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The purpose of this article is to inform women interested in using birth control pills, as well as those
already using these pills, how this method of birth control works. The article assumes that the reader
has little scientific background and is unfamiliar with the specifics of the female reproductive cycle and
the roles of hormones in this cycle. These concepts are therefore explained in detail.

Selecting a method of birth control to use is an important decision with significant implications. By
understanding how hormonal birth control pills work, women can make a knowledgeable choice about
whether or not to use this method of birth control. Understanding this process will also make women
aware of how to maximize the effectiveness of birth control pills against pregnancy. An article of this
nature might be found on medical websites such as WebMD.com.
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Birth control pills, also called oral contraceptives, or simply, ͞the Pill,͟ are pharmaceutical products that,
as the name suggests, are taken to prevent pregnancy. There are four basic types of birth control pills:

c rombination estrogen/progestin
c Phasic estrogen/progestin
c Progestin only
c ͞Seasonale͟ (an estrogen based pill resulting in only four periods per year)

These four methods work through the action of hormones to decrease the probability of conception
(when sperm and egg meet) or implantation (when the fertilized egg attaches to the uterus).

When used correctly, ͞the Pill͟ is over 90 percent effective in preventing pregnancy. It does not,
however, provide protection against HIV and other sexually transmitted infections or diseases. Birth
control pills may also be used to treat mild acne or to normalize irregular menstrual cycles.
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The menstrual cycle is a 28 day cycle, beginning on the first day of a woman͛s menstrual period.
Ovulation, the process in which a mature egg (ovum) is released from the ovary, occurs on day 14 of the
menstrual cycle. This opens a 24 hour window for sperm to penetrate the egg (fertilization). However,
because sperm can survive for a few days in the female reproductive tract, this 24-hour window is not
the only time of the month that intercourse may lead to pregnancy.

Once ovulation occurs the ovum enters the uterine (fallopian) tube, where it can become fertilized. If
fertilization occurs, the genetic material of the sperm and egg combine and the fertilized ovum becomes
a zygote. The single-cell zygote divides to become a mass of cells, a morula, which undergoes further
transformation to become a blastocyst. The blastocyst implants in the inner membrane of the uterus,
called the endometrium, about seven days after fertilization has occurred.


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The female reproductive cycle is initiated and
maintained by hormones. The hypothalamus is a
portion of the brain that links the nervous and
endocrine systems of the body via the pituitary
gland, a major organ of the endocrine system
which secretes hormones to regulate
physiological processes. The hypothalamus
releases GnRH (Gonadotrophin-releasing
hormone) to stimulate the anterior pituitary.

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When stimulated, the anterior pituitary secretes
the gonadotrophins LH (Luteinizing hormone)
and FSH (Follicle-stimulating hormone). LH
stimulates theca interna cells to convert
cholesterol into androstenedione, which
granulosa cells can then use as a precursor to
produce estrogen. The LH surge, an acute rise in
LH levels triggered by a peak in estrogen levels,
causes ovulation to occur.

FSH has several important functions in the


menstrual cycle. Firstly, it initiates the growth of
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ovarian follicles. These follicles are aggregations
of cells within the ovary, each containing a single
immature ovum. FSH also stimulates granulosa cells to divide and to produce inhibin and estrogen.
Inhibin provides negative feedback to the anterior pituitary for the production of FSH, which means that
as the levels of inhibin rise in the body, the anterior pituitary is signaled to stop secreting FSH.
  
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Both LH and FSH lead to the production of estrogen. This hormone is responsible for the proliferation of
endometrium cells. Estrogen also determines secondary sex characteristics (enlargement of breasts,
growth of body hair, etc.).

At moderate, constant levels, estrogen provides negative


feedback to the anterior pituitary for LH production and to
the hypothalamus for GnRH production. In large doses
however, estrogen provides positive feedback, stimulating
the release of LH. This spike in estrogen concentrations
occurs about mid-cycle, causing the LH surge and thereafter
ovulation. After ovulation occurs, the hormone
progesterone is produced, causing the endometrium to
[ [   produce secretions.

   

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Birth control pills work through the action of synthetic hormones, specifically estrogen and/or progestin,
a synthetic hormone that acts much like progesterone. These pills prevent pregnancy through many
mechanisms, primarily by stopping ovulation.

 

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Birth control pills stop ovulation from occurring by preventing the secretion of the Gonadotrophins LH
and FSH. The synthetic hormones of birth control pills stabilize the natural hormone levels of the body.
Without the natural mid-cycle spike in estrogen levels, the anterior pituitary is not stimulated to release
LH and FSH. Instead, the moderate, constant estrogen levels provide negative feedback to the anterior
pituitary and hypothalamus, halting LH and FSH production. The LH surge is not triggered, and ovulation
does not occur.

Pills typically come in packs of 21 to 28 pills and are to


be taken regularly at the same time each day in order
to maintain hormone levels in the body. Packs of 28
contain one week of ͞reminder͟ pills (in the picture
shown to the left, the last row of white pills) that do
not contain any hormones. The purpose of these pills
is to keep once-a-day pill-taking habits consistent and
avoid confusion and the chance of missing hormone
pills (in the picture shown to the left, the first three
rows of colored pills).

Packs of 21 do not contain these ͞reminder͟ pills. ronsumers simply stop taking the hormone pills for
one week, and must be careful to remember when to restart their pill regimen. For both the 21- and 28-
day pill regimens, the menstrual period occurs during this week without hormone-containing pills.
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The Pill can prevent pregnancy in other ways. Progestin causes changes in the cervical mucous and the
endometrium to enhance the Pills effectiveness. The cervical mucous thickens, preventing sperm from
entering the uterus, and the lining of the uterus thins, preventing implantation.

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In summary, birth control pills use estrogen and/or progestin to regulate the natural hormone levels of
the menstrual cycle. By stabilizing estrogen levels, the LH surge does not occur to trigger ovulation, and
the ovaries do not release an egg to be fertilized. The hormones of ͞the Pill͟ also cause other changes in
the body to decrease the likelihood of becoming pregnant, including changes in the cervical mucous and
changes in the lining of the uterus.

Used properly, birth control pills are 99.8 percent effective. In practice, however, they are only about 90
percent effective. Women can decrease their chances of becoming pregnant by taking birth control pills
regularly, once a day, at the same time every day. A regular schedule is important for stabilizing the
body͛s hormone levels, and can drastically increase the effectiveness of ͞the Pill.͟
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http://www.drugs.com/cdi/tri-sprintec.html

http://www.merck.com/mmhe/sec22/ch241/ch241e.html

http://www.medicinenet.com/hormonal_methods_of_birth_control/article.htm

Figure 1: http://www.soc.ucsb.edu/sexinfo/article/the-menstrual-cycle

Figure 2:
http://www.cartage.org.lb/en/themes/sciences/lifescience/generalbiology/physiology/ReproductiveSys
tem/HumanReproduction/HumanReproduction.htm

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