The combined oral contraceptive pill – better known as the pill – has been available in Australia since 1961 and remains a popular contraceptive choice. Of the 70% of Australian women who employ some form of birth control, 27-34% use oral contraception. The combined oral contraceptive pill contains two hormones, oestrogen and progesterone. When these hormones are combined they safely alter the menstrual cycle to prevent ovulation, which is the main way that the pill prevents pregnancy. The pill can also be used for some non-contraceptive reasons, such as treating heavy or painful periods or managing irregular cycles.
As with a lot of health topics, there can be a lot of misinformation floating around about the pill. With that in mind, here are some of the most common pill-related myths that we discuss with our patients:
1. “The pill will make me get fat” – This is probably the concern we hear the most, and understandably causes a lot of anxiety! To be clear, there is currently no actual evidence that the pill causes weight gain. However, it’s useful to consider that people often start taking the pill at a time of life transition - such as starting a new relationship - which might also affect their usual eating and exercise habits. If you’re worried about weight changes, it can help to discuss these concerns with your GP.
2. “The pill gives me acne” - This isn’t strictly a myth and some people will find that the hormonal effects of certain pills can lead to break outs. However, it’s also important to know that the pill can be quite helpful for women who are already experiencing acne, especially pill formulations which block the effect of androgens on the skin.
3. “The pill causes cancer” – This one is a bit trickier and like a lot of issues the answer isn’t black or white. There is good evidence that the combined oral contraceptive pill actually reduces the lifetime risk of endometrial and ovarian cancer. There is also evidence that taking the pill can temporarily and slightly increase the risk of developing breast or ovarian cancer. On balance, experts currently advise that the reduced risk of endometrial and ovarian cancer outweighs the transient slight increased risk of breast or cervical cancer, but it is really important to discuss any other risk factors with your GP. You can also read more about it through Cancer Council Australia’s Position statement
4. “The pill will affect my long term fertility” - There is currently no evidence that taking the pill is associated with a long-term reduction in fertility. Studies report that most women ovulate within a month of stopping combined oral contraception and conception rates are comparable to woman who have not been taking the pill. Some women find that it takes longer for their periods to return to normal once they stop the pill, however this may be because of an underlying issue that wasn’t evident when taking the pill. It may be reasonable to investigate if periods still haven’t returned after 3 months (and you haven’t fallen pregnant).
5. “It’s bad if I skip my period on the pill” - One of the great things about the combined pill is that it can give you some control over your cycles! There’s no major health reason why you need to have a “withdrawal bleed” (period) every month and it is usually safe to take active pills back to back, but in some people it can lead to spotting. It’s best to have a chat with your GP about how to make sure you’re taking your pill correctly
6. “My pill won’t work if I take antibiotics” - This myth is a bit of an old truth, as information about medication interactions has changed since the pill was first available. Whilst there are a few medications that can interact with the pill and make it less effective, most commonly used antibiotics are actually fine. You should always let your health professional know that you are taking the pill and can ask them to double check any new medications, which includes natural supplements. When in doubt, it’s still sensible to use additional protection such as condoms until you can be confident that the pill is effective.
7. “I can’t fall pregnant on the pill” - Unfortunately this isn’t true either. Although the pill is 99.7% effective when used perfectly, it is only 91% effective with typical human use, meaning about one in 10 women taking with pill may have an unplanned pregnancy. Reasons for this include forgetting to take the pill, or if you have vomiting or diarrhoea that may affect pill absorption. If you do accidentally fall pregnant whilst taking the pill, speak with your GP or sexual health professional about options. It can be reassuring for some people to know that the pill is actually not known to be harmful to early pregnancies.
It’s important to note that the risks of taking the pill may be higher for some women, and you should always discuss any side effects with your doctor. Getting birth control right can be a bit tricky, and unfortunately figuring out the best fit can be a process of ‘trial and error’ for some women. Your GP is in a great position to help you navigate these issues and work through any concerns you might have. Remember – no question is silly and you should always feel free to ask anything!