The pill not a set-and-forget medication
The pill can be used safely by most women for decades. However, regular check-ins with your prescriber are essential, according to health experts.
While some people can be on the same oral contraceptive for decades without a problem, it shouldn’t be a set-and-forget medication, and regular check-ins are essential, according to doctors.
Adding other medications or supplements to your schedule can influence side effects and the pill’s effectiveness. New health conditions, such as obesity and inflammatory bowel disease, is also cause to check-in with your prescriber.
“The key thing about contraception is it’s about having a range of options and knowing that the right option might change for the same person over time,” says Dr Beth Messenger, the medical director of Sexual Wellbeing Aotearoa.
Dr Beth Messenger, the medical director of Sexual Wellbeing Aotearoa.
supplied
“That’s why having a check-in is useful. It’s not just about [doctors] medically wanting to ask them questions, but it’s actually also an opportunity for them to check in and go ‘Well, actually, is this still the right thing for me, and if there is something else I should be looking at?'”
Oral contraception, aka “the pill,” was the most popular contraception amongst a group of almost 7,000 New Zealanders surveyed in 2020, according to data from Sexual Wellbeing Aotearoa. Almost 40 percent of respondents reported currently using the pill, followed by 33 percent citing condoms as their primary contraceptive. IUS was used by 17 percent of respondents (IUS, or intrauterine system, is a t-shaped object that contains progesterone and is inserted into the uterus for up to six years).
How often should you check in with your doctor?
Patients of Sexual Wellbeing Aotearoa are required to have an appointment with a doctor or a prescribing nurse every six months to continue with their oral contraceptive prescription. However, an annual check-in is probably sufficient, Messenger says.
When someone first goes on any hormonal contraceptive, Dr Michelle Wise, an associate professor of gynecology at the University of Auckland, recommends a check-in at the one-month mark to monitor blood pressure. A combined oral contraceptive, which has estrogen and progesterone, can increase blood pressure. Some oral contraceptives only contain progesterone.
“Most side effects will settle down around three months, so you could also check in with people around three to four months, and then I think an annual check-up is probably enough.
“It's safe to take the pill long term, and the reason you check-in is in case you develop another health condition, or you start a new medication, or your plans change and you don't need contraception, or you need a more long-acting contraception,” Wise added.
Perimenopause, the final years that a woman continues to ovulate before reaching menopause, is another marker to reassess what contraception someone is taking.
“At perimenopause... we would change our attitude towards which pill we might give because maybe we can actually address some of the perimenopausal things and your contraception at the same time.”
Perimenopause can bring on uncomfortable symptoms such as mood changes, sleep problems, night sweats, and hot flushes.
Risk factors and warning signs
The combined pill can trigger a slightly increased risk of a stroke and blood clots in the lungs or in the legs, which is called deep vein thrombosis.
“The absolute risk is low. It’s probably in the order of two in 100,000, but that risk does increase if you take the combined pill.
“It’s way more increased if you become pregnant, so you know everything is relative.”
Separate conditions such as obesity, diabetes, and taking up smoking can push someone’s risk for blood clots higher, as well as the risk of a stroke. Add the pill to that, and the risk will increase further, says Messenger.
“It's when you start adding all of those things together, it's not always necessarily just one of those things on its own that would make you concerned, but when you look at the whole picture, you think maybe this isn't a good idea...”
Specific types of migraine, such as migraine with a visual aura (like flashes of light or a blind spot) along with the combined oral contraceptive, can increase a woman’s risk of a stroke, Messenger says.
Social media backlash
While the pill is still New Zealand’s preferred contraception, new forms of long-acting hormonal contraception are coming on the market, so it's likely fewer people are taking an oral contraceptive, says Wise.
However, Wise is also seeing the impact of wellness influencers on social media with false claims about the pill being unsafe. The influencers have wrongly claimed that the pill and sometimes other hormonal contraceptives can lead to issues such as infertility, a clouded mind, or fatigue.
This has led to some people, especially teenagers and young adults, ditching the pill either as a contraceptive. Or, if they're taking it for other reasons, such as heavy or painful periods, or to reduce symptoms of endometriosis and polycystic ovarian syndrome, their symptoms return.
“That's not coming from the medical professionals. That is coming from people who are completely unqualified, who pick and choose what they want to talk about.”
