All About the Birth Control Pill

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• 0:04Introduction
• 0:28How the pill works
• 2:00Benefits
• 4:16Blood clot risk
• 5:24Breast cancer risk
• 6:56Side effects
• 8:05Effectiveness and fertility

Full transcript

1. 0:04Introduction

   Hi, I'm Dr. Taz Varkey. Today I want to teach you specifically about the combination estrogen progesterone pill. So we know of this as the birth control pill, but I really need to make one thing clear: the birth control pill can actually include two different types of pills, the estrogen progesterone combination pill that I'm talking about today. So you might hear me refer to this as the combination oral contraceptive pill from time to time, and also versus the progesterone-only pill.

2. 0:28How the pill works

   I'm going to talk about that method in a few videos, but today I want to talk about the combination oral contraceptive pill. Okay, so this birth control pill works by preventing ovulation. What does that mean?

3. 0:50

   Well, generally when we ovulate once a month, that happens because there's a signal that's sent from the brain to the ovary, the Tulsi ovary, to let that egg go. Well, the birth control pill tricks the brain into thinking that you're pregnant and keeps that signal from being sent, so you never ovulate, and in that way it's kind of regulating your hormones during a regular menstrual cycle.

4. 1:13

   A woman's hormones, when she's not on anything, on any pills, are kind of fluctuating, where the first half of the month you have estrogen dominating and the second half of the month you have more progesterone. So think of your hormones as kind of roller coastering during a typical menstrual month. But when you're on the birth control pill, they stay steady. Okay, and so your estrogen and progesterone depends on which one, sometimes they change from week to week, but generally they're relatively constant.

5. 1:37

   And because of this, A, you don't ovulate, and that's part of how it works. But it can also give us many benefits in terms of other ways in which it changes our mood and at things like acne. So basically the birth control pill is working by keeping our hormone levels constant and preventing ovulation.

6. 2:00Benefits

   So some of the benefits of the birth control pill, well, I just alluded to a few of them because it's affecting the concentration or the variance of your hormones for the whole month. It's gonna prevent things like acne for some patients, or PMS. It can really help regulate a woman's period. So some women have irregularly timed periods, they're coming every six weeks or eight weeks or every two weeks.

7. 2:23

   It'll help regulate you to a once a month period, and it can also help with women who have really painful or a heavy flow because these constant levels of hormones every day help to thin out the lining in most patients. So many patients are really pleased to see that they have very light to no bleeding on the birth control pill, and that's a really nice benefit.

8. 2:46

   So sometimes we use this as a therapy for women with really heavy or irregular periods. Other benefits of the birth control pill, these might surprise you, but the birth control pill has been shown in many studies to reduce the risk of both ovarian and uterine cancer. The estimates in the reduction of the risk of these cancers, for ovarian it's about 40% reduction, 30 to 40 percent, and for uterine about 30 to 50 percent reduction in the risk of these two cancers.

9. 3:08

   Now that sounds like a tremendous reduction, and the line should be out the door given this information, right? But the reason that you have to put this in context: if a woman has a one in a hundred chance of getting ovarian cancer and I reduce that risk by 40 percent, well, I'm going to reduce her risk to 0.6 out of 100.

10. 3:30

    That's only a 0.4 reduction. So though it's something, it's great, because most women's inherent risk for ovarian cancer is very low. This reduction in the risk of ovarian cancer, it's not that big a deal, to be honest.

11. 3:52

    Now, if you have a family history of ovarian cancer or uterine cancer, it is a big deal, if your risk is 20% because your mom had ovarian cancer or the sibling. Well, then that 20% reduction may be a bigger deal for you. Okay, so these are all things, examples of things we take into consideration when we're choosing a particular method of contraception or deciding to give someone the combination birth control pill.

12. 4:16Blood clot risk

    In terms of the risks, I get asked about that a lot. Blood clotting is a risk of taking the combination estrogen progesterone pill, and we think that's mostly because of the estrogen component. Now, a blood clot to the leg is known as a deep vein thrombosis, one to the lung is a pulmonary embolus, a blood clot to the heart or the brain is a heart attack or stroke.

