How to Use Birth Control Pills

Birth control pills use hormones to prevent pregnancy in a few different ways, depending on the pill. Combination birth control pills stop the release of an ovum (egg) from your ovaries, thicken your cervical mucus to keep sperm from getting through the cervix, and thin the uterine lining to keep sperm from fertilizing the egg. The minipill thickens cervical mucus and thins the lining of the uterus. It may suppress ovulation too. While popular slang refers to birth control as “The Pill,” there are actually several types of birth control pills. If you've never taken birth control before and you want to be sure you use it correctly (crucial for maximum effectiveness), make sure you research your options and discuss them with your doctor.

Part 1
Part 1 of 4:

Choosing a Pill

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    Talk with your healthcare provider about your options. There are many safe and effective birth control options available for women. Birth control pills are widely available and can be inexpensive, making them an attractive option;[1] however, depending on your needs, health, and pre-existing medical conditions, certain choices may be better for you, so it’s important to discuss your birth control needs with your healthcare provider.
    • There are two main kinds of birth control pills. Combination pills use the hormones estrogen and progestin. Another type, the minipill, uses only progestin.[2]
    • Combination pills also come in two types. Monophasic birth control pills all contain the same amount of estrogen and progestin. Multiphasic pills vary the amount of hormones in certain phases.
    • Combination pills also come as “low-dose” pills. These pills contain less than 20 micrograms of ethinyl estradiol (normal birth control pills contain 50 micrograms or less). Women who are sensitive to hormones, especially estrogen, may benefit from the low-dose pill; however, the low-dose pill may also cause more bleeding between periods.
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    Consider your health. Combination pills are commonly prescribed, but they are not always appropriate. Your doctor and you will make the final decision. If any of the following apply to you, your doctor may recommend that you do not use combination pills:[3]
    • You are breastfeeding
    • You are older than age 35 and a smoker
    • You have high blood pressure
    • You have a history of pulmonary embolism or deep vein thrombosis or you have an inherited condition that increases your risk of clots
    • You have a history of breast cancer
    • You have a history or heart disease or stroke
    • You have medical complications related to diabetes
    • You have liver or kidney disease
    • You have unexplained uterine or vaginal bleeding
    • You have a history of blood clots
    • You have lupus
    • You have migraine with aura
    • You will be having major surgery that immobilizes you for a prolonged period of time
    • You take St. John’s wort, anticonvulsants, or anti-tuberculous medications
    • Your doctor may recommend that you do not use the minipill if you have breast cancer, unexplained uterine or vaginal bleeding, or take anticonvulsant or anti-tuberculous medications.
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    Consider the benefits of combination pills. Combination pills offer a variety of benefits that make them an attractive choice for many women; however, they also carry some risks. When considering which type of pill is right for you, you may want to take both of these into account. Benefits of the combination pill include:[4] [5]
    • Highly effective prevention of pregnancy when used correctly (99%)
      • About eight in 100 women will become pregnant during the first year of using this pill due to incorrect usage
    • Reduces menstrual cramping
    • May protect against pelvic inflammatory disease
    • Decreases your risk of ovarian and endometrial cancers
    • Can reduce the frequency and heaviness of menstrual cycles
    • Improves acne
    • May help improve bone mineral density
    • Reduces androgen production caused by polycystic ovary syndrome (PCOS)
    • Protects against ectopic pregnancy
    • Reduces the risk of iron deficiency anemia due to heavy menstrual flow
    • Protects against breast and ovarian cysts
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    Consider the risks of combination pills. While combination pills offer many benefits, there are also risks that you should discuss with your doctor. Most of these risks are rare, but can be serious. Many of these risks increase if you have certain medical conditions or if you smoke.[6] Risks of using combination birth control pills include:[7]
    • No protection against sexually transmitted infections or HIV (you must use condoms to protect against these)
    • Increased risk of heart attack and stroke
    • Increased risk of blood clots
    • Increased risk of developing high blood pressure
    • Increased risk of developing liver tumors, gallstones, or jaundice
    • Increased breast tenderness
    • Nausea or vomiting
    • Weight gain
    • Headache
    • Depression
    • Irregular bleeding
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    Consider the benefits of the minipill. Minipills, or progestin-only pills, have fewer benefits than combination pills; however, they also tend to have fewer risks. You should talk to your doctor to determine whether the minipill is a good choice for you. Benefits of the minipill include:[8] [9]
    • May be able to be taken even if you have certain health problems, such as blood clots, high blood pressure, migraines, or risk of heart disease
    • Can be used during breastfeeding
    • Reduces menstrual cramping
    • May make periods lighter
    • May help protect against pelvic inflammatory disease
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    Consider the risks of the minipill. While the risks of the minipill are fewer than for combination pills, it is still possible to experience rare but severe side effects from using it. Speak with your doctor to consider whether the benefits outweigh the risks for you. Risks of using the minipill include:[10] [11]
    • No protection against sexually transmitted infections or HIV (you must use condoms to protect against these)
    • Potentially less effective than combination pills
    • Backup birth control is required if you forget to take the pill within three hours of the same time every day
    • Bleeding between periods (more common with the minipill than with combination pills)
    • Increased breast tenderness
    • Nausea and vomiting
    • Increased risk of ovarian cysts
    • Slightly increased risk of ectopic pregnancy vs. combination pills
    • Possible increase in acne
    • Weight gain
    • Depression
    • Unusual hair growth
    • Headache
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    Think about your menstruation preferences. If you are healthy enough for birth control pills, you have a few options. If you choose combination birth control pills — which many women do — you can choose to reduce the frequency of your menstrual cycles if you wish.[12]
    • Continuous-dose pills, also called extended-cycle pills, reduce the number of menstrual cycles you have each year. Women may have as few as four periods a year. Some women may stop having a period altogether.[13]
    • Conventional pills do not reduce the number of menstrual cycles. You’ll still have a period every month.[14]
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    Know that some medications can interfere with the pill. Your doctor can help you determine whether you are taking any medications or supplements that will interfere with your birth control’s effectiveness. Medications that are known to interfere with the effectiveness of hormonal birth control include:
    • Several antibiotics, including penicillin and tetracycline
    • Certain seizure medications
    • Certain drugs used to treat HIV
    • Anti-tuberculosis drugs
    • St. John’s wort
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    Tell your doctor about any medications that you take. Before you decide on a birth control pill, tell your doctor about any medications and supplements that you’re currently taking. Some medications interfere with the effectiveness of birth control pills, and many others may cause negative interactions and side effects. Make sure to mention if you take any of the following:
    • Thyroid hormone drugs
    • Benzodiazepines (such as diazepam)
    • Prednisone drugs
    • Tricyclic antidepressants
    • Beta-blockers
    • Anti-coagulants (“blood thinners” like warfarin)
    • Insulin
Part 2
Part 2 of 4:

Starting Your Regimen

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    Follow your doctor’s directions. You should always follow the directions given to you by your physician. Different pills have different requirements. Some need to be started at a special time and some need to be taken at specific times. Start by reading the instructions and then follow the next steps.
    • If you do not take the birth control pills as directed, they may not be effective and you may become pregnant.
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    Do not smoke. Smoking makes taking the pill extremely dangerous to your health. Together they put you at a very high risk for blood clots, which can easily kill you. Women who are older than age 35 and smoke should not use any type of combination birth control pill.
    • If you're smoking, stop. Even occasional, social smoking can be dangerous. If you're not smoking, don't start.
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    Start taking the pill. Depending on the type of birth control pill you have been prescribed, you may need to start taking your pill at a certain time. Always ask your prescribing doctor how you should start your pill. In general, you have a few options:[15]
    • You can start combination pills on the first day of your period.
    • You can also start combination pills on the Sunday after your menstrual period starts.
    • If you have just given birth vaginally, you must wait three weeks to start the combination pill.
    • You should wait at least six weeks after giving birth before starting the combination pill if you have an increased risk of blood clots or you are nursing.
    • You can start taking the combination pill right away if you have had an abortion or miscarriage.
    • Always start your new pack of combination pills on the same day of the week as you started the first pack.
    • You can start the minipill (progestin-only) pill at any time. If you plan to have vaginal intercourse during the first 48 hours of using the minipill, use a backup form of contraception.
    • You must take the minipill at the same time each day. Choose a time when you will remember to take your pill, such as when you get up or right before you go to bed.
    • You can start the minipill right away if you have had an abortion or miscarriage.
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    Know that it is still possible to become pregnant in certain cases. If you start taking your birth control pills on the first day of your period, it is effective at protecting against pregnancy immediately. If you started your pill on a different day, there is a chance that you could become pregnant if you have unprotected sexual intercourse.
    • As such, it is recommended you use backup birth control for the duration of your first pill pack.
    • If you begin your regimen at any other time it can take up to a full month for the pill to become fully effective.
    • To avoid pregnancy, if you did not start your pill within 5 days of the start of your period, you should use an alternate form of contraception for a full month, or one full cycle of pills.
Part 3
Part 3 of 4:

Taking the Pill

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    Take the pill at the same time every day. You can take it at morning or at night, but most women find that they remember them better at night because their nightly routine for going to bed doesn't vary as much as their morning routines. If you fail to take your pill at the same time every day, you may experience spotting and you will not be as well protected.
    • If you use the minipill, you must take each pill within three hours of the same time every day. If you do not, you must use a backup form of contraception for the next 48 hours. For example, if you usually take your pill at 8 PM but you forgot until midnight, you should take the pill but also use a backup form of contraception, such as condoms, for the next 48 hours.[16]
    • Setting an alarm on your cellphone to take your pills or putting them next to your toothbrush can help you remember if you tend to be forgetful.
    • There are even mobile apps that will remind you to take your pill, such as myPill and Lady Pill Reminder.
    • Take the pill about half an hour after eating to help you avoid nausea.[17]
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    Be aware of what type of pill you’re using. Combination pills come in several different “phases.” For some of them, the level of hormones in the pills changes throughout the month. If you are taking any pill other than a monophasic pill, you may have extra instructions on what to do if you miss a pill that are specific to the pill you’re taking.
    • Monophasic pills contain the same level of estrogen and progestin in all of the pills. If you forget to take one of these pills, take it as soon as you remember. Take the next day’s pill at your regular time. Examples include Ortho-cyclen, Seasonale, and Yaz.
    • Biphasic pills change the level of estrogen and progestin once during the month. Examples include Kariva and Mircette Ortho-Novum 10/11.
    • Triphasic pills change the level of estrogen and progestin every seven days during the first three weeks of pills. Examples include Ortho Tri-Cyclen, Enpresse, and Cyclessa.
    • Quadriphasic pills change the level of estrogen and progestin four times during the cycle. Natazia is the only quadriphasic pill prescribed in the US.
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    Take combination pills according to your chosen regimen. Combination pills can be conventional or continuous-dosage (or extended-dosage). Depending on what type of combination pill you’ve chosen, you may take different pills at different times of the month. Refer to your instructions.
    • For 21-day combination pills, you will take one pill at the same time every day for 21 days. For seven days, you will not take pills. You will generally have your period at this time. After seven days you start a new pack of pills.
    • For 28-day combination pills, you will take one pill at the same time every day for 28 days. Some of these pills do not contain hormones, or may only contain estrogen. You will experience bleeding for four to seven days while you are taking these pills.
    • For three-month combination pills, you will take one pill at the same time every day for 84 days. Then you will take one pill at the same time every day for seven days that does not contain hormones, or only contains estrogen. You will experience bleeding for these seven days every three months.
    • For one-year combination pills, you will take one pill at the same time every day for the full year. You may have fewer periods, or may even stop menstruating altogether.
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    Let your body adjust to the hormones. Remember that you may experience symptoms of pregnancy during the first month as your body adjusts to hormones (swelling breasts, sensitive nipples, spotting, nausea).[18] Certain types of birth control pills may also cause you to stop having periods, so make sure you and your doctor are clear about which one you're on so you know what to look for.
    • If you’re concerned that you may be pregnant, you can use a home pregnancy test. They are accurate even while you are taking birth control pills.[19]
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    Watch out for spotting. Watch for spotting or breakthrough bleeding (bleeding in between periods) if you are taking pills that are designed to prevent you from having periods every month. Even pills that allow you to have periods can still sometimes lead to spotting. This is normal. It takes a while for your body to adjust to the new schedule and the spotting typically goes away within three months, but may take as long as six months.[20]
    • Spotting or “breakthrough bleeding” is more common with low-dose combination pills.
    • Bleeding is also more common if you miss a day or if you do not take the pills at the same time every day.
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    Make sure you refill in time. You don’t want to run out of pills, so make sure to schedule an appointment with your doctor before you need a refill. You should generally schedule an appointment when you have two packs of pills left on your prescription.
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    Try different birth control if the first one doesn't work for you. Don't be afraid to try different brands or different birth control methods. Talk to your doctor about taking a different brand of pill if you are bothered by symptoms of premenstrual syndrome or side effects of the particular pill you're on. There are many birth control methods other than the pill, many of which are easier to deal with.[21]
    • Other hormonal forms of birth control