Oral contraceptives, known commonly as "the pill", have been available in Thailand since the 1960s, and have long been the most popular contraceptive due to their availability – unlike in many other countries it can be bought over-the-counter – and low cost. In addition, when taken correctly, the pill is 99 per cent effective.
"The pill has been the flagship of family planning in this country," says Dr Pansak Sugkraroek from Bumrungrad Hospital. "Women can obtain the contraceptive pill for free, or for about a five baht donation, from any government hospital." The pills obtained this way, however, usually contain higher dosages of oestrogen and have more side effects than those bought through commercial channels.
If starting out, see a gynaecologist
Dr Yaowaluk Rapeepattana from Samitivej Hospital says that there are over 300 different brands of the contraceptive pill on the market. "So how can women know what is the best fit for them? I recommend that women go to see a gynaecologist before using the pill. There are many conditions that mean you must be careful when taking the pill. And even the new arrivals, the pills containing low-dose hormones, can have side-effects."
The 300-plus brands all contain the same active ingredients – oestrogen and progestogen. The price depends on where a particular brand is made and how it is marketed. "When a particular pill is still under license, it will usually be made abroad and will be more expensive" says Dr Pansak. Pills marketed as being premium brands, and as being able to reduce acne, enlarge the breasts or not lead to an increase in weight, will also cost more.
How it works
A standard "combined pill" contains 50mg of oestrogen, while low-dose pills usually contain 30mg. The type of oestrogen used is ethinylestradiol, while there are various types of progestogen – and it is this hormone that will determine a pill’s side effects. Two per cent of pills globally contain only progestogen and are known as mini-pills.
Oestrogen and progestogen work together to prevent the ovary releasing an egg each month, and the progestogen also thickens mucus in the cervix, making it more difficult for sperm to enter. Progestogen-only pills have only the latter effect. Both pills can prevent fertilised eggs staying in the uterus.
The main benefit is of course reduced risk of pregnancy. But there are some additional benefits for women on the pill, including a lower risk of several types of cancer, less benign breast disease, fewer ovarian cysts, less pelvic inflammatory disease and a more regular menstrual cycle with less blood loss, fewer cramps and fewer premenstrual symptoms.
A small number of women may experience temporary side effects, such as nausea, weight gain or loss and breast tenderness, particularly for the first few cycles.
It’s not for everybody
Some women should not take the pill, including women aged over 35 who smoke, or have heart disease. Women with high blood pressure, high cholesterol levels, liver disease, fibroid uterine growths and several other conditions should also avoid the pill. "A gynaecologist will take into account your family history, your age, whether you smoke and various other factors before recommending the pill," Dr Yaowaluk says.
Serious complications from taking the pill are rare. "The most serious effect can be thrombosis – the formation of blood clots," says Dr Yaowaluk. This risk has decreased over the years as most pills have reduced oestrogen levels from 100mg to a 50mg – but those available cheaply in Thailand may still have a higher dosage.