HOW MUCH do birth control pills cost without insurance?” asked an anonymous student on Everytime, an online social platform for university students. She added that she was prepared to pay uninsured and hence higher prices for the pills in order to avoid leaving the prescription of birth control on her medical records. Her concern is understandable within the norms of Korean society, which has little understanding of the various purposes and effects of contraceptive pills and judges women for taking them. Taking pills is for one’s own health; thus, women should not be restricted from doing so because of the conservative societal atmosphere. In an attempt to resolve the common misconceptions towards the pills, The Yonsei Annals conducted an interview with gynecologist Kim.
How do contraceptive pills work?
How can contraceptive pills prevent pregnancy? They work by inhibiting the natural ovulation process. During the ovulation process, estrogen and progesterone, the two female sex hormones, are emitted naturally from women’s ovaries. They are supposedly to prepare women’s bodies for pregnancy but an imbalance in the two hormones can result in irregular, too little or too much period and period cramps, all known as premenstrual syndrome. An artificial emission of two female sex hormones in the form of pills can serve to inhibit the natural ovulation process, preventing pregnancy. It can also fix imbalance in hormones, treating the premenstrual symptoms. An ancillary function of contraceptive pills is that they change the cervical mucus, which inhibits sperms from entering the ovary, and results in the prevention of conception. Thus, gynecologists commonly prescribe contraceptive pills for various purposes including contraception and treatment. This is possible because the combination of estrogen and progesterone contained in the pills affects and controls the overall reproductive system of a woman. These hormones can control metrorrhagia* and menstruation cycles. Contraceptive pills are therefore also prescribed to treat patients who suffer from irregular bleeding or periods. Moreover, middle-aged women with severe menopausal disorders are given the same treatment. The blanket term “birth control pills” is perhaps a misnomer, as they actually help a broad age range of women with a variety of health issues.
Different types of contraceptive pills and their effects
Contraceptive pills are commonly divided into four generations. The first-generation was the very first type to be released. They are no longer sold due to the side-effects derived from their high concentration of estrogen. The generations that followed were improved by having lower levels of estrogen and varied types of progesterone. The second-generation pills have relatively little estrogen while the third and fourth generation pills carry different types of progesterone with the intention of reducing possible side-effects and strengthening treatment purposes. The table on the next page explains composition of four generations of contraceptive pills and their distinguishing characteristics**.
Over-the-counter drugs and prescription drugs differ in their concentrations of hormones. Those containing low concentrations can be bought at the pharmacy counter without consulting a gynecologist, but the ones with higher concentrations need prescription. In an interview with the Annals, gynecologist Kim Ji-hye said, “I would normally recommend patients to have second-generation pills [because not everyone shows undesirable symptoms]. If side-effects appear, then I would prescribe the fourth-generation pills. They don’t result in common side-effects such as weight gain, breast pain or bleeding, and they also improve one’s skin.” However, fourth-generation pills have a higher chance of developing thrombosis***, so those who have a family history of thrombosis are not prescribed with fourth-generation pills. If you have not shown any symptoms during and after a year within taking the pills, then you can continue to take the same pills. Kim added that there are many women come to her with questions regarding the safety of birth control pills. During the interview, she assured that they are the safest form of contraception and many negative assumptions about them are unfounded and should be corrected.
Resolving common misconceptions
The following is a series of questions and answers with gynecologist Kim regarding common misconceptions about contraceptive pills.
Q. Is it safe to take only pills as a form of contraception?
A. Contraceptive pills, when the exact method is followed, have the highest success rate in terms of preventing pregnancy, compared to any other forms of contraception. However, I advise to also use condoms during sexual intercourse, which further guarantees the prevention of pregnancy. Using condoms has an added benefit of preventing sexually transmitted diseases (STDs).
Q. Can you develop resistance to these pills?
Q. Can contraceptive pills cause cervical cancer?
A. Some patients come and ask me if pills can cause cervical cancer, but this is an ungrounded rumor. There is a very weak correlation between cervical cancer and the intake of contraceptive pills. There is almost no relation at all.
Q. It is true that taking pills increases the chance of developing thrombosis?
A. When you are pregnant, the risk of developing thrombosis rises. The chance caused by taking pills is much lower than that. So, saying you can’t take pills because of the chance of thrombosis does not make sense. For those who have high blood pressure or diabetes or are smokers, the risk of thrombosis can be increased. Especially for patients who have family history of thrombosis, they need to use barrier methods of contraception instead such as condoms.
Q. Can smokers take birth control pills simultaneously?
A. No. When smokers ask me, I make them choose between the two.
Q. For those who are reluctant to take pills for their side-effects, what advice would you give?
A. There is nothing as harmful as unwanted pregnancy. Also, contraceptive pills have many benefits such as the prevention of ovarian cancer and endometrial cancer and strengthening bones. So it is foolish to avoid the intake of pills under necessary circumstances.
Q. What cautions would you give when taking pills?
A. Please take it regularly and once you start, finish the monthly intake. If there are other pills that you have been taking before, please consult the doctor to see if those can be taken along with contraceptive pills. In the case of neurological medicine, epilepsy medicine or tuberculosis drugs, you should definitely consult with a gynecologist.
The right way to take pills
For those planning to take contraceptive pills, it is crucial to follow the exact method in order for contraceptive pills to achieve their intended purpose. You need to start taking pills within five days of the start of your monthly menstruation cycle. You need to take one pill everyday for 21 days consecutively, at the exact same time. If you accidently skip a day, take two pills the next day, and the gap between the intakes should be less than 12 hours. Skipping for more than two days will drastically reduce the success rate. Kim said, “If you stick to the procedure properly, the success rate is 99.9%. This means that in one year, only one among 1,000 patients will get pregnant after taking contraceptive pills. This failure rate is negligible. No contraception is as effective as pills [as long as the right procedure is followed.]”
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Many young women share concerns regarding the use of pills; yet they are reluctant to openly talk about them both online and offline. Instead of treating this topic as taboo and trying to hide such usage, it is important that society acknowledges the various benefits of “birth control” pills. It should move towards being more open-minded and informed, enabling women to easily access the information and resources they need to take care of their own well-being.
*Metrorrhagia: abnormal vaginal bleeding
**Seoul National University Hospital
***Thrombosis: formation of a blood clot, blocking blood vessels