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How to Start Birth Control Pills. This fundamental knowledge has been used both to suppress the cycle, with the goal of contraception, as well as to stimulate ovulation with the hopes of promoting fertility.
Two ideal targets for hormonal contraception would be the hormones FSH and LH, which play dual roles in the normal menstrual cycle, first re-starting the cycle after menstrual bleeding and then triggering ovulation at the mid-point of the cycle. Because FSH and LH are required to trigger ovulation, artificially blocking these two hormones would therefore robustly suppress ovulation.
Why then are the hormones P and E commonly used in the Pill instead? It is generally easier to add something to a biological system than to remove something, and since P and E suppress the release of FSH and LH these are logical choices for halting the sequence of events that lead to ovulation. While not entirely accurate, this statement does have some truth to it. Although the outward appearance is the same menstrual bleeding in week 1 of a 28 day cycle the constant high levels of P and E for a woman taking the Pill actually abolish the normal hormonal cycling that underlies ovulation.
Historically, women have been pregnant or nursing much of their adult lives and thereby suppressing ovulation naturally, suggesting that halting menstruation is not inherently harmful. Yet, many women still wonder if it is safe to eliminate menstruation using oral contraceptives. Actually, women have been using the Pill in this off-label manner under medical supervision since the time it debuted — skipping the week of placebo pills in order to postpone their periods during a vacation or special event, for example.
Continuous menstrual suppression via the Pill has also been used to treat endometriosis, debilitating menstrual pains and other menstruation-related ailments. However, it is only recently that certain formulations of the Pill began to be marketed for the specific purpose of eliminating periods. Each packet of Seasonale contains 84 Pills and 7 placebos, resulting in 4 periods per year. In , the Pill, Lybrel, was introduced, eliminating the placebos entirely with the goal of suppressing menstruation as long as the Pill is taken.
So, although at first glance it may seem unusual to provide an oral contraceptive regimen that eliminates periods, the use of Seasonale, Lybrel and other similar formulations is a logical progression from the original concepts behind the Pill. These new formulations contain the same types and amounts of hormones as the standard Pills, so should be comparable in terms of side effects both immediate and potentially long-term.
However, the lack of menstruation does mean that a woman who becomes pregnant on this regimen may not realize it as soon as she otherwise would. How popular this newly-advertised birth control regimen will be given that it removes the visible monthly proof of its efficacy remains to be seen. I am speechless. Combination OCs have been widely used to treat physical premenstrual symptoms. Women and their physicians have a high level of comfort with their use, and OC users benefit from their relatively low cost and positive effects on the menstrual cycle.
Few controlled trials have evaluated OCs for their effects on premenstrual symptoms, and past studies demonstrated little difference in the experience of OC users and nonusers in this regard.
The reduced estrogen doses in current OC formulations may result in a decreased degree of ovarian inhibition compared with that afforded by older OCs, especially during the pill-free interval.
In the female reproductive system, the degree of follicular activity during OC use is dependent on the type and dose of steroids used, the type of regimen, user adherence, and individual metabolic responsiveness to the OC prescribed.
These symptoms resulted in a high rate of premature discontinuation of use, and therefore hormone doses in combined OCs have been reduced. OCs inhibit follicular development, and high-dose OCs maintain steroid levels sufficient to suppress ovarian function during the pill-free interval; with low-dose OCs, however, effective serum levels of ethinyl estradiol EE are maintained for only 2 to 3 days after administration is suspended, and follicular development may resume because of inadequate endocrine suppression.
Patient adherence is another crucial factor when low-dose OCs are used. The risk of ovulation is at its maximum during the 7-day pill-free interval, and the risk of pregnancy increases substantially for a woman using these formulations if she does not start her new pill pack on time. In addition, individual women metabolize medications differently, and faster metabolism may jeopardize the efficacy of low-dose pills.
Women who take hormonal contraceptives using this standard regimen have a monthly withdrawal bleed that traditionally has assured them that they are not pregnant. However, the standard regimen's 7-day pill-free interval is associated with significant drawbacks. For example, commonly used low-dose OC formulations have a very real potential for reduced ovarian inhibition during this interval. Also, OC users may experience an increase in monthly hormone-withdrawal symptoms—pelvic pain, headaches, bloating, and breast tenderness—during the pill-free interval.
Hormone-related symptoms were assessed in a study of women of childbearing age who used OCs and kept daily symptom diaries. Of the evaluable women, were current OC users at study entry and 69 women were categorized as new starts because they had had no recent OC use 26 had not previously used OCs and 43 were former OC users. Several neuroendocrine agents, or hormones, are produced by the hypothalamus. The most important hormone for reproduction is called gonadotropin releasing hormone, better known as GnRH.
It is released in a rhythmic fashion every 60 to minutes. GnRH stimulates the pituitary gland to produce follicle stimulating hormone FSH , the hormone responsible for starting follicle egg development and causing the level of estrogen, the primary female hormone, to rise. Leutinizing hormone LH , the other reproductive pituitary hormone, aids in egg maturation and provides the hormonal trigger to cause ovulation and the release of eggs from the ovary.
The main function of the ovaries is the production of eggs and hormones. At birth, the ovaries contain several million immature eggs. No new eggs will be developed.
These eggs are constantly undergoing a process of development and loss. Most will die without reaching maturity. This process of egg loss occurs at all times, including before birth, before puberty and while on birth control pills. The ovary undergoes a constant process of egg depletion throughout its lifetime. As the levels of FSH and LH in the blood increase with puberty, the eggs begin to mature and a collection of fluid — the follicle — begins to develop around each one. The first day of menses is identified as cycle day one.
Estrogen is at a low point. Therefore, the pituitary secretes FSH and LH, a process which actually begins before the onset of your menses.
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