Birth Control: The Pill
There’s also a combination pill pack that has hormone pills for 12 weeks and then pills without hormones for 7 days. With this pack, users have periods once every 3 months instead of once a month.
Combination birth control (COC) pills
These are pills that have both estrogen and progesterone. They are the most used birth control pills.
- COC prevents pregnancy 92 out of 100 times. This means in 1 year, 8 out of 100 people who use COC’s get pregnant.
- COC does not protect against sexually transmitted infections. Use condoms with new partners.
- Most COCs have 3 rows of hormonal pills and 1 row of placebo pills.
- Some have less than 7 placebo pills.
- Some have placebo pills every 3 months.
Benefits
- Patient controlled.
- More predictable periods.
- Lighter and less painful periods.
- Prevents pregnancy.
- Less acne.
- Less risk of uterine and ovarian cancer when taken long term.
- Less symptoms of endometriosis and PCOS.
- Able to get pregnant right away after stopping. No impact on your ability to get pregnant in the future.
Risks
- Getting pregnant.
- Although rare there is a risk of blood clots in the legs or lungs. The risk of getting a blood clot is more than 10 times less than during pregnancy. It is slightly higher than when not on a COC.
When do I start the pill?
The COC can be started anytime if you are reasonably sure you are not pregnant. You do not need to wait for the next menstrual cycle. You do not need to wait until the Sunday after a period.
Postpartum: Wait to start until instructed by your provider after delivery. Most COC’s are started 6 weeks after delivery. This is due to the risk of blood clots in the postpartum time. COC’s are safe in breastfeeding and do not decrease milk supply when started 6 weeks after delivery.
Miscarriage or abortion: If you plan to use COC after miscarriage or abortion, start the first Sunday after the pregnancy passes. You may still have vaginal bleeding at that time. It is ok to start your pills though.
When does the pill start working?
- If the pill is started the first 5 days of a regular period, it works right away.
- If started any other time during a menstrual cycle:
- Do not have sex for 7 days or use another birth control method, such as condoms, for 7 days.
- If switching from an IUD, do not have sex or use a back-up birth control method for 7 days.
- You do not need to use a back-up method if you switch from a non-IUD method, such as pill, patch, ring, or shot.
How do I take the pill?
This depends on the type of pill you are using.
Cyclic dosing
21-day pill packs
- Take 1 pill at the same time each day for 21 days.
- Wait 7 days before starting a new pack.
- During the week you are not taking the pill, you will have your period.
28-day pill packs
- Take 1 pill at the same time each day for 28 days.
- Depending on the brand, the first 21 or first 24 pills have estrogen and progestin.
- The remaining pills may be:
- Estrogen-only pills
- Pills with a dietary supplement, such as iron, but no hormones
- Inactive pills that do not have hormones or supplements
90-day pill packs
- Take 1 pill at the same time each day for 84 days.
- Depending on the brand, the last 7 pills either have no hormones or have estrogen only.
- With both brands, you will have a period during the last 7 days every 3 months.
Continuous dosing
- If the provider prescribes a COC, take the active pills for 3 weeks.
- Throw out placebo pills.
- Start a new pack of pills right away.
Missed or late combined birth control pills
If you are late taking a pill and it is less than 24 hours since you should have taken it
or
If you missed a pill and it has been 24 to 48 hours since you should have taken it:- Take the late or missed pill as soon as possible.
- Keep taking the pills at the normal time. Even if you must take 2 pills the same day.
- No need for more contraception protection.
You often do not need emergency contraception if you missed hormonal pills early in your cycle or in the last week of your previous cycle. You may think about taking it though.
If you missed 2 or more pills in a row and it has been more than 48 hours since you should have taken a pill:
- Take the most recent missed pill as soon as possible. Throw away the other missed pills.
- Keep taking the rest of the pills at the normal time. Even if you must take 2 pills in the same day.
- Use back-up contraception, such as condoms, or do not have sex until you take your pills 7 days in a row.
If you missed pills the last week of your hormonal pills (days 15 to 21 for a 28-day pill pack):
- Skip the pills in the hormone-free week. Finish your hormone pills in your current pack.
- Start a new pack the next day.
- If you cannot start a new pack right away, use back-up contraception, such as condoms, or do not have sex until you take your pills 7 days in a row.
You may want to take emergency contraception if you missed hormonal pills the first week in the pill pack and you had unprotected sex in the past 5 days.
Go to the Emergency Room (ER) if you have:
• Eye problems, such as vision loss of blurring
• Speech problems
• Severe headaches
• Dizziness
• Weakness
• Numbness
• Shortness of breath or chest pain
• Severe leg pain in your thigh or calf and leg swellingSide Effects
Breakthrough bleeding
- Light bleeding (spotting) is very common the first 3 months. This is more common with continuous pill use. It is not harmful.
- If flow is light, keep taking pills. Call your care team if you keep having bleeding after the 3rd cycle of pills. Ask about changing pills.
- Call your care team if your flow is heavy. This means soaking more than 1 pad in 1 hour.
Nausea
- This is common the first 2 to 3 months. Try taking the pill at bedtime or on a full stomach.
Headaches
- This is common the first 2 to 3 months. Keep track of how severe and often you have them.
- Try over the counter pain relievers, such as naproxen sodium, ibuprofen, or Tylenol®.