13. 4:39

    So blood clots can be very serious. Now, the good thing is the risk for getting a blood clot on the birth control pill is still very low. It's about 3 out of 10,000 woman-years, we call it. Just think of it as three out of 10,000. Now, there are certain conditions that might increase your risk of a blood clot even higher, such as pregnancy.

14. 5:01

    So if you're pregnant, your risk of a blood clot goes up to 15 out of 10,000. So that's, you know, a five-fold increase in the risk of blood clotting if you get pregnant. So really, the reason we don't stress so much about this risk, increased risk of blood clotting, is because if we give you the birth control pill, we're keeping you from getting pregnant, which is actually a higher risk state for blood clotting.

15. 5:24Breast cancer risk

    So unless someone's had a personal history of maybe a heart attack, or they've had a blood clot themselves, or they have a higher risk of blood clotting for some other reason, we don't worry too much about the blood clot risk. But again, we have to take someone's individual medical history into consideration. Other risks that I get asked about a lot, breast cancer. Until recently we did not have any good studies that were confirming whether there was an increase or a decrease in the risk of breast cancer.

16. 5:47

    The studies were conflicting. But in 2017 there was a very large study done in Denmark that looked at over a million, actually 1.8 million women, and they studied all hormonal contraceptive methods, and they found that there is a 20% increase in the risk of breast cancer in women who are using hormonal contraception.

17. 6:10

    Now, that was true whether it was the birth control pill or the progesterone IUD or the shot. There was a 20% increase in those women versus women who weren't on hormonal contraceptives. But remember what I said about that ovarian cancer reduction. This 20% increase in a low risk woman who has maybe a one in a hundred risk of breast cancer, if she's, depending on her age of course, a young woman, a 20% increase takes you to 1.2 out of 100.

18. 6:34

    So this is also a very negligible increase in the risk of breast cancer, and I don't think, and many experts don't think, that this should be reason to avoid the birth control pill, because the benefits and the prevention of pregnancy so far outweigh this tiny risk of increased risk of breast cancer.

19. 6:56Side effects

    Again, if you have a personal history of breast cancer or family history that's strong, we might reconsider that. So lastly, I want to cover common questions about minor side effects. Am I gonna gain weight? Am I gonna get mood swings? Is my acne gonna get worse? The answer to all of this is, yeah, maybe. It's really different for each patient, and depending on her inherent chemistry, and there's so many different birth control pills we can choose from, maybe 20 different on the market, that all have slightly different estrogen dosing or different progesterone, and that will affect how you respond to a particular pill.

20. 7:20

    So the first pill I choose depends on the patient's, you know, kind of medical situation.

21. 7:42

    Maybe she's already battling acne, so that will help me pick a particular pill that's good for acne or PMS. But, you know, until she tries it, I'm not gonna know if it suits her. I always tell my patients, I could give ten women the same birth control pill, five will love it, and each of the other five will complain of a different side effect. So we just have to try it, and then you just have to work with your doctor to find the right dosing if that one's not right for you.

22. 8:05Effectiveness and fertility

    Lastly, in terms of the effectiveness, if it's taken properly it can be as high as 99 percent, but in actual use, because people miss pills and such, its range is about 93 to 96 percent effective. But if you take it every day, maybe not, so it'll be higher.

23. 8:26

    And lastly, fertility. The birth control pill will not impact your fertility. Once you stop it, you have just as good a chance of getting pregnant the next month as soon as anyone else. Every now and then I have a patient who feels her cycle was thrown off a little bit by being on the birth control pill, but if that's the case, it quickly regulates.

24. 8:48

    And I honestly think a lot of these women already have irregular periods. Maybe they went on the pill to fix it, and then when they stopped the pill, their inherent pattern of irregular periods came back out. So that's it. It's a lot of information, but these are all commonly asked questions, and I hope it'll help. Remember, these videos are not meant to be medical advice for you. They don't substitute for a visit with your own doctor because every woman's situation is unique. Thank you for tuning in, and don't forget to subscribe.