How do birth control pills work

The pill - what is it actually?

The birth control pill, also known colloquially as the “pill”, is a hormonal contraceptive in tablet form. For more than 50 years, the pill has been the most popular and widely used method of contraception because it is one of the most reliable. Because there are so many different pills with different active ingredient compositions and dosages, the pill meets the individual needs of its users. You may have come across the medical term "oral contraceptive", which means nothing more than "oral (orally) administered contraceptive". This is precisely where the pill differs from all other contraceptives that are not taken but instead, for example, inserted into the vagina, injected or implanted under the skin.

Why is the pill so popular?

There are many reasons why the pill is so popular. One of the most important is that you feel completely safe with her and that you can enjoy love and sexuality with your boyfriend carefree - because when used correctly, the pill is one of the safest contraceptives in the world. Thanks to the large selection of different pills that have a similar effect, but differ in their composition and the amount of hormones, you can, with the help of your gynecologist, find exactly the pill that best suits you and your personal needs. In addition, the pill is easy to use and generally well tolerated due to the very low levels of hormones. Many girls and women also find it pleasant that the menstrual period becomes weaker under the influence of the pill, as the uterine lining does not build up as much during the cycle. In addition, you usually know exactly to the day when your menstrual period starts and therefore no longer have to expect unpleasant surprises.

A simple trick - this is how the pill works

The pill owes its preventive effect to a simple trick: it works on the very engine that drives your menstrual cycle and that is responsible for your fertility: the hormonal cycle. The pill itself contains hormones that are very similar to your body's own hormones, estrogen and progesterone. In a very specific concentration, they prevent an egg from maturing in the follicle during your cycle and ultimately jumping from the ovary into the fallopian tube, just like with an existing pregnancy. If, in exceptional cases, an egg is able to mature and begin its migration through the fallopian tube after ovulation, the pill even has two other aces up its sleeve: It solidifies the mucus plug that closes the cervix during your entire menstrual cycle so that no sperm cells pass through the uterus can penetrate to the egg. The hormones also prevent the lining of the uterus from building up sufficiently. As a result, the uterus is not prepared for the egg to implant. If, despite the pill, a fertilized egg got into the uterus, it would not be able to implant itself here and develop further.

Where do you get the pill

If there are no medical reasons against it, you can have your gynecologist prescribe the pill for you as soon as your menstrual period has started and you would like to sleep with your boyfriend. Before your 16th birthday, however, you still need the consent of your parents. Your health insurance will cover the costs up to your 22nd birthday, but you have to pay the prescription fee yourself from your 18th birthday. The preliminary examinations that are necessary before your gynecologist prescribes the pill and the regular check-ups are free of charge for you.

The pill and security

The Pearl Index reveals how reliable the pill is. The pearl index of the pill is very low: it is between 0.1 and 0.9 for the micro-pill and 0.5 for the mini-pill. This means that within a year, less than 1 in 100 women get pregnant despite taking the pill. For comparison: unprotected sexual intercourse, i.e. without any contraception, has a Pearl Index of 85. The pill actually protects you reliably against pregnancy - if you use it correctly and take it regularly.

Of course, neither of us nor you are protected from application errors. For this reason, the Pearl Index is calculated once for correct and once for so-called "typical use" for each method of contraception. It can happen that, for example, you forget to take the pill or certain medication, vomiting or diarrhea interfere with the effectiveness of contraception. The Pearl Index of "typical use", including application errors, is therefore always higher for almost all contraception methods than the Pearl Index for correct contraception.

An overview of the different contraceptives

The pill is one of the safest contraceptives. But what does it exactly mean? For example, how safe is the pill compared to a condom or unprotected sex, and does it make a difference which pill you take?

What types of pills are there?

The pill can be taken in different rhythms. Your gynecologist will decide together with you which preparation is best for you. Here you can find out in advance what options are available to you.

Estrogen-free contraception - few hormones, many advantages

As combination preparations, micropills contain both estrogens and gestagens. Unfortunately, some women do not tolerate these pills very well because they suffer from estrogen-related side effects or they simply want to give up estrogens. For these women, other preparations are available as alternatives that do not contain any estrogens: the classic minipill and the estrogen-free pill.

Unfortunately, it only changes the composition of the uterine lining and that of the mucous plug. Ovulation can still occur while taking the conventional mini pill. In addition, the tablets must always be taken at the same time and within a time window of ± 3 hours, which means that the protection against pregnancy is also less reliable.

