The Pill

It is one of the most effective non-surgical birth control methods when taken as directed. Less than one out of 100 women who correctly use the pill for one year will become pregnant. However, actual failure rate is higher if one considers pregnancies that occur because pills are forgotten or taken inconsistently. Most commonly, an unplanned pregnancy occurs after a woman discontinues the pill and has unprotected intercourse prior to initiating another effective method of contraception.

There are many possible side effects to pill use, ranging in frequency from rare to often, and in severity from fairly minor to life-threatening. These adverse effects are grouped below according to severity. Warning symptoms to be alert to and to report to your clinic or doctor are listed.

• Spotting or bleeding between normal periods, "break-through bleeding"
• Weight and/or appetite changes
• Nausea, prevented by taking the pill with food
• Breast tenderness or fullness
• Mood changes, irritability and infrequently, in sex drive change
• Hormonal changes resulting in vaginal itching and possible vaginitis

• Hypertension - (occasional) High blood pressure. There may not be any symptoms. Blood pressure should be checked every 6 to 12 months by a health care practitioner. High blood pressure will usually reverse after stopping the pill.
• Amenorrhea - (occasional) Failure of menstrual periods to return after stopping the pill. There may be slight delay, as long as six months, in return of regular menses after stopping the pill. This is sometimes accompanied by galactorrhea, a milky discharge from the nipples. Amenorrhea is more apt to occur in those women who had irregular periods prior to pill use.
• Gall bladder disease - (rare) Development of gallstones. Symptoms are upper abdominal pain, indigestion.
• Liver tumors - Rare, but reported with long-term oral contraceptive use. Abdominal pain occurs, possible rupture and extensive bleeding.

Circulatory problems due to blood clots or thrombosis are the potential life-threatening side effects of the pill. These include stroke, heart attack, and cardiovascular disease. Women over the age of 35, are obese, have high cholesterol levels, and who smoke are most at risk.

• Abdominal Pain
• Vomiting
• Weakness
• Chest Pain (Severe)
• Shortness of Breath
• Cough
• Left Arm or Shoulder Pain
• Headache (severe)
• Dizziness
• Weakness
• Sudden Intellectual Impairment
• Eye Problems
• Complete or Partial Loss of Vision
• Sudden Visual Impairment
• Severe Leg Pains
• Swelling
• Localized Heat
• Tenderness

• In preparation for and during convalescence from surgery, check with your surgeon.
• During recovery from accidental injuries, especially if there are fractures and if a leg or arm is immobilized (casted or splinted).
• During acute illness which impairs liver function (eg. mono).
• When pregnant or breast feeding

** Check first with your health care provider before stopping pill use.

• During the first month of use.
• When one or more pills are missed in one cycle.
• When certain other medications are taken at the same time. Inform your health care practitioner of all medications you take, to avoid drug interactions. This includes prescriptive, over-the-counter, and recreational drugs.

• History of blood clots, including heart attack, stroke, angina, or any thromboembolic condition.
• History of liver tumor, chronic impaired liver function.
• History of cancer of the breast or reproductive system.
• Pregnancy, known or suspected.

• Heavy smoking habits, more than 15 cigarettes per day, especially in women over 35 years old
• Vascular and migraine headaches
• Hypertension
• Diabetes
• Severe mononucleosis
• Sickle cell disease
• Depression
• Epilepsy
• Varicose veins
• Hyperlipidemia, or family history of undiagnosed abnormal vaginal bleeding
• Over 50 years of age
• Gall Bladder disease

1. Start taking your pill on the Sunday after your period begins, or on the 1st day of your period. Follow instructions of your health care practitioner.
2. Take one pill a day at the same time of the day. Try to associate some other daily activity with pill taking. Try to take it within one hour of the chosen time.

1. If you miss one pill, take it as soon as you remember. Take the next pill at the regular time. Use back-up contraception for 7 days.
2. If you miss two pills in a row, take two pills, and then two pills the next day. Use back-up contraception for 7 days.
3. If you miss three pills in a row, throw away that pill pack and start a new pack on the following Sunday, if you were a "Sunday Starter." Or start a new pack immediately if your started pills on the first day of your menses. A menstrual flow will probably start after missing 3 pills. Use back-up contraception for 7 days.
4. If you miss pills from the 4th week of a pill pack, there is no risk as these pills do not contain hormones. Discard the missed pills.
5. Menstrual periods for women on the pill tend to be lighter and shorter than usual. Occasionally there is only spotting or no blood at all. If you miss one period, there is very little risk of pregnancy if you have taken all of your birth control pills regularly. If you miss two menstrual periods in a row, you should come to the health center for a pregnancy test. If you have missed a pill during the month and do not get a menstrual period, consult your health care practitioner.
6. Break-through bleeding can occur in the first few months of pill-taking, when pills have been missed, or when other medications have decreased the pill's effectiveness.
7. Back-up contraception is indicated in the first month of pill use since you may not be fully protected from pregnancy until the 2nd cycle. Use of back-up contraception is indicated when pills have been missed, and whenever the effectiveness of birth control pills is decreased.
8. Other medications, such as Ampicillin, Tetracycline, Carbamazepine, Dilantin, and Rifampin can reduce the effectiveness of birth control pills. Inform your health care practitioner that you are on the pill.

Birth control pills do not protect you from sexually transmitted infections.
Always use a condom.

Use an effective "back-up" contraceptive any time pill use is interrupted.

Oral contraceptives may alter the way the body handles certain vitamins and minerals. Recent studies suggest that blood levels of copper, iron, vitamin A, and vitamin K increase during the use of oral contraceptives, while the levels of magnesium, zinc, folic acid, vitamins B2, B6, B12, and C decrease.

It is important to note that although routine vitamin supplementation is not necessary for every woman using oral contraceptives, experts do agree that certain vitamins, particularly B6, B12, C, and folic acid, should be increased to protect women from potential nutrient deficiencies. Consuming foods with adequate amounts of those vitamins reduced by oral contraceptives is a good way to prevent a deficiency. For some individuals, especially those who have inadequate diets, a vitamin supplementation may be required. Following is a list of food items with adequate amounts of vitamins B6, B12, C, and folic acid.

• Vitamin B6: meats, fish, bananas, walnuts, green vegetables, whole grains, potatoes
• Vitamin B12: meats, fish, milk
• Vitamin C: citrus fruit, green leafy vegetables, citrus juices, broccoli
• Folic Acid: green leafy vegetables, fresh fruits, organ meats, yeast, whole grain cereals

Women using oral contraceptives should eat a variety of foods in addition to those high in vitamins B6, B12, C, and folic acid, to receive all the essential nutrients. A daily dietary plan that includes these suggested foods will provide all the nutrients necessary for good health.

Busch/Livingston Health Center 732-445-3250
Livingston Campus (behind the Athletic Center)
110 Hospital Road
Piscataway, NJ 08854-8043

Hurtado Health Center 732-932-7402
College Avenue Campus (next to Clothier)
11 Bishop Place
New Brunswick, NJ 08901-1180

Willets Health Center 732-932-9805
Douglass/Cook Campus (across Nichol Ave. from the bookstore)
11 Suydam Street
New Brunswick, NJ 08901-2889

Camden Health Center 856-225-6005
Camden Campus (in the Student Center)
326 Penn Street
Camden, NJ 08102

Newark Health Center 973-353-5231
104 Blumenthal Hall (Student Services Building)
249 University Avenue
Newark, NJ 07102

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