Oral Contraceptive Pills

Frequently Asked Questions

 

I am interested in taking birth control pills. What should I do?

I already take birth control pills. Can I get refills from the Health and Wellness Center?

How does the pill work?

What are the advantages and disadvantages?

Who should not take oral contraceptive pills?

 

Oral contraceptive pills are an extremely effective form of birth control. If used perfectly, only 1 out of 1,000 women will become pregnant within a year.

 

They are available in two types:

  1. combination oral contraceptive pills

  2. progestin-only pills

The majority of women take combination oral contraceptive pills (which contain both estrogen and progestin). These are more effective than the progestin-only pills. The progestin pills ("minipills") are helpful for women who are unable to take pills which contain estrogen.  

What are some of the side effects?

Are there any pill interactions?

How do I take the pill?

What if I miss a pill or two?

What brands of pills are offered at the Health and Wellness Center?

How much do the pills cost?

If I am prescribed birth control pills from the Student Health Center, how do I get refills?

 

 

QUESTION: I am interested in taking birth control pills. What should I do?

If you are interested in oral contraceptive pills, make an appointment to talk with a health care provider here at the Health and Wellness Center. We will discuss the pros and cons of oral contraceptive use with you. We can also help you determine if oral contraceptive pills are right for you.

If you decide that you would like to start taking oral contraceptive pills, you will be asked questions to make sure that it is safe for you to take the pill. Your blood pressure will also be checked. Assuming everything is okay, you can start the pills. If you wish to continue receiving pills from the Health and Wellness Center, you will need a pelvic exam sometime in the nine-month period after you start the pills. An annual gynecological exam, which includes the pelvic exam, is needed to screen for sexually transmitted infections and to obtain a Pap smear (a screening test for cervical cancer).

For those women who have never had a pelvic exam, we have an online Women's Health tutorial and offer sessions with trained peer health educators, who can provide an overview of the information and answer any questions you may have. If you'd like to make an appointment with a peer health educator, you may do so by calling the Center for Health Education & Wellness at 410-516-8396

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QUESTION: I already take birth control pills prescribed from my doctor back home. Can I get these pills refilled at the Health and Wellness Center?

We are not able to fill outside prescriptions for oral contraceptives from your private physician. This is because we do not operate a full-service, licensed pharmacy. There are many local pharmacies where you can fill such prescriptions. 

 

You can receive oral contraceptive pills and refills from our clinic only if your gynecological care is provided here at the Health and Wellness Center. These pills are prescribed and dispensed by our health care providers, not by a pharmacist.

 

If you wish to transfer your care here to the Health and Wellness Center, please have a copy of your medical records (specifically, your last pap smear test and gynecological exam) sent to our clinic.

 

Our address and fax number:

 

The Johns Hopkins University Student Health & Wellness Center

3400 North Charles Street, AMR II
Baltimore, MD. 21218-2682

Fax# (410) 516-4784

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QUESTION: How do the "pill" work?

Oral contraceptive pills work primarily by inhibiting the ovaries from releasing eggs (inhibiting ovulation). The cervix also produces thicker mucous so that it is more difficult for sperm to travel. The pills may also act on the endometrium to make implantation more difficult.

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QUESTION: What are some of the advantages and disadvantages of taking combination oral contraceptive pills?

 

Advantages:

  • Oral contraceptive pills are extremely effective. If used perfectly, only 1 out of 1,000 women will become pregnant within a year.

  • They are reversible. There is no loss of fertility.

  • They are considered safe for most women. Oral contraceptive pills are one of the most extensively and scientifically studied medications available.

  • They do not interfere with intercourse.

  • Birth control pills may decrease menstrual cramps and pain. Menstrual periods may become lighter and shorter.

  • There is a decreased risk of ovarian and endometrial cancer.

  • There is a decreased rate of benign breast disease.

  • Oral contraceptives may prevent functional ovarian cysts.

  • They may help prevent rheumatoid arthritis.

  • They can decrease ectopic pregancy.

  • They may help preserve bone mineral density .

  • They may improve acne.

Disadvantages:

  • Oral contraceptives do not protect against sexually transmitted infections, including HIV/AIDS.

  • They must be taken on a daily basis.

  • They cost money.

  • They may cause nausea and vomiting.

  • There is an increased risk of blood clots.

  • Some women may have spotting between menstrual cycles.

  • Some women may have decreased libido.

  • Some women may have an elevation in blood pressure.

  • Oral contraceptives can accelerate the development of gallbladder disease in women who already have gallbladder problems.

  • Some women may develop benign liver tumors.

  • Some women may develop or have worsening of headaches.

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QUESTION: Who should not take oral contraceptive pills?

 

Women who have any of the following conditions should not take oral contraceptive pills.

  • a history of blood clots

  • active liver disease

  • a history of breast cancer

  • migraine headaches associated with neurological symptoms

  • over 35 years old and smoke heavily (20 or more cigarettes a day)

  • pregnant

  • a history of stroke or coronary heart disease

  • high blood pressure greater than 160/100

  • diabetes with involvement of the eye, kidney, nerves, or blood vessels

  • diabetes for more than 20 years

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QUESTION: What are some of the side effects?

 

Minor side effects:

  • nausea and vomiting (Tip: taking the pill with food may help reduce nausea.)