The modern estrogen-free pill with the active ingredient desogestrel has the same advantages as combination preparations with estrogen: In addition to compressing the mucus plug in the cervix, it prevents ovulation and, with its 12-hour intake window, enables a high degree of flexibility.

If the estrogen-free pill is your first pill, you are protected from pregnancy from the first day of use and do not have to use additional contraception - provided you follow the instructions for use.

The classic mini pill

The classic minipill without estrogens mainly works in the cervix: There it promotes the thickening of the cervical mucus and thus prevents the sperm from migrating via the vagina towards the uterus and the fallopian tubes. The minipill cannot inhibit ovulation 100 percent and it must be taken every day at the same time, i.e. within three hours before or after the specified daily intake time. So the conventional mini pill requires a lot of discipline and a regular lifestyle.

The modern estrogen-free pill - more flexibility

The estrogen-free pill is also a mini pill. The name is a bit misleading as the mini pill is always estrogen-free. In fact, the difference to the minipill is not in the lack of estrogen, but in the fact that the estrogen-free pill uses a special progestogen, desogestrel. Its advantage is that, in addition to thickening the mucus in the cervix, it also reliably prevents ovulation: This dual strategy of the estrogen-free pill makes it just as effective as the conventional micropill, so that you do not have to resort to additional contraceptive methods. So it works just as reliably as combination preparations but with the decisive advantage that it contains far fewer hormones and does not trigger any estrogen-related side effects. In addition, the estrogen-free pill offers a larger window of time than the conventional pill: once you sweat, you can take the estrogen-free pill within 12 hours and its reliable effectiveness is not limited. Regardless of this, you should of course - as with any other pill - ensure that you take it as regularly as possible in order to be optimally protected. All in all, the estrogen-free pill with desogestrel offers you considerably more flexibility and security than the conventional mini pill.

The micro pill - popular and widespread

The micropill is the most commonly prescribed pill today. It works through a combination of two hormones, an estrogen (ethinylestradiol) and a gestagen, in which the various micropills differ. The interaction of these two hormones, which normally prepares the body for pregnancy, is used by the micropill and, so to speak, "fakes" the body into a pregnancy. The progestin, which mimics the body's own progesterone, takes on three contraceptive tasks: it inhibits ovulation, makes the mucus plug in the cervix tough and impervious to sperm and would also prevent a fertilized egg cell from implanting in the uterus, whereby fertilization is already carried out by the Ovulation inhibition is very unlikely. Small amount - big effect: The pill owes the name micro-pill to the fact that the hormones in modern preparations are much lower in dosage than in older pills.

The higher the dose of estrogen in a pill, the more stable your cycle is. The micropill contains only as much estrogen as is absolutely necessary to stabilize your cycle, which is usually between 20 and 35 micrograms. The progestin in the micropill is responsible for the contraceptive effect and is additionally supported by the estrogens. The micropill protects you against pregnancy with almost 100 percent certainty and keeps your cycle stable; at the same time it is well tolerated due to the low hormone dosage.

In addition to being reliable, the pill is safe and has other advantages

Safely protected:
The pill is one of the safest contraceptives. With a Pearl Index of 0.1-0.9, if used correctly, you can very safely rule out an unwanted pregnancy.

You can rely on the pill as a contraceptive for a long time: it can accompany you from adolescence to your 40s or 50s.

Less pain:
Many women experience very severe pain during their period, which can radiate all over their bodies. The pill ensures that these ailments are regulated.

Less bleeding:
Taking the pill will reduce the strength and duration of your bleeding. This makes the days a little more pleasant.

Stable cycle:
The pill keeps the hormone level and thus the cycle constant. In this way you can estimate the onset and the duration of your days very precisely and do not experience any "nasty surprises".

What you need to know about the side effects of the pill

Even if the pill is very widespread and one of the most popular contraceptives, you must always be aware that it is not a lifestyle or beauty product, but a highly effective medicine. The hormones in the pill get into the whole body and affect your hormonal balance there. As a result, the pill reliably protects you against pregnancy, but on the other hand it can also cause undesirable side effects. Therefore, you should always make the decision to take the pill together with your gynecologist. He is informed about your individual state of health through the necessary preliminary examinations and can judge which pill is best for you on the basis of this. He can also tell you what side effects you may have to expect and what to look out for while you are taking the pill.

Basically, the pill - and especially the modern low-dose preparations - rarely cause side effects. Above all, the dose of estrogen and the type of progestin it contains make a decisive contribution to ensuring that the pill is well tolerated. If there are side effects anyway, this is not necessarily a cause for concern, as these are usually harmless. In addition, it is often the case that side effects such as intermenstrual bleeding, breast tenderness or headaches disappear again after the first few weeks or months - because of course your body first has to get used to the hormonal change. However, it is always important not to simply stop taking the pill due to side effects, because then there is no longer reliable contraceptive protection. Ask your gynecologist for advice in the event of side effects or persistent symptoms.

Some complaints such as headaches, stomach aches or a leg asleep are - as long as they only occur occasionally - quite normal. However, you may have the same ailments over and over again. In this case, you should speak to your gynecologist to get to the bottom of the matter and to check whether your contraceptive could possibly be a trigger for your symptoms. Because although the pill and other hormonal contraceptives protect against unwanted pregnancy, you should not forget that this is an effective drug that requires a prescription. And as with any such remedy, unwanted effects from the pill, contraceptive ring and the like cannot be ruled out - even if most of them are rare.

“Thrombosis” is the term used to describe the formation of a blood clot in a blood vessel, which disrupts the flow of blood. In the worst case, this can lead to an insufficient supply of oxygen to organs and tissues. But it is very unlikely that it will come to this - especially with young, healthy women.

However, there are a few factors that can make thrombosis more likely to occur.

  • The first year while using an estrogen-based contraceptive
  • Overweight (a BMI of over 30)
  • Elevated blood pressure (over 160 mmHg)
  • Smoke
  • Bleeding disorder
  • Recent delivery
  • Age over 35
  • Increased fat levels in the blood
  • Close relatives (mother, father, siblings) who had a thrombosis before the age of 50
  • A surgery
  • Long haul flights

Basically, as long as you have a balanced lifestyle, the best thing to do is to prevent thrombosis - regardless of whether you take the pill or not. This means that you should exercise enough, eat healthily and not smoke. If you keep harmful influences such as nicotine, obesity and excessive alcohol consumption away from you, a thrombosis is usually unlikely, even if you are taking the pill. Note: Did you know that pregnancy increases the risk of thrombosis by 5 times?

Some women experience dryness in their intimate areas after taking the pill. Even if this undesirable effect is not harmful to health, it can be perceived as annoying - e.g. during sex. A deficiency of the hormone estrogen is often the cause: the pill suppresses the body's own estrogen production. A pill high in estrogen can help. It is best to talk to your gynecologist about your problem. In case of doubt, special creams and gels can help to ensure that everything "runs smoothly" again.

It can happen that women suffer from pain and tension in the breasts as a result of the pill, which can be very uncomfortable, if not harmful to health. One cause of these symptoms can be an excessively high level of estrogen in the pill. Many women already find it helpful to switch to an estrogen-free pill. This protects you just as reliably as the conventional birth control pill - only with a different hormone composition. If you suffer from sore breasts, you should speak to your gynecologist about the estrogen-free pill.

In some women, the pill can help water build up in the body. This water retention occurs predominantly in the extremities, i.e. in the hands and feet, and is often uncomfortable for those affected - especially in the hot summer months. One reason for edema can be the estrogen contained in the pill, which some women do not tolerate well. The estrogen-free pill can be a real alternative for them, as it also provides very reliable protection against unwanted pregnancy - only with a different hormone composition. If you are struggling with water retention, talk to your gynecologist about the estrogen-free pill the next time you visit.

Not all side effects are bad!

Like any medicine, the pill has side effects, but not all of them are bad or uncomfortable. With many girls and women, for example, the bleeding with the pill is significantly less, it is usually predictable to the day, the pain is less and the so-called premenstrual syndrome (PMS) with its various physical and mental complaints affects many girls and Women no longer create so strong. In exceptional cases, you can even postpone your bleeding with the help of the long cycle, for example if you want to go on vacation and get your period during this time.

Last but not least, some pills also inhibit the so-called androgens in your body. Androgens are male sex hormones that the female body also produces in small amounts. However, if there are too many of them, they fuel the production of sebum in the skin's sebum glands - the result is oily skin, oily hair, and pimples that often seem to spring up like mushrooms during puberty. Many girls and young women, thanks to these anti-androgenic effects, have less to contend with these annoying problems.