The pill – what’s new?

  24. May 2022

The pill has been used as a contraceptive for over 50 years. The pill remains one of the safest contraceptives and is the most commonly used method of preventing pregnancy.

The pill is generally understood as an estrogen-progestin combination preparation. If it is in a low dose, as is usually the case today, it is referred to as a micropill. There are also progestin-only products, the so-called minipills or progestin pills.

How the pill works

  • Suppression of ovulation. As a result, the woman’s entire cycle consists of infertile days.
  • Change of cervical mucus in the cervical canal. This becomes thicker and more viscous. This prevents sperm from entering the uterus.
  • Preventing the monthly build-up of the lining of the uterus.

Application
With almost all preparations, one hormone pill is taken daily for 21 days. Then follows a seven-day hormone-free interval, which triggers menstrual-like bleeding (hormone-withdrawal bleeding). Afterwards the woman starts all over again with a new monthly pack.

However, there are also combination preparations with 28 pills per monthly pack – the last seven pills are hormone-free and are only there so that the woman does not have to interrupt her usual daily intake rhythm. Thus, these preparations also correspond to the “21 and 7” intake scheme.

In addition, there is also a combination preparation that follows a “24 and 4” intake rhythm: Each monthly pack contains 24 hormone-containing pills and four active ingredient-free pills.

Long cycle
Long cycle means that the pill is taken without a break. This means that the hormone level does not drop and there is no bleeding.

The non-stop use of pills increases safety. The long cycle has – just like a “normal” use of the pill – no effect on later fertility. Side effects also do not occur more frequently than with the classic application form. The risk of bleeding between periods may be slightly higher at the beginning of the long cycle. But the body usually gets used to the new situation quickly.

The long cycle is suitable for women for whom a drop in hormone levels during the pill break regularly causes great discomfort, e.g. because migraine attacks occur more frequently during this time. By suppressing the cycle-related hormone fluctuations, these symptoms can improve. Long cycle may also be an option for women who suffer from mood swings during menstruation or have painful bleeding.

Antiandrogenic pill
The pill is not always prescribed (only) for contraception. Sometimes the pill is also used to treat androgenization symptoms in women. These are physical changes that are due to androgens (male sex hormones like testosterone). These include, for example, acne and hirsutism, i.e. increased body hair, e.g. on the chin, upper lip, chest etc.

Women affected by such androgenization symptoms may benefit from the anti-androgenic effects of certain pills. Combination preparations that contain a specific progestin component, for example dienogest or drospirenone, are suitable.

Side effects
Most side effects are uncomfortable but not dangerous. Some women suffer, for example, from nausea and dizziness, headaches, mood swings, depressive moods, sexual apathy or a feeling of tension in the breasts. These side effects are rather rare. If they occur, it may make sense to change the preparation. Intermenstrual bleeding is common in the first period of application, and it usually disappears after two to three months. If they persist, another preparation can be tried.

Many women worry about gaining weight with the pill. In fact, this only happens in a few cases. There is hardly any difference between the individual preparations.

Serious health problems are rare. The pill increases the risk of thrombosis. Therefore, it is important to talk about possible pre-existing conditions or risk factors before prescribing the pill.

There is no risk of thrombosis with progestin-only pills.

What’s new?
This year 2022 two new pills will be available in Switzerland:

1. Slinda
Slinda is a progestin-only pill, which is a good alternative to the previous progestin pills (Cerazette/Azalia, etc.). In contrast to the existing progestin pills, Slinda contains the progestin drospirenone. Studies have shown that fewer bleeding disorders occur with Slinda, as well as fewer skin problems than with previous progestin pills containing the progestin levonorgestrel.

2. Drovelis
Drovelis is a combined pill that contains a different estrogen than the previous pills. This is called estretol and is combined with the progestogen drospirenone in the Drovelis pill. In studies, Drovelis showed a rather low risk of thrombosis and had relatively few side effects.

We will be happy to advise you in our consultation on the subject of contraception and discuss which pill is best for you.