Making the Pill Work for You

Dr. Uma Lerner is a practicing Psychiatrist based in San Francisco, CA. Dr. Lerner utilizes a combination of cognitive-behavioral, mindfulness, and psychodynamic techniques in addition to medication management and specializes in reproductive mental health. Please see an important disclosure at the end of this post.*

Why is it important to take birth control pills at the same time each day? Before answering that question, perhaps we should first ask another question:

Why do we take oral contraceptive pills?

For many of us, it is to prevent pregnancy, but people also use birth control pills for a number of other reasons. In a 2015 online survey of US women, almost half said that they sought out prescription contraception for a primary reason other than birth control.

Some of the reasons were:

  • Regulate menstruation
  • Lighten periods
  • Improve acne
  • Manage mood
  • Reduce menstrual cramps

Oral contraceptives can also be prescribed by a doctor as part of fertility (IVF) treatments, polycystic ovarian syndrome (PCOS) treatment, lowering the risk of endometrial cancer and ovarian cysts, or managing migraines. The pill can also reduce the risk of anemia, as heavy menstrual bleeding is a common but challenging health condition.

And the list of health benefits continues! Birth control pills can be used to skip, shorten, or lighten the bleeding.

Oral contraceptives are also used for treatment and pain reduction for endometriosis along with or instead of surgical treatment. Studies have shown that women who continuously used an oral birth control had a reduction in the recurrence of painful periods, pelvic pain, and endometrioma cysts.

Another study has shown that women who have used oral contraceptives reduce their risk of developing endometrial cancer when compared with people who have never used oral birth control. Ovarian cancer risk reduction is associated with the length of birth control use — the longer the duration of use, the greater the reduction in risk. It is estimated that the worldwide use of oral contraceptive prevents 30,000 deaths from ovarian cancer annually.

Additionally, there is approximately 20% reduction in both colon and rectal cancers among current users of hormonal birth control.

So, What are the Side Effects of Oral Contraceptives?

Nearly half of women surveyed report being concerned about side effects before starting their first prescription. The most frequent concerns were weight gain, mood swings, blood clots, infertility, nausea/vomiting, and irregular/missed periods. It’s important to bring up questions and concerns with your doctor. Afterall, this is your body and health we are talking about, and each person is different.

Some reported side effects, including menstrual bleeding irregularities and mood swings, may be related to not taking the pill at the same time everyday. Other noted side effects may actually be normal cyclical bodily changes such as water retention and breast tenderness.

Estimated 1.2 million pregnancies each year can be attributed to inconsistent or incorrect contraception use

In a 2011–2013 survey, approximately 62% of women aged 15–44 were using some type of contraceptive method. Oral contraceptive pills remain the most common form of contraception with 1 in 5 women of reproductive age taking the pill.

It is estimated that about 1.2 million pregnancies each year can be attributed to inconsistent or incorrect contraception use. Forgetting one to three pills per cycle is a frequent problem, and is more common in adolescents and young adults. Missing or forgetting to take the pill is reported as one of the main reasons for seeking emergency contraception. With correct use, oral contraceptives have only a 1% risk of unintended pregnancy.

Taking the Pill can be Stressful!

© Aavia smart pill case, 2019

In one study, high perceived stress was associated with missing a pill. In other words, stressful and hectic lives may contribute to poor birth control adherence. It can be one more thing to do in your already demanding life. Having a daily routine improves consistent birth control use and effectiveness. Of birth control users who never miss a pill, 90% have a routine that involves taking the pill at the same time everyday. In a survey of college students, the only significant difference between those who tend to miss pills and those who don’t, was having a fixed time for taking oral contraceptives. When looking at psychological factors which reduced missing pills, the study noted that the only factor was feeling a higher sense of control in planning around and taking the pill.

Forgetfulness may be mitigated by reminder systems (eg smartphone apps). In a study employing daily email reminders, those who received reminders tended to not miss oral contraceptives. Subjectively, most women found the daily emails somewhat or very helpful for remembering to take the pill daily. After the study was completed, most women wanted to continue received the reminders. In another study, daily text reminders that included an educational message significantly reduced the number of women who experienced a lapse in use.

We all have different lives and routines, and it’s important that each person figures out the lifestyle that suits them—starting with making your birth control work for you.


Dr. Uma Lerner is a practicing Psychiatrist based in San Francisco. Dr. Lerner utilizes a combination of cognitive-behavioral, mindfulness, and psychodynamic techniques in addition to medication management and specializes in depression, anxiety, bipolar disorder, ADHD, life transitions, grief, and loss. Dr. Lerner is an Assistant Clinical Professor of Psychiatry at the University of California, San Francisco Medical School, where she teaches and supervises medical students and psychiatry residents.

She has expertise in managing psychiatric and emotional challenges during pregnancy and while breastfeeding. You can learn more about Dr. Lerner’s practice here.

*No information on this post should be relied upon to make a medical diagnosis, or determine treatment for a medical condition. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Though I am a physician, my blog posts are for information purposes only and shouldn’t be seen as medical advice. Different people react to hormones differently, and it is important to be clinically evaluated and talk about your specific situation with your doctor.


Sources:

Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15–44: United States, 2011–2013. NCHS data brief, no 173. Hyattsville, MD: National Center for Health Statistics. 2014.

Bahamondes LM, Bahamondes V, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Human Reproduction Update 2015; Volume 21, Issue 5, Pages 640–651.

Gavin L, Pazol K. Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs. Morb Mortal Wkly Rep 2016;65:231–234.

Nelson A, et al. Women’s perceptions and treatment patterns related to contraception: results of a survey of US women. Contraception 2018;97:256–263.

Klein D, et al. Provision of Contraception: Key Recommendations from the CDC. Am Fam Physician 2015;91(9):625–633.

Chabbert-Buffet N, et al. Missed pills: frequency, reasons, consequences and solutions. Eur J Contracept Reprod Health Care 2017;3:165–169.

Choi A, Dempsey A. Strategies to improve compliance among oral contraceptive pill users: a review of the literature. Open Access Journal of Contraception 2014;5:17–22.

Hughey AB, et al. Daily context matters: predictors of missed oral contraceptive pills among college and graduate students. American Journal of Obstetrics & Gynecology Volume 203, Issue 4, 323.e1–323.e7.

Molloy, et al. Adherence to the oral contraceptive pill: a cross-sectional survey of modifiable behavioural determinants. BMC Public Health 2012;12:838.

Fox MC, et al. Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance. Contraception Volume 68, Issue 5, 365–371.

Gal N, et al. Evaluation of smartphone oral contraceptive reminder applications. Research in Social and Administrative Pharmacy 2015;1–4.

Castaño P, et al. Effect of Daily Text Messages on Oral Contraceptive Continuation: A Randomized Controlled Trial. Obstetrics & Gynecology 2012;119(1):14–20.

Beral V, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008;371(9609), 303–314.

Dossus L, et al. Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2010;127: 442–451.