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How does The Pill work?

Regardless of your views on The Pill, I’m going to explain how it works. Even if you don’t believe in contraception, I think it’s important to understand what it is, how it works and more importantly, why it fails. I’ve been on it myself for quite some time now and I realized that I was sort of taking it with blind faith in it’s magical powers to prevent pregnancy. Even if you think you know how it works, I’m going to go a bit more in depth into the biology (which may make you male readers a bit squeamish, but if you don’t think this is relative information to you: think again!)

The history of contraception goes way back to Genesis (not the Phil Collins band) where the first concept of birth control is mentioned: coitus interruptus. Otherwise known as the withdrawal method. Many years went by and gradually people realized that men aren’t generally ninjas and the withdrawal method doesn’t work. Which is just as well: “coitus interruptus” doesn’t sound like much of a good time anyway. It wasn’t until the 1960s that The Pill was introduced, but the history of contraception is pretty fascinating. I highly recommend the American Experience presentation on it, which can be found via PBS. (They have a great visual component that might make more sense of the information explanation in this blog.)

We have to start our journey through contraception by talking about the menstrual cycle. Your period is actually good for something else other than getting you a day or two off school a month (in high school, my gal friends and I called them “mental health days” —and boy were they ever). When a young gal enters puberty and begins to have her period, she can then become pregnant.

Why do we have a period, you ask? Because each month the lining of our uterus (“baby haus”) builds up with all sorts of nutrient rich tissue. It doesn’t care if we’re home every Friday night watching 7th Heaven reruns, forever alone. Our bodies still say, “Look who’s fertile as fuck!” and prepare our innards to accommodate a baby. The real event is that we ovulate, and our ovaries (one or the other, they take turns) releases an egg. That egg heads down our fallopian tube to the uterus. And that’s where it sits, like a nervous preteen with awkward eyeliner waiting for their date to the YMCA dance. All dressed up and no place to go, unless that is, a sperm (or, you know, a few fucking thousand) shows up and plows her like an Amish man supporting his family. The unfertilized egg basically dies of rejection and the nice, cozy uterine lining sloughs off and…well, you know what happens next.

Thus begins the first day of the menstrual cycle. Your first day of bleeding has occurred because there are low levels of progesterone and estrogen in our bodies, and that sends a signal to the part of our brain called the hypothalamus. The hypothalamus sends a hormone called GnRH to the pituitary gland. That hormone tells the pituitary gland to release something called Follicle Stimulating Hormone and Lutenizing Hormone. These hormones travel to the ovaries in the bloodstream and force the follicles in the ovaries to mature (grow up!) and each of those follicles contains an egg, otherwise known as an ovum, as well as the cells that produce estrogen.

Still with me? I know this is hefty, but I swear, it’s going to make sense and you’re all going to sound really fucking smart when you talk about it.

So, you’ve got these follicles with eggs, right? Well, guess what? Some of them suck, some of them are totally slow and they’re not going to get to release an egg. “There can only be one!” — literally. There’s going to one egg released. Meanwhile, there’s all this estrogen happening and that’s what’s thickening up the lining of the uterus (called the endometrium, if you wanna sound like a real smart ass). This is taking place during the early to middle days of your cycle, because around day 14 of your cycle, you actually release that egg, because the estrogen is through the roof and cranks up that LH hormone I talked about.

And now there’s an egg hanging out in your uterus and the follicle it used to be attached to starts producing progesterone. It’s the progesterone that makes the lining of your uterus all nice and homey. It also tells the hypothalamus and pituitary gland to shut the fuck up and stop making those two hormones, FSH and LH, so that no more follicles make eggs.

And when the sperm stand that egg up, progesterone stops. (If the sperm shows up and they hit it off, that’s a totally different story) The decrease in progesterone makes the lining break down, because at this point it’s totally useless. And that’s when your period starts. Then, the cycle starts all over again.

Totally rad, right? Except you’re a fine young woman who has sexual intercourse involving a penis and, frankly, you don’t want to get pregnant. For whatever reason, you don’t want no endometrium hanging out in your uterus. So, what do you do? Maybe you decide to start taking The Pill. 

Because The Pill prevents you from ovulating and that’s why it keeps you from getting pregnant. If those horny sperm show up to accost your lovely egg and she stays in the house, laughing at them from her bedroom window, you aren’t going to get pregnant.

The Pill has synthetic forms of estrogen and progestin, which is a form of progesterone, that tell the pituitary gland and hypothalamus to let those follicles be young forever; never grow up, never release an egg. Just stay immature, guys. Instead of being only one, now there’s no one. Not only that, but that constant level of progestin makes your uterine lining about as fun as the fucking Sahara. The mucus in your cervix is like a fucking sand trap. Basically? If a sperm could even get in there, he’d be all, “FUCK IT, THIS PARTY SUCKS.”

Not a whole lot happening in there. That is, until you take the “placebo pills” or “reminder pills” or “sugar pills” — in the pack, there are these pills that are a different color. Unlike the pills you’ve been taking all month, these have no hormones in them. You don’t even have to take them, if you can remember to start your next pack on the right day. During this time, when you haven’t got that estrogen and progestin in your system, the lining of the uterus will break down and you’ll have a “withdrawal bleed” which you might think of as your period, but really, it’s not. Imagine that your period is your favorite band, and the withdrawal bleed you have on the pill is some 12 year old on Youtube doing a cover. It’s just not the same.

Seems pretty easy, right? Well, more or less, it is. The Pill works well for many women in preventing pregnancy, if they remember to take it at the same time every day. Now, if you took it last night at 7pm and tonight you take it at 7:15pm, that’s okay. That is hardly enough time to throw your hormone levels for a loop. But if you take it more than four hours late or you completely forget to take it, then you’ll need to use a back up form of birth control for the rest of the cycle (until you start your new pill pack). Back up is usually a condom. Now, you might want to consider always using a condom, even if you’re on The Pill, because while it will do a pretty damn good job of keeping you from being on 16 & Pregnant, it won’t keep you from being 16 & HIV Positive. It doesn’t protect you against sexually transmitted diseases.So that means HIV/AIDS as well as things like gonorrhea, chlamydia, public lice, herpes or anything else.

Another thing to remember is that just because you took you pill at the right time, it doesn’t mean that it will successfully be absorbed into your blood stream during digestion: if you were out drinking and barfed at a frat party, you probably threw your pill up if you’d taken it right before you went out. So, it’s back up BC for you. You don’t necessarily have to puke for it to be ineffective: if you have some lo mein with friends and get yourself a nice case of Chinese take-out diarrhea, you may not have absorbed that pill. Also, there are several herbal remedies that will cause the pill to be ineffective, like St John’s Wart (which honestly, I don’t know what it’s used for, but they warn you about it). 

What you say? You’ve heard of someone’s best friend’s cousin who took her pill *perfectly* and still got knocked up?

But she had recently had strep throat and was on antibiotics?

The use of antibiotics can make your pill ineffective.

It’s hard to tell, but if you have to take antibiotics for any reason, it’s better to be safe than sorry and use a back up method until your next pill cycle begins.

So, you know the basics. Pregnancy is preventable. From a purely biological stand point, you can be in a sexually responsible relationship. The Pill is a popular way to do that. For some women, there will be side effects, but there are several types, with varying levels of estrogen, so if you start taking it and you feel really shitty for more than 3 months, you can try a different type.

But no matter what pill you’re taking, keep your ears open for recalls, like this one. It doesn’t happen often, but you have to be your own advocate.

Bottom line: if you aren’t ready to be responsible about sex, you aren’t ready to have sex. Stay educated and above all else: take care of yourself.

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