Options for the contraceptive pill
Dear Dr Mitchell,
I had been taking Pearl oral contraceptives, but after my period I still spotted so I stopped taking it. I would like to know what other pill can be taken that doesn’t have any major side effects
The Pearl oral contraceptive pill is a 30-microgram combined oral contraceptive pill. It is one of the more commonly used birth control pills because it is widely available and is inexpensive, in addition to the fact that it is considered a relatively low-dose pill. This means that it has a good safety profile because of the low level of oestrogen in the pills.
It is not uncommon to have irregular spotting while on the oral contraceptive pill. This tends to be more common, especially if the pills are taken irregularly. In some women a higher dose pill has to be used to control the irregular spotting, especially if it occurs in the middle of taking the pack of 21 pills. If the irregular spotting occurs at the end of the period, then it might help to go on a lower dose pill and use a preparation where the pills are taken for 24 days instead of 21 days. Yaz is a suitable preparation that is ultra-low dose, having 20 micrograms of oestrogen, and so the safety profile is very good. You will take a pill every day for 28 days then start a new pack. While you are taking the last four pills in the pack then you will have a monthly period. The last four pills are actually iron tablets and are used as reminders to keep taking a pill every day.
The lower oestrogen level and progesterone in the pill reduces bloating, weight gain, depression, and allows for all the contraceptive benefits while taking in less hormones.
Most low dose (30-35 micrograms) and ultra-low (20 micrograms) dose pills have similar safety profiles and so while there are no major contraindications to taking oestrogen and progesterone, you can choose from any of the several brands that are widely available.
However, the abnormal bleeding at the end of the period might not be related to the type of pill that you are taking. The problem could be due to an infection in the cervix (cervicitis), pelvic inflammatory disease, precancerous changes in the cervix and cancer of the cervix.
It is important for you to get a complete physical examination with an endocervical, high vaginal swab and a Pap smear done. If there is an infection then this can be treated to prevent the abnormal vaginal bleeding.
It is important to see your doctor before making the decision to switch to another brand of oral contraceptive pills. A pelvic ultrasound should also be done to determine if there is any abnormality in the lining of the uterus or the ovaries that is contributing to the abnormal bleeding.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.