ATLANTA WOMEN’S SPECIALTY GROUP
BIRTH CONTROL PILL FACT SHEET
AND INSTRUCTIONS
FACTS ABOUT THE PILL:
A monthly series of pills usually 28 to a package. The combination pill contains a precise amount of 2 hormones like substances, estrogen and progesterone. These hormones are similar to the ones produced by the women’s body that regulate the menstrual cycle.
HOW SOON DOES THE PILL START TO PROTECT AGAINST PREGNANCY?
You need to be taking the birth control pills for one month before you are protected from pregnancy. During this month you must use an additional method of birth control each time you have sex. We recommend that you use foam and condoms as your back up method of birth control. This is not necessary after the first month, you will be protected from pregnancy even during y our period if you do not miss any pills. No matter how long you have been taking birth control pills, the day you do not take a pill you are not protected from pregnancy. Do not take or continue to take the pill if you think you are pregnant.
WHAT DO I DO IF I MISS A PILL?
If you miss one pill take it as soon as you remember even if it means taking two pills at the same time. If you miss two (consecutive) pills in a row, take two pills a day for two days. For example, if you miss Monday’s and Tuesday’s pill take two on Wednesday and two on Thursday. If you miss 2 pills, you are not protected from pregnancy for the rest of the cycle (pack) you are taking. You must use another method of birth control until your next period.
If you miss three pills in a row, throw away the pack of pills and begin a new pack of pills the first Sunday after your next period. This period will probably begin right away. No matter when your period begins, you must use another method of birth control each time you have sex from the time you missed your pill through the next whole pack of pills. If you experience vomiting or diarrhea it is possible that your body will not absorb enough of the hormones into the pill to prevent pregnancy. It is recommended that you use a back up method each time you have sex until your next period.
DO THE PILLS CAUSE SIDE EFFECTS
Some women do have side effects when they start taking birth control pills. You may have some mild nausea, breast tenderness, increase in breast size and weight changes. Some women experience spotting between periods that can vary in length and amount. It may occur for your first three (3) cycles (packs) of pill use. These side effects may worry you, but they usually disappear after a few months. You do not need to stop taking your pills.
CAN THE PILLS CAUSE SERIOUS PROBLEMS?
Yes the pills can cause serious problems. These are rare but can occur. If you experience any of the following symptoms, you must contact this office:
A. ABDOMINAL PAIN
C. CHEST PAIN
H. HEADACHES
E. EYE PROBLEMS (visual changes)
S. SEVERE LEG PAIN
IS IT DANGEROUS TO SMOKE WHILE I TAKE BIRTH CONTROL PILLS:
Yes, smoking and pill use increase your risk of Heart Disease, Heart Attack and Blood Clots. If you are 35 years or greater you should not take birth control pills if you smoke.
I am requesting oral contraceptive (birth control pills) as a method of Family Planning. I understand that if used correctly, all the time, less than one woman per 100 will become pregnant each year.
Name: ______
BENEFITS:
I have been told that I may experience the following benefits from using birth control pills:
More regular menstrual bleeding Decrease menstrual bleeding
Decreased menstrual cramps Prevention of Pregnancy
Decrease risk of benign breast conditions Decrease risk of ovarian and endometrial cancer
Suppression of endometriosis
RISKS:
I understand that while using oral contraceptives, I may experience the following minor side effects:
Nausea, Depression, Headaches, Breast Tenderness, Spotting between Periods, Increase vaginal secretions, Weight changes (loss or gain).
I have been told that birth control maybe associated with Blood Clots of the Legs and Lungs, Stroke, Heart Attacks, High Blood Pressure, Gall Bladder Disease, Benign Liver Tumors and Rarely Death.
I HAVE BEEN TOLD THAT TO LESSEN THE CHANGES OF SERIOUS PROBLEMS IT IS MY RESPONSIBILITY TO CONTACT THE OFFICE IMMEDIATELY IF I START HAVING ANY OF THE FOLLOWING SYMPTOMS:
Severe Headaches, Severe Leg Pain, Severe Abdominal Pain, Blurred or Loss of Vision, Chest Pains or Shortness of Breath.
ALTERNATIVES:
I have been told of the other methods of Birth Control.
STOPPING THE PILLS:
I have been told that I may stop the pill at any time. I understand that after stopping the pills I should wait until I have three normal periods before I try to become pregnant and that I should use another method of Birth control during this time. I also realize that there may be a delay of up to several months before I am able to become pregnant. The name of my birth Control Pills is: ______.
INSTRUCTIONS:
Instructions for the use of the Pill have been explained to me and I have been told that I may read a more complete description of the pill in the booklet and product insert which is available to me.
QUESTIONS:
I have been given the opportunity to ask questions about the pills and this consent form.
BIRTH CONTROL PILLS PREVENT PREGNANCY. PILLS DO NOT PROTECT YOU FROM SEXUALLY TRANSMITTED DISEASES.
:______: :______:
Date: Signature
:______:
Witness