Do I need to take the sugar pills in my birth control?

For a tiny tablet, the Pill can raise a lot of questions. Do you really need to take it at the same time everyday? Is there are any truth to reports that it’s bad for you? And what do those sugar pills actually do?

In most combined pill packets, you’ll find seven sugar pills alongside the active hormone tablets. You’re instructed to take them during your period — but what happens if you don’t?

According to Dr Deborah Bateson, Medical Director of Family Planning NSW, the sugar pills were originally included as a reminder.

“They were just a way of getting women into the habit of remembering to take their pill, they don’t actually “do” anything,” she says.

“Traditional pill packs contain 21 active pills and seven sugar pills, while newer types have 24 hormone pills and four placebo pills. In other countries, they just have 21 active pills and no placebo pills at all.” (Post continues after gallery.)

Popular forms of birth control

Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.

Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.

Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.

DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.

CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.

The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.

Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.

Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled

The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.

SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

“Their only purpose is a reminder. It’s not harmful to take them, and it’s not harmful NOT to take them. Some women take them, others pop them out each day and throw them away and some people ignore them altogether,” Dr Bateson adds. Either way, the important thing is that you return to the active pills after those seven days are up.

If you do choose to take the sugar pills, you will have a “withdrawal bleed”. You are still covered from pregnancy during this time, as long as you have not missed any of the active pills prior, and return to taking the active pills when those seven days are over.

“When you’re on the Pill, you don’t actually get a period because you’re not ovulating. When you take the sugar pills, you have a drop in hormones which causes the withdrawal bleed, which is essentially a fake period,” explains Dr Bateson.

Dr Bateson says it’s also perfectly safe to skip the sugar pills (and so your “period”) for an extended length of time, if you desire.

Image: Lena Dunham shared this photo of her pill on Instagram, writing: "A gangster's best accessory"

"Traditionally, women have been advised to take three months' worth of pills at a time, then have a withdrawal bleed and then continue that cycle. But really good safety data has found that it's safe to go longer and have an extended pill cycle of up to 12 months."

"It is possible for some women to still get breakthrough bleeding through this. If that's the case and you have four days of bleeding, take a break then restart but also talk to your doctor just to check everything."

Despite what you might have been told, skipping your period like this doesn't cause any kind of "build up" inside your body. "There's nothing building up inside by not having a period. The pill thins out your uterus lining over time so there's actually not anything to have a period," says Dr Bateson.

"There are also no long-term effects of taking the Pill for an extended period, as long as you are eligible to take it (i.e you don't have any conditions or develop anything that requires you to stop). You can stay on it until you're 50 if you like." (Post continues after video.)

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