How to take the contraceptive pill?

In France, 43.4% of women on contraception take the pill, according to a survey conducted in 2013 by the National Institute of Demographic Studies. However, the percentage of women using the contraceptive pill fell to 36.5% in 2016, according to new figures published recently. This decline in using the pill, particularly noticeable among women in the 20 to 29 age group, does not prevent it from being the most popular contraceptive method in France.

General information on the contraceptive pill

What is contraception?

The current combined pills have three main mechanisms of action: blocking ovulation in the ovaries, modifying the endometrium, making it less hospitable for implanting a fertilised egg and finally thickening the cervical mucus to prevent spermatozoa from crossing the cervix. These include contraceptive patches, contraceptive implants, diaphragms, cervical caps, vaginal rings, female condoms, male condoms, injectable progestins, contraceptive sterilisation methods, spermicides, intrauterine devices (IUDs), emergency contraception and contraceptive pills.

The types of pills and how they work

Combination pills, also known as oestrogen-progestin pills, are distinguished from progestin-only pills:

Progestin-only pills

These contain a single hormone, progestin. The pills are taken continuously without a break. They comprise 28 tablets and affect the cervical mucus. Also known as "micropills", progestin-only pills contain a low dose of progestin and appear more suitable for women for whom oestrogen is contraindicated.

Combination pills

These are also known as oestrogen-progestogen pills and combine two synthetic hormones from progesterone and oestradiol. The pack contains 21 tablets. A 7-day break should then be taken. Combination pills work by negative feedback; that is, they promote low secretion of the hormones FSH and LH. In summary, three mechanisms of action of the pills can be distinguished:

When should I start taking the pill?

If you are taking the pill for the first time, consider your menstrual cycle. Start at the same time as your period; that is, on the same day as your first bleed. It is important to note this 1st day. Then, try to take one pill a day. Take your pills at regular times. Some pills can be taken with an average delay of 12 hours. However, it is important to check this possibility, which should be stated in the instructions. Protection begins when the first pill is taken for oestrogen-progestin pills. Progestin-only pills are less immediately effective because protection only begins after the 7th pill.

Several tips are available to help you remember to take your pills. For example, it is advisable to choose a time to take your pills, such as in the evening before going to sleep, in the morning as soon as you wake up before getting out of bed, before taking a shower, just after brushing your teeth, at the same time as your breakfast and so on. For example, you can place your pack next to an object you use at fixed times. However, setting a reminder with a ring tone on your smartphone is an effective way to remember to take your pill every day.

Once you have finished the first pack, it is recommended that you start the second pack (in all cases). The start of the new pack should coincide with the day you started the first pack. For example, if you started the first pack on a Friday, it should end on a Thursday, forcing you to start a new pack on another Friday.

How do you deal with missed doses?

If you miss your tablet, do not panic. Take the missed pill as soon as you remember. Then, return to your normal schedule. You can also refer to the package insert. Some pills allow a delay of 3 hours, others 12 hours and others 24 hours. If this delay is exceeded, it is recommended that you use another method of contraception, such as a condom, until the 7th day after you take your pills again.

For 21-pill packs, a 7-day break is required from day 22 to day 28 before you can start a new pack (your period arrives during this break). However, blister packs of 28 tablets should be taken continuously, even during your period.

It is possible to change from one type of pill to another. Consult the instructions to identify the correct pill and discuss this with a health professional (pharmacist, midwife or GP).

The possibility of a rapid start

This method allows you to start taking your pills on any day other than the day of your period as normally indicated. It is important to have the advice of a specialist to do this. It is also recommended that you take a pregnancy test to ensure that you are not pregnant.

Furthermore, the pill is only effective from the 7th day after the first dose. It is therefore strongly advised to use a condom during this period. Generally, the rapid start is considered when the user does not want to wait for her next period to start taking the pill.