- Get medical attention if you have headaches with:
- Dizziness
- Weakness
- Numbness
- Visual changes
- Speech problems
- Or it is a severe headache.
Weight gain
- There is no evidence COCs cause weight gain.
- You may have some fluid retention. It should be no more than 5 pounds.
No period during placebo pills
- If you have not missed any pills, this may be normal. Take a home pregnancy test if you think you might be pregnant. If negative, keep taking the pills.
Birth Control: The Pill
The birth control pill (also called “the Pill”) is a daily pill that has hormones to change the way the body works and prevent pregnancy. Hormones are chemicals substances that control the body’s cells and organs. In this case, the hormones in the Pill control the ovaries and the uterus.
How Does the Pill Work?
There are two kinds of birth control pills: combination pills and mini-pills.
Most birth control pills are combination pills, which have two hormones: estrogen and progesterone. They help prevent ovulation (the release of an egg during the monthly cycle). For a pregnancy to happen, sperm needs to fertilize (“meet”) an egg.
Mini-pills have just one hormone: progesterone. They sometimes prevent ovulation. But they mostly work by making it tough for sperm to enter the uterus and reach any eggs that were released.
The two kinds of birth control pills also might make it hard for an egg to attach to the wall of the uterus so the egg can’t grow there.
How Are Birth Control Pills Taken?
Combination Pills: Most combination pills come in a 21-day pack or a 28-day pack. Users take 1 hormone pill each day at about the same time for 21 days. Depending on the pack, they’ll stop taking the birth control pills for 7 days or take a pill that has no hormones for 7 days. During those 7 days, they’ll get a period. Some people like the 28-day pack because it keeps them in the habit of taking a pill each day so they won’t forget.
There’s also a combination pill pack that has hormone pills for 12 weeks and then pills without hormones for 7 days. With this pack, users have periods once every 3 months instead of once a month.
Mini-Pills: Users take a mini-pill every day without a break and might have irregular periods or no periods. The mini-pill doesn’t work as well as combination pills to help prevent pregnancy.
For the first 7 days after someone starts taking the Pill, they should use a second form of birth control, like condoms, to avoid getting pregnant. After 7 days, the Pill should work alone to prevent pregnancy. This timing can vary based on the type of Pill and when they start taking it. Also, it’s important to keep using condoms to protect against sexually transmitted diseases (STDs).
All birth control pills work best when the user takes them every day at the same time, even if they’re not going to have sex. This is extra important with mini-pills — for them to work, no doses can be missed.
If someone skips or forgets pills, they’re not protected against pregnancy and should use a backup form of birth control, like condoms, or stop having sex for a while.
How Well Does the Pill Work?
Over the course of a year, about 8 out of 100 couples who use the Pill to prevent pregnancy will have an accidental pregnancy. The Pill is an effective form of birth control, but even missing 1 day increases the chances of a pregnancy.
In general, how well each kind of birth control method works depends on many things. These include whether a person has any health conditions or is taking any medicines or herbal supplements that might make it less effective. For example, a medicine like an antibiotic can make the Pill not work as well.
Does the Pill Protect Against STDs?
The birth control pill doesn’t protect against STDs. Couples having sex must always use condoms along with the Pill to avoid getting and spreading STDs.
Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.
What Are Possible Side Effects of the Pill?
The Pill is a safe and effective method of birth control. Most users have no side effects or very few.
Side effects that can happen from the Pill include:
- irregular periods (more common with the mini-pill)
- nausea, headaches, dizziness, and breast tenderness
- mood changes
- blood clots (rare in users younger than age 35 who don’t smoke)
Some of these side effects improve over the first 3 months on the Pill. If they’re bothersome or don’t get better, a doctor may prescribe a different brand.
The Pill also has some effects that many users enjoy. It can make periods lighter, reduce cramps, and improve acne. Combination birth control pills have also been found to protect against:
- some kinds of breast disease
- anemia
- ovarian cysts (little sacs in the ovaries filled with liquid)
- cancers of the ovaries and endometrium (lining of the uterus)
Who Can Use Birth Control Pills?
Someone who can remember to take a pill each day and wants excellent protection from pregnancy can use birth control pills.
In some cases, medical conditions make the use of the Pill less effective or more risky. For example, it’s not recommended for anyone who has had blood clots, liver problems, or some kinds of migraine headaches.
People with high blood pressure that’s under control can sometimes use the Pill if their doctor monitors them. Anyone who has had unexplained vaginal bleeding (bleeding that’s not during their periods) or who might be pregnant should talk with their doctor.
Where Are Birth Control Pills Available?
One kind of mini-pill is available without a doctor’s prescription online and in places like drugstores. Doctors can prescribe other kinds of birth control pills. They’ll ask about the patient’s health and family medical history, and do an exam. This might include a pelvic exam. They’ll explain when to begin taking birth control pills and what to do if any are missed.
The doctor might do a blood pressure check a few months later and make sure there are no other problems. After that, people who have sex you should get routine exams every 6 months to a year, or as recommended.
It’s not safe to take someone else’s birth control pills.
How Much Do Birth Control Pills Cost?
The Pill usually costs between $0–$50 a month, depending on the type. Many health clinics (like Planned Parenthood) sell birth control pills for less. And birth control pills and doctor visits are covered by many health insurance plans.
