INSTRUCTIONS FOR PILL USERS Birth control pills offer you no protection against the virus which causes AIDS, nor do they provide a physical barrier to the transmission of sexually transmitted diseases.


Birth control pills offer you no protection against the virus
which causes AIDS, nor do they provide a physical
barrier to the transmission of sexually transmitted diseases. 
If you anticipate that you may have more than
one partner in the years ahead and you are going to use birth
control pills, strongly consider using spermicidal
condoms consistently.  Choose a pattern of sexual activity
that protects you from infection with the AIDS virus. 
Once infected, you will not have a second opportunity to
make this choice...once infected you will be infected
for life.

1.    The pill works primarily by stopping ovulation (release
      of an egg).  If no egg meets the sperm, pregnancy
      cannot occur.  For patients who follow these directions
      carefully, the pill is the most effective reversible
      contraceptive currently available.  

2.    Choose a backup method of birth control (such as
      condoms and foam) to use with your first pack of pills
      because the pill may not fully protect you from
      pregnancy during the first month.  Keep this backup
      method handy all the time and learn to use it correctly
      in case you:
         *  Run out of pills.
         *  Forget your pills.
         *  Experience any of the pill danger signals and
            discontinue pill use.
         *  Want protection from transmission of sexually
            transmitted infections, most notably the virus
            which causes AIDS (condoms provide the best
            protection from disease transmission).

3.    Start your pills the way your provider suggests.  Either
      start your first pack of pills on the first day of bleeding
      during your period or on the first Sunday after your
      period begins.

4.    Take one pill a day until you finish the pack. Then, if
      you are using a 28-day pack, begin a new pack
      immediately.  Skip no days between packages.

NUISANCE SIDE EFFECTS: Some side effects are very
common during the first few months of pill use.  Usually these
will improve or disappear within three months.  Some
common side effects are:

nausea or vomiting    break-through bleeding between periods
weight gain or loss   moodiness
bloating              missing a period
breast tenderness     increased vaginal discharge but not with
                      itching or burning

skin changes (acne or darkening of the skin on the face - this
may not disappear even if you stop using the pill)

5.    Try to associate taking your pill with something that
      you do every day, like going to bed, eating a meal, or
      brushing your teeth.  Establishing a regular routine
      may make it easier to remember.  Pills work best if you
      take one about the same time every day in order to
      keep a steady level of hormones in your system.

6.    Check your pack of birth control pills each morning to
      make sure you took your pill the day before. 

7.    If you have bleeding between periods, try to take your
      pills at the same time every day.  If you have spotting
      (light bleeding between periods) for several cycles, you
      may want to call your clinician to see whether you
      need a different pill.  Spotting is more likely to occur
      with the current low-dose control pills.  Because
      spotting is generally not an ominous sign in young
      women, your clinician may take a "watch and wait"
      approach if you are not concerned or inconvenienced. 
      If you suddenly begin to have bleeding between
      periods, have not previously had this problem, and
      have not missed pills or taken pills late, consider
      having your doctor check you for an infection.  Spotting
      between periods may also signal decreased pill
      effectiveness.  Some clinicians recommend a backup
      contraceptive for women experiencing spotting on pills,
      especially if the woman is taking medication which may
      lower pill effectiveness.

8.    The effectiveness of birth control pills may be slightly
      decreased by a number of drugs that change
      gastrointestinal absorption or liver function, such as
      rifampin for tuberculosis, Dilantin (phenytoin),
      carbamazepine, ampicillin or tetracycline.

9.    If you forget to take your birth control pill, follow the
      instructions below:

           *If you miss 1 pill but remember within 12 hours,
           take the forgotten pill immediately.  (For
           example, if you usually take your pill at night but
           forget, then take it the next morning.)  Take
           your next pill at the usual time, even if it means
           taking 2 pills in one day.

           *If you miss 1 pill and the delay is longer than
           12 hours, take the forgotten pill at night and
           next pill at the usual time.  Complete the rest of
           your cycle as you normally would and FOLLOW
           THE 14 DAY RULE:  For the next 14 days, use
           another effective backup method for the full 14
           days even if you begin a new pack or have your
           period.  Do not pay attention about any
           breakthrough bleeding or spotting; this is

           *If you miss 2 pills, take 2 pills at once. 
           Although you may feel queasy or nauseated by
           taking two pills, your chances of becoming
           pregnant will be reduced.  After you take the 2
           pills, remove and discard the other "forgotten"
           pills.  Thus the next pill you take will be the one
           you would have normally taken had you not
           forgotten the other pills.  Again, FOLLOW THE
           14 DAY RULE: Use another effective method of
           birth control for an entire 14 days.

10.   If you have diarrhea or vomiting, use your backup
      method of birth control until your next period. Start
      using a backup method on your first day of diarrhea or
      vomiting.  Many women experience nausea the first
      month they take pills.  If you experience nausea, try
      taking pills at night or with food.

11.   Periods tend to be short and scanty on the pills and you
      may not see fresh blood at all.  A drop of blood or a brown
      brown smudge on your tampon or underwear is considered a

12.  If you do not have your menstrual period when expected while
     taking birth control pills, you may want to consult your

         * If you have not missed any pills and you miss 1 period
         without any signs of pregnancy, pregnancy is very
         unlikely.  Many women taking birth control pills
         occasionally miss 1 period.  Call the clinic if you are
         worried.  You are fairly safe and can start a new
         package of pills at the regularly scheduled time.

         * If you forget 1 or more pills and miss a period, you
         should stop taking the pills and use another method of   
         birth control.  Contact your clinic for a pelvic
         examination or a sensitive pregnancy test.

         * If you miss 2 periods in a row, come to clinic for a
         pregnancy test before resuming the pill, even if you
         took your pills every day.

13.  If you do become pregnant while taking birth control pills,
     you must decide whether you want to have a child at this
     time or, alternatively, whether abortion is an option for
     you.  The risk of having a baby with birth defects may be
     increased by taking pills during the first couple of months
     of pregnancy; although if an increased risk exists, it is
     very, very small.

14.  If you decide you want to become pregnant,  stop taking
     pills.  You may wish to use another reliable method of birth
     control until you have two or three normal menstrual periods
     off the pill so that when you become pregnant, your date of
     delivery might be accurately calculated.

15.  If you see any clinician for any reason, be sure to mention
     that you are on birth control pills, particularly if you are
     admitted to the hospital.

16.  If you notice any pronounced mood changes - depression,
     irritability or change in sex drive - see your clinician.
     Switching pill brands may help.  Also, taking 100 mg Vitamin
     B6 daily may decrease the effect of the pill in producing
     mood changes.

17.  Read the new pill package insert for women on pills. It
     provides a balanced picture of risks and benefits of pills.

18   Learn the pill danger signs.  Any 1 of 5 symptoms may mean
     that you are in serious trouble.  Note that the first letter
     of each symptom spell out the word "ACHES".


    A  * Abdominal pain (severe)

    C  * Chest pain (severe), cough, shortness of breath

    H  * Headache (severe) dizziness, weakness, or numbness

    E  * Eye problems (vision loss of blurring) speech problems

    S  * Severe leg pain (calf or thigh)

See your clinician if you have any of these problems, or if you
develop depression, yellow jaundice or a breast lump.


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