This article exists as part of the online archive for HuffPost Australia, which closed in 2021.

Before Going On The Contraceptive Pill, Ask These Questions

You need to know what it does to your body.
How much do you really know about The Pill?
How much do you really know about The Pill?

The contraceptive pill is the most popular form of birth control in Australia, but its use is not free of controversy.

It's an affordable, effective way to avoid pregnancy, but it also comes with a host of side effects both scientifically documented and anecdotal -- including things like cancer, skin blemishes and mental health issues.

While some women say the pill helps with their skin and moods, others say it leaves them temperamental, bloated and unhappy.

Before trying the pill, make sure you know the answers to these questions and remember, always listen to your body.

What is actually in 'the pill'?

The pill is made from synthetic sex hormones.
The pill is made from synthetic sex hormones.

There are about 30 pills available in Australia, and they are based on synthetic versions of two sex hormones -- estrogen and progestin.

Combined oral contraceptive pills have both estrogen and progestin, while others only use progestogen.

How does it work?

GP Clare Ballingall told The Huffington Post Australia the combined oral contraceptive pill did three things to quell the body's reproductive system.

"It suppresses ovulation, so generally, every month a woman's body produces an egg from the ovaries but on the pill, that doesn't happen.

"The second way it works is by thickening up the mucous produced by the neck of the womb, so even if an egg was produced, sperm would have trouble getting through.

"The third way it works is by making the lining of the womb quite hostile. Generally, the lining of the womb is a lovely vascular, cushioned surface perfect for an egg but these hormones stop the walls from growing each month."

How effective is it?

Family Planning NSW senior medical officer Mary Stewart previously told HuffPost Australia that while the pill was 99 percent effective in theory, studies showed that human error brought it down to 91 percent, and one Choice study even showed 60 percent of women who had an unexpected pregnancy were either using condoms or on the pill at the time.

"If you're a perfect pill taker then it's very effective," Stewart told HuffPost Australia.

"In a real-world situation though, we know that most women will sometimes forget to take the pill every day and that reduces its effectiveness."

If you forget to take it, you may get pregnant.
If you forget to take it, you may get pregnant.

Why are there different pills and how do they differ?

Of the 30+ pills on the market in Australia, the price can vary from $18 to $80 for three months depending on whether they're on the Pharmaceutical Benefits Scheme or not.

Some new pills claim to have additional benefits, and others are low or high dosages of hormone.

Family Planning NSW medical director Deborah Bateson told HuffPost Australia the more expensive pills weren't necessarily the best.

"In clinical practice, we generally recommend people start with a PBS-listed pill because they're very safe. They are generally the pills that have been on the market for a long time and are very, very safe.

"If people have problems, on those pills, we can look at other options."

Are there rules for skipping a pill and what does it do to the body?

Accidents happen, but Ballingall said skipping puts women at risk of pregnancy.

"I'm always surprised at the low level of health literacy out there when it comes to things like skipping a pill," the Tasmanian chair of the Royal Australian College of General Practitioners said.

"Even very well-educated women will tell me they do things like forget to take the pill for three days, and then take three at once. It's just horrendous.

"If you're on a progesterone-only pill, that's just like taking the morning-after pill."

The morning-after pill is a progesterone-based pill that stops the body from ovulating and makes the uterus wall lining hostile. It's designed to be taken up to 120 hours after sex to make pregnancy less likely. It causes side effects in a quarter of women including vomiting, stomach aches and headaches.

Ballingall said the most important thing to know was that skipping a pill, even by 24 hours, can affect fertility to the point where you can fall pregnant.

What happens when you bleed on your period?

There's no reason to bleed every month if you're on the pill.
There's no reason to bleed every month if you're on the pill.

Here's a newsflash: there's no medical reason why you need to take the sugar pills, and bleed while on the pill. In fact, it's not even considered to be a 'menstrual bleed' rather it's a 'hormone withdrawal bleed'.

Here's the difference, as explained by Ballingall:

"There's absolutely no reason why you have to have a bleed when you're on the pill and that surprises a lot of people.

"Often we have girls coming in with their mothers, and when I say there's no reason why you wouldn't have, say, four bleeds a year instead of each month, and the mothers often get concerned.

"They want to know where all the blood goes, as if there's a damming back of menstrual flow.

"A normal period happens when an ovulation hormone makes the lining of the womb grow, with lots of blood vessels, so it's a good environment for an egg. If the egg is not fertilised, all the hormones drop off and the lining of the womb is shed. That's a menstrual period.

"Conversely when you're on the pill, the same effect that makes the womb hostile means you don't get thick, cushioned walls. When you take the sugar pill, you're not getting those hormones so whatever wall lining has built up will be shed, but it's far less.

"With extended taking of the pill without a break, there is an increased chance of spotting, and what some women do is take the pill until they experience spotting, and then go on the sugar pill for about four days, before starting again."

How does the pill affect mental health?

Researchers agreed there were no studies that showed concrete correlations between mental health issues and The Pill as yet.

Bateson said there were anecdotal stories of women who had increased mood swings, but also others who had the opposite effect.

"For every study showing a link, there seems to be another study showing the opposite," Bateson said.

"Women need to listen to their bodies and if a pill is not working for them, they need to speak to their GP by all means."

If you feel down, listen to your body.
If you feel down, listen to your body.

What are other side effects?

A woman's chance of stroke, heart disease and blood clots increase after taking The Pill. In 2016 the Therapeutic Goods Administration created new safety guidelines to warn women about the link between blood clots are associated with pills containing containing ethinylestradiol and/or progestogen.

Ballingal said women who experienced aural migraines should never take the pill because their chance of stroke is increased more than the average person.

Bateson said there were also positive side effects.

"There are a lot of women who go on the pill for reasons other than contraceptives, like to control hormonal acne," she said.

BONUS QUESTION: How did the pill arrive in Australia?

Historian Diana Wyndham told HuffPost Australia it was scandalous when it arrived in 1961, because it gave women the right to control conception.

"At the time there was a great huffing and puffing by the doctors who had to prescribe it -- they were all carrying on about how it was an encouragement to promiscuity," Wyndham told HuffPost Australia.

Between 1960 and 1970, the rate of Australian women on birth control went up from 67 percent to 87 percent, credited largely to The Pill.

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