.

For more information on the vaginal ring and contraceptive patch, visit Sexuality and U.

Myth: The pill makes you gain weight

“No, and there have been many studies that show the pill does not make you gain weight,” says Dr. Caccia. Often, girls start taking the pill at times when eating habits are more likely to change: when they first start dating or their first year away at university. “It’s not the pill itself; it’s the behaviours that go with it,” explains Dr Caccia.

That said, some women may find that certain pills increases their desire to eat. The solution: Switch to a different birth control pill or try to maintain the same diet as when you were not on the pill.

Never. The birth control pill protects against pregnancy, not sexually transmitted infections (STIs). Condoms and other barrier methods protect against STIs. Their use is an important part of practicing safe sex.

Discussing birth control options with your teen also means emphasizing the importance of safe sex, says Dr. Caccia. "You need to talk to your teen about safe sex, which includes using barrier methods of birth control - mostly condoms. You always have to worry about sexually transmitted infections (STIs)".

Myth: My body needs a 'rest' from all birth control at least once a year

No, your body does not need you to stop taking the pill at any point. “People who take a break often get pregnant,” says Dr. Caccia.

The early formulations of the pill had much higher doses of hormones than today’s pills. The high-dose pills caused many side effects. Women took ‘breaks’ to avoid these side effects. Now the pill is given in a much lower dose. It is effective, with only minimal side effects such as headaches, nausea and breast tenderness. These side effects are usually temporary.

Myth: Using birth control pills may mean it's harder to get pregnant when I finally do try

“That’s absolutely wrong,” says Dr. Caccia. The pill does not harm your fertility, or prevent pregnancy in the future. What influences fertility is the age a woman attempts conception, not her history of using the pill. “You are more likely to conceive if you do it earlier rather than later.”

Many women are given the pill to correct an underlying hormonal problem or failure to make eggs regularly. “This problem may still exist when a woman stops the pill," says Dr. Caccia, "and it is this problem that makes it more difficult to conceive, not the use of the pill.”

Some doctors recommend staying off the pill a few months before conceiving. This allows time for the menstrual cycle to regulate. However, it is not unsafe to try sooner.

Conception can happen as soon as a woman stops the pill. For this reason, many doctors recommend women take folic acid or prenatal vitamins for three months before going off the pill.

Myth: The pill increases chances of getting cancer

Not true. In fact, the pill decreases the risk of cancer. Studies show that when taken for five years, the pill reduces the risk of uterine and ovarian cancer by 50 per cent. There are also many other non-contraceptive benefits. The pill reduces gynecological problems, the likelihood of developing anemia, and pain from menstrual cramps.

“Unless you have a specific contraindication to the pill, there is no reason women cannot be on the pill throughout their reproductive life, unless they want to get pregnant,” says Dr. Caccia.

Fact: All birth control pills are the same, only the dosage changes

True, and the formulations of hormones inside the pill also change. “There are subtle differences between birth control pills,” explains Dr. Caccia, adding that some women respond better to certain pills than others. Given the variety of pills, a woman can easily find the right pill that works for her. “It’s like shoes; you have to find a pair that works for you.”

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