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Why might a person take the COCP? While the word contraception is quite literally in the title of the name, that is not the only reason why people choose to take the pill. In fact, there are a wide range of purposes that the pill meets. Monitoring As previously mentioned by Dr Jacobson, one of the reasons for making the decision to begin taking the pill is to monitor pain. “... Menstrual control, if you are suffering from either heavy periods, or painful periods, or both; the pill, if you take it in cycles, periods can be lighter, shorter \[and\] less painful. “If you do what is called ‘tri-cycling the pill’, which means you take it three packs in a row, then break after nine weeks, you can make your periods less frequent, and if you take it continuously, you can end up with no period at all,” explained Dr Jacobson. Health risks In the last issue of Retail Pharmacy Assistants magazine, we explored one of the main health-related reasons that people will take the pill, being endometriosis; it most commonly occurs in the pelvis, and can affect a woman’s reproductive system, causing heavy bleeding. Dr Jacobson explains that “the pill is very good at controlling the pain of endometriosis”, and “using the pill in that continuous way, or tri-cycling it,” can help monitor the bleeding. Quite often, the pill is also used in IVF, “...to produce a period at a particular time, so scheduling for IVF”. “Even though they’re trying to get pregnant, we use the pill to try and get the timing right. We use it to create withdraw bleeds, to make sure that the uterus is working,” said Dr Jacobson. Additionally, “... some people who have had surgery are at risk of a condition called Asherman’s Syndrome, which is scarring of the uterus. We can use the pill to tell if the endometrium is working, because if there’s a lot of scar tissue the pill won’t do anything,” he added. Social reasons One aspect of the pill is the ability to control when the period occurs. A lot of people, “if they have a particular event and don’t want to have their period, they’ll use the pill to schedule it, so they can skip a period”. Weighing up the pros and cons While there are many positive ways in which the COCP or mini pill can aid in someone’s life – like any medication – it comes with symptoms and some negative side effects that deter some people from taking it. Mood changes: “I think the reason most people stop taking the pill is because it affects their mood. Some people find that they basically get depressed on it,” said Dr Jacobson. “I would say that’s a common reason for stopping it.” A study cited by authors at Nordic Federation Societies of Obstetrics and Gynaecology, assessed adverse mood symptoms in ongoing (and past) COCP- users. Of 1466 German women, current users of the pill reported being more irritable (13 per cent), more anxious (1.9 per cent) and more depressed (10.3 per cent). Whereas 8.8 per cent reported less irritability, 13 per cent reported less anxiety and 5.7 per cent stated they felt less depressed.2 it suppresses ovulation, so it stops the egg popping out of the ovaries. Not all contraceptives work like that though. What that tends to do is suppress cyst formation, so you are actually less likely to develop an ovarian cyst that could burst, and torsion, which is twisting of the ovary. “We often put those who have problems with ovarian cysts on the pill, ” said Dr. Jacobson. Improves skin: A lot of women will go on the pill to try and control acne. “It clears up quite well on the pill, not everybody, but a lot of women.” The bottom line Dr Jacobson’s main concluding message is that COCP has been utilised by an incredibly large number of women over the years. “One of the reasons why we know so much about the side effects of the pill is because it’s so successful and has been used so widely around the world. “... millions of women have used it for many years, and we know the side effects in great detail. Just because there’s a long list of side effects doesn’t mean that it’s dangerous, it means that we know a lot about it.” Due to the large amount of research that has been collated over the years in regard to COCP and other forms of the pill, patients should rest assured that it is not being prescribed lightly and that help can be received if side effects or negative symptoms begin. “...new drugs that have a shorter list of side effects may be far more dangerous because we don’t have the information,” concluded Dr Jacobson. References 1.healthdirect, 2019. ‘Morning after pill’ (emergency contraception pill). Accessed on 21.5.2020. healthdirect.gov.au/morning-after-pill 2. Poromaa IS, Segebladh B. Adverse mood symptoms with oral contraceptives. Acta Obstet Gynecol Scand 2012;91: DOI:10.1111/ j.1600‐0412.2011.01333.x. CONTRACEPTION VS FERTILITY 25 Range of side effects Other, more mild side effects of taking the pill include: • Acne • Bloating • Fatigue • Increased appetite • Tenderness/pain in breasts • Nausea. Blood clot formation: Dr Jacobson said: “The oestrogen in the pill can encourage blood clot formation. We call it DVT (Deep Vein Thrombosis). Being on the pill and being pregnant are two risk factors of getting DVT. If they \[blood clots\] break off from the legs, through your veins and to the heart, that can be very dangerous. If someone has a history of DVT, then perhaps they shouldn’t go on the pill.” Lessens likelihood of cysts: A positive takeaway from the COCP, is that “... RETAIL PHARMACY ASSISTANTS • JUN 2020