  • spotting between periods 

  • breast swelling and tenderness

  • headaches

  • mood changes

  • weight gain (minimal)

Some of these minor side effects will go away after 3-4 cycles.

 

 

Serious side effects:

 

Serious side effects include high blood pressure and formation of blood clots. Notify your health care provider immediately if you have any of these symptoms:

  • Abdominal pain (severe)

  • Chest pain

  • Headache (severe)

  • Eye problems, visual disturbances

  • Severe localized leg pain (calf or thigh)

(The easy way to remember this is to know the mnemonic "ACHES".)

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Question: Are there any pill interactions?

 

Check with you health care provider. Here are examples of some medications which can interact with oral contraceptives.

  • Anti-seizure medications (i.e. phenytoin, phenobarbitol, carbamazepine)

  • Griseofulvin (anti-fungal medication)

  • Rifampin (medicine used for tuberculosis)

  • Some antibiotics (check with your health care provider)

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QUESTION: How do I take the pill?

 

Oral contraceptive pills are very easy to take. They usually come in packages of 21 or 28 pills. You take them once daily at about the same time each day. You may want to associate your pill with something else that you do on a daily basis (i.e. brushing you teeth, waking up in the morning) in order to help you to remember to take them regularly.

 

There many ways to start oral contraceptive pills. Here are two popular methods.

  • Start on the Sunday after your menstrual period starts. (If your period starts on a Sunday, start the pill on that Sunday.) 

  • Start on the first day of your menstrual period

All combination oral contraceptive pill cycles consist of three weeks of active pills (containing hormones) and one week with no hormones. In a 28-day pill pack, the fourth week of pills are the "reminder" or "blank" pills and do not contain hormones. If you use a 28-day pill pack, remember not to skip any days between packs.

 

If you are using the 21-day pill pack, take one pill every day. After you are done with the pill pack, start a new pack seven days later.

 

If you are new to birth control pills, please remember to use a back-up form of contraception (i.e. condom) for the first seven days.

 

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QUESTION: What if I forget to take a pill or two?

 

Missing pills can give you spotting or irregular bleeding. This may also increase your risk of pregnancy.

  • If you are more than 12 hours late, take your missed pill when you remember it. Use a back-up method of contraception (i.e. condoms) until you have been on the hormonal pills for 7 days.

  • If you are more than 24 hours late, take the missed pill and today's pill at the same time. Use a back-up form of contraception for the next seven days.

  • If you miss 2 pills, take the last pill you missed right away. Take the next pill on time. Throw out the other missed pill. Use a back-up method of contraception until you have been on the hormonal pills for 7 days.

  • If you miss any of the "reminder" pills, you will not become pregnant, and you do not need back-up contraception.

  • If you are in the third week of pills when you miss a pill, follow the instructions above. However, when you get to the "reminder" (blank) pills, do not take the "reminder" pills. Instead, start a new pack. You may not have a period until the end of the second pack. 

  • If you have had intercourse at a time when you are not protected from pregnancy, call your health care provider immediately and ask about emergency contraception. Emergency contraception is best taken within the first 72 hours after intercourse in order to reduce your risk of pregnancy.

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QUESTION: What brands of pills are offered at the Student Health and Wellness Center?

  • Lutera (generic Aviane/Alesse®)

  • Trinessa (generic OrthoTri-cyclen®)

  • OrthoTri-cyclen Lo®

  • Levora (generic Portia/Nordette®)

Last updated 04/07/2008

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QUESTION: How much do the pills cost at the Student Health and Wellness Center?

Click here for a list of prices of oral contraceptive pills. 

If you have the Johns Hopkins University Student Health Insurance Plan, the cost is $8.00 per pack. You must present your Johns Hopkins University Health Insurance card when picking up your filled prescription in order to receive this lower co-payment.

You can pay with cash, check, or j-card. We can also bill your student university account. We are unable to accept credit cards at this time.

By law, oral contraceptive pills cannot be returned.

(Please be aware that due to recent increases in prices from the manufacturers, the Health and Wellness Center may not be able to continue selling birth control pills for less than cost. Please see the letter from the medical director for further information.)

* Prices subject to change. Last updated 04/07/2008

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QUESTION: If I am prescribed birth control pills from the Student Health Center, how do I get refills?

There are two ways to receive refills at the Health and Wellness Center:

1. Call and schedule an appointment for a refill of pills.(410) 516-8270

We do not operate a full-service pharmacy. Therefore, we do not have a licensed pharmacist on-site. Our health care providers are the ones who dispense the medications from our formulary. Our health care providers are also busy seeing patients all day long. Therefore, an appointment for refills is strongly encouraged. 

2. Use our online electronic refill service. This service is available only to those students who receive their annual gynecological exams and birth control at the Health and Wellness Center. Please allow two business days for the processing of your prescription. You may pick up your filled prescription from the front desk during regular office hours.

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References:

 Burkman R. et al. Current perspectives on oral contraceptive use. American Journal of Obstetrics and Gynecology. 2001;185(2)

Hatcher R. et al. Contraceptive Technology. 17th ed. Ardent Media Inc; 1998

 

The above information is for educational purposes only. The content is not a substitute for the treatment and services of a trained health care professional. Please ask your health care provider if you have any questions.
©2005 Johns Hopkins University Student Health and Wellness Center