Birth control pills are commonly used by couples to avoid unplanned pregnancies. This is unlike emergency contraception, and is always used as a method to ensure that unplanned pregnancies do not occur. The pills are regarded as safe and reliable in terms of effectiveness. Additionally, usage of the pills is also known to be extremely easy, without any impact on pleasure during intercourse. A common question on the minds of users is birth control – do I have to take the brown pills? Following subsections offer a detailed look at birth control pills, and offer answers to the above question. This will help couples do away doubts that persist about use of the pills and the schedule.

How do birth control pills prevent pregnancy?

Before looking at the schedule and the brown pills, it is essential to understand how the pills work. This will give the complete context about the pills and the schedule. Birth control pills work by preventing fertilization – the process when the sperm enters or joins the egg.  This is achieved by preventing ovulation, the process that is responsible for the egg, and in the absence of the egg, the sperm does not fertilize. The pills are essentially hormone pills that achieve this action. Additionally, the pills also bring about a thickening of the mucus that lines the cervix. This thick mucus, makes it impossible for the sperm to swim to an egg for fertilization. To sum up, the pill works by preventing ovulation and also by preventing the sperm from swimming to the egg.

What is fertilization?

It is now time to understand a little more about fertilization, to know how birth control pills work. Fertilization refers to the union of sperm nucleus with the egg nucleus. Typically, the ovary releases one egg monthly, and this in turn moves to the fallopian tubes. It remains in the fallopian tubes for a period of 24 hours. During this period, fertilization occurs when sperm nucleus combines with the egg nucleus. However, if sperm nucleus does not combine with the egg nucleus during this period, fertilization does not occur and the menstruation occurs, with the destruction of the egg.

Conditions that make birth control pills a suitable option?

In addition to preventing unplanned pregnancy, or any high risk pregnancy, the pills are also used when certain health conditions are being treated. For instance, certain symptoms linked to PMS can be adverse in nature, and it may be necessary to use the pills for a certain period. The pills are also sometimes used to regulate the frequency of periods, and also to manage migraines linked to menstruation. Finally, birth control pills are also used to help manage acne in women who suffer from serious cases of acne.

What are combination birth control pills?

Combination pills are the most common and most popular type of birth control pills. These pills contain synthetic hormones estrogen and progesterone.  Most pills come either in packs of 28 day pills, or 21 day pills or 91 day pills. Certain packs contain a set of pills that are known as placebo pills; these are commonly known as brown pills. The number of such pills may differ in packs and this will determine the manner in which the pills are to be taken or not taken. Here is a quick look at the different pill packs.

#1 – Four week or 28 day packs. This pack contains 28 pills, with the first 21 pills containing hormones. Seven pills that are intended to be taken from day 22 to day 28, are placebo pills that do not contain the hormones.

#2 – Three week or 21 day packs. This pack contains 21 pills; and women are to take a break of seven days on conclusion of the pack before starting the next pack.

#3 – Three month or 91 day packs. This pack is for a period of three months, and contains 84 pills with hormones and 7 placebo pills. The seven placebo pills are to be taken after completing the 84 pills.

So, what is the placebo pill?

The placebo pill is effectively an inactive pill that typically contains folic acid, or vitamins. In certain brands the pills are also sugar pills and do not have any mechanism of action or hormones. The purpose of these pills is two-fold; one to permit women to have menstruation during the period the inactive pills are taken, and two, to serve as a reminder for women who intend to continue taking the pill for a long time. For instance, women who plan to take the pill for a period of two months, will need to take hormone pills for three weeks, followed by a break of one week, before starting the next round of hormone pills. To ensure that the break is actually seven days, and to also get women into the habit of taking the pill daily, packs contain the inactive pills.

Women who take the three month pill pack, will take the hormone pills for a period of 84 days, and the inactive pills for seven days on conclusion of the hormone pills. In such circumstances, women are likely to have periods only during the seven days, when the inactive pills are taken. When the hormone pills are temporarily stopped, women get their periods, as the hormone levels dip and this triggers periods.

Birth control. Do I have to take the brown pills?

With the background information behind, it is time to answer the question – is it necessary to take the inactive/placebo pills? As mentioned above, the placebo pills or the inactive pills are not of any necessary medical value. There are mainly for the purpose of ensuring that gap of seven days and to also remind the individual about the need for taking the pill daily. While the pills may contain vitamins or minerals, the same may also be consumed in other forms, if required. Therefore, the short answer to the question is, no, it is not mandatory to take the brown pills.

However, the purpose of the pills is actually practical in nature, and it would serve a good purpose for women who plan to take birth control pills for a longer period. For instance, after the last hormone pill has been taken, the gap should not be more than seven days before the next pill. Women may sometimes end up skipping a day or missing a day, because of preoccupations. The placebo pill or the inactive pill will help keep track and this will prevent unplanned pregnancies. In the event that women plan to leave out the brown pills, it is then necessary to have a proper reminder to restart the next dose at the end of seven days.

Can the placebo pills be skipped and the next dose started straightaway?

Yes, the placebo pills can be skipped and the next dose of hormone pills can be started immediately after the last hormone pill of the previous pack. This applies to women who do not want a break in the intake of pills, wherein women do not wish to have periods in the seven day stretch. This is practiced by women who may have to travel or for other personal reasons and choices. While this can be done occasionally, it is not the best or the healthiest practice to be repeated frequently. Also, it is important to consult a specialist to understand possible undesirable effects or impact on health.

Women with certain health conditions may also continue hormone pills for a longer or extended duration. For instance, women with PCOS or endometriosis may be recommended use of birth control pills with back to back dosages to handle the impact of the underlying condition.

A note of caution – The above practice is possible only with certain formulations and brands and may not be possible with all brands/formulations. Women are to check the pills before making a purchase to understand if back to back consumption of birth control pills are supported by the chosen formulation.

Migraine or symptoms with placebo/inactive pills

A small section of women on birth control pills are known to experience undesirable outcomes when on placebo pills. For instance, this could be migraine or other simple effects.  Additionally, some women are also known to suffer from longer periods or heavy periods, and this may in turn have an impact on their health. By skipping the placebo pills or the inactive pills, it is possible to ensure that frequency of periods are limited, and thereby experience lesser effects of extended or heavy periods.

Possible effects of long term use of birth control pills without a gap for periods

There is a likelihood of certain effects when the pills are taken for an extended period without a gap. For instance, women may end up with light bleeding, or could experience spotting. This could occur between two periods that are separated by a gap that is not extended and not normal. This is known to resolve naturally, and does not require any separate medication or treatment – it is fairly common among users. This condition is medically known as breakthrough bleeding and is assumed to occur because of the thinner lining in the uterus.

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