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A Guide to Starting Birth Control Pills in Singapore
Reviewed by Dr Bosty Chan, MBChB, MRCS
In Singapore, a wide variety of contraceptive methods are available. However, there is no robust data about the level of awareness and knowledge of contraception among women in Singapore. We just don’t talk about it enough.
Ironically, the sales of birth control pills were at a four year high in Singapore in 2020. The usage of birth control pills in Singapore is definitely more common than we think.
Perhaps it is the societal pressure to procreate (hint hint: the well-meaning parents, uncles and aunties every Chinese New Year) that contraceptive methods are just a big no-no to be discussed about.
Or perhaps it is just the Asian culture where sexual health is still a topic that brings about awkwardness and embarrassment (especially if marriage is not on the cards).
Well, sexual health is an important aspect of life.
An unintended pregnancy that is not welcomed is frequently associated with an increased risk of health problems for both mother and baby. If you are of a reproductive age and are sexually active and you are not intending to get pregnant, here is our guide to starting birth control pills in Singapore.
It is all about the hormones…
Hormonal methods of birth control contain either a combination of estrogen and progestin or progestin only. They are a safe and reliable way to prevent pregnancy for most women.
Hormonal methods of birth control can come in many forms: an implant, injections, an intrauterine device (IUD), pills, skin patches and vaginal rings.
How should I choose?
It can be difficult to decide which birth control method is best due to the variety of options available. The best method is one that works best for you. You should be able to use it consistently and it should not cause you bothersome side effects.
Here is a list of factors you can put into your consideration when selecting a birth control method:
- Efficacy: is it effective at preventing pregnancy?
- Convenience: is it easy to use?
- How long can the drug or device be used?
- Does it affect your menstrual period?
- What side effects can it cause?
- Costs involved
- Privacy concerns
- Whether or not it also protects against sexually transmitted diseases
- How quickly will your fertility return if you stop taking it?
There can be no perfect birth control method; always weigh out the advantages and disadvantages of the different options before deciding which method is best for you. You should also always consult your doctor to find out what works best for your body.
Birth Control Pills
Most birth control pills contain a combination of estrogen and progestin. The combination pill reduces the risk of pregnancy by:
- Preventing ovulation
This means your body does not produce eggs for the sperm to fertilise.
- Keeping the mucus in the cervix thick
This makes it harder for sperm to move to meet the egg to fertilise it.
- Keeping the lining of the uterus thin
This makes it difficult for a fertilized egg to continue to develop in the body.
It is important to understand that birth control pills do not prevent or protect you and your partner against sexually transmitted diseases. You and your partner will still need to practice safe sex.
The biggest downside of the pill is that, in order to maximize its effectiveness, you have to remember to take it every day, ideally at the same time of day. Some people find this difficult or inconvenient.
A thing to note about forgetfulness…
When taken properly, birth control pills are a highly effective form of contraception. When taken “perfectly” at the same time every day, without fail – birth control pills are found to have a 99% effectiveness rate.
However, missed pills or forgetting to restart the pill after the week of your period will greatly increase the risk of pregnancy.
You can set a recurring reminder alarm on your phone to take your pills or keep your pills next to something you use every day (like your phone charger or make-up kit). If you are a caffeine-addict, it is also a good idea to pair the pill with your morning coffee.
The pill also makes menstrual bleeding more regular, with an overall lighter flow. Other benefits of the pill include a reduction in:
- Menstrual cramps or pain (yay to improving PMS symptoms!)
In fact, the pill can be prescribed to regulate menstrual periods, provide pain relief from menstrual cramps and to manage PMS symptoms.
Depending on the severity and frequency of your menstrual symptoms, your healthcare professional may recommend taking painkillers instead. However, birth control pills may be used as a longer term measure to minimize these symptoms.
- Acne (yay to fewer pimples!)
Some birth control pills are approved to be used for the treatment of acne after all other acne treatment options have failed.
- Iron-deficiency anemia (a low blood count due to low iron levels)
We lose iron when we lose blood. Birth control pills can suppress menstruation, reducing blood loss.
- Risk of ovarian cancer or cancer of the endometrium (the lining of the uterus)
Research has shown that the risk of ovarian cancer and endometrial cancer are reduced by 30-40% in women who have ever used birth control pills compared to women who have never used them. Studies also show that this protection may last for over 30 years after the last use of birth control pills.
- Menses for holidays
Most practitioners would opt for progestin-only pill (NorE), to be taken 3 days before the trip, and stop when trip over. Taking a progestin-only pill has less side effects and does not confer contraception.
The side effects
Possible side effects of the pill include:
- Nausea, breast tenderness, bloating and mood changes
These typically improve within 2-3 months without treatment (while continuing the pill).
- Irregular bleeding: also called “breakthrough bleeding” or “spotting”, can happen during the first few months of taking the pill.
It almost always resolves without any treatment within 2-3 months. Forgetting a pill can also cause breakthrough bleeding.
#1. Birth control pills can cause weight gain
Contrary to popular belief, taking birth control pills does not cause weight gain. Research has shown that there is no established relationship between birth control pills and weight gain.
#2. Birth control pills can cause heart problems and strokes
When the pill was first introduced in the 1960s, the doses of both hormones (estrogen and progestin) used were quite high. High doses of estrogen and progestin resulted in cardiovascular complications, such as high blood pressure, heart attacks, strokes and blood clots in the legs and lungs.
The pills prescribed today have much lower doses of estrogen and progestin, reducing the risk of these complications. As a result, birth control pills are now considered a safe and reliable option for most healthy, non-smoking people. While there is a very small risk of blood clots, this risk is actually lower than the risk during pregnancy or soon after giving birth.
However, if you are 35 or older and smoke cigarettes, always consult a doctor before starting birth control pills. Studies have shown that there is a higher risk for cardiovascular complications in this group of women.
#3. Birth control pills can cause breast cancer
Experts have studied the possible association between taking the pill and the risk of breast cancer. While these studies demonstrated mixed results, some evidence suggests that people who take the pill do have a slightly higher risk of getting breast cancer later in life than those who do not. However, if there is an increase in risk, it is very small, especially in younger people.
It is important to balance this against the benefits of the pill, which include not only pregnancy prevention but a significant reduction in the risk of ovarian and endometrial cancer. Always speak to your doctor to address any concerns or doubts you may have.
The pill may not work as well to prevent pregnancy if you also take certain other medications.
Medications that have been found to reduce the effectiveness of birth control pills include medications for epilepsy (e.g. phenytoin), certain antibiotics (e.g. rifampin for the treatment of tuberculosis) and herbal supplements (e.g. St John’s Wort for depression).
It is always advisable to inform your doctor of all the medications and even supplements (herbal or non-herbal) that you are taking or intending to start taking before embarking on birth control pills.
Starting the pill
In Singapore, birth control pills are prescription-only medications. This means that you will need to consult a doctor for a legal prescription.
You may have heard of brands like: Microgynon 30, Diane-35, Mercilon, Yasmin and Yaz. These are common birth control pills in Singapore. They are birth control pills that contain a combination of estrogen and progestin.
At Dame, we stock the most common five brands of birth control pills in Singapore. They can be classified into 3 different generations, with Microgynon 30 being the earliest on the market (since the 1970s!). The newest on the market would be Yasmin and Yaz.
All 5 pills are safe, effective and reliable as birth control methods when taken correctly. They mainly differ in the strength of the estrogen component and the type of progestin in the pill. Different users experience different side effects due to the different strength and hormone components.
The newer generations of birth control pills were developed to address certain side effects experienced with the earlier generations like acne. For example, other than being an effective birth control pill, Yaz is also FDA approved for the treatment of acne.
You would also find differences in the price of the birth control pills. Microgynon 30 has been around on the market for the longest time, it is also the cheapest amongst the 5 brands. Yasmin and Yaz being the newer ones on the market, are the more expensive ones. Here at Dame, we also stock the generic versions of Yaz and Diane-35, this would confer some cost savings.
Always speak to your doctor to understand which birth control pill works best for your body and your lifestyle habits.
An unplanned pregnancy can be a difficult time for anyone regardless of age. Teenage girls (and their parents!) facing a pregnancy crisis at home may approach helplines like Babes and the Pregnancy Crisis and Support Services.
You may be curious to find that some birth control pills contain only progestin (sometimes called the “mini pill”) such as Cerelle and Cerazette. These may be an option for women who cannot or should not take estrogen. This includes those who are breastfeeding or who have worsened migraines or high blood pressure with combination birth control pills.
Progestin-only pills appear to be as effective as combination pills when taken at the same time every day. However, they are more time-sensitive compared to combination pills. Progestin-only pills have a slightly higher failure rate if you are more than 3 hours late in taking them compared to combination pills. Always speak to your doctor to find out what works best for you.
Pregnancy after hormonal birth control
Birth control pills do not increase the risk of infertility. In fact, women who use the pill usually start ovulating regularly again within one to three months of stopping birth control.
Most women return to their normal level of fertility within a cycle or two. For some, it may take several months before their cycle (including when they ovulate) becomes regular and they can get pregnant. This is more likely for people whose periods were irregular before starting birth control.
Age requirements in Singapore for birth control pills
There are age to have sex in Singapore is 16 years old.
Meaning doctors are allowed to prescribe birth control pills to 16 years old and older.
However, this is still at the discretion of your doctor, who would need to assess your suitability, both medically and psychologically.
For birth control purposes, you will need to find a sensitive and trusted doctor who will explain the risk and benefits of starting birth control pills. Our doctors can help with that. And while you are encouraged to inform your parents too, it is not mandatory for them to join in the consultation
The teen years are also when you might start having acne and birth control pills could help. Dame generally prefers to explore non-hormonal methods to control the acne first, unless your goal is to have both acne control and birth control at the same time.
Birth control pills are taken regularly to prevent pregnancy while emergency contraception refers to a birth control method that is used to prevent pregnancy after having unprotected sex. That’s why it’s also called the “morning after pill” or “plan B”. It should be used as soon as possible after unprotected sex, ideally within 120 hours.
If you have unprotected sex or if you suspect there is a problem with your birth control method (for example, you missed a pill for 2 or more day), you can use emergency contraception to reduce your risk of pregnancy. Emergency contraception does not induce an abortion. Always speak to your doctor to find out which form of birth control works best for you.
At Dame, we believe in choice. We carry the largest selection of birth control methods that can be readily access through our online platform. With just a few clicks, you can get a professional consult with our experts, and the medications can be shipped discreetly to you.
There is even an option for subscription, if you are looking to commit to something regular and fuss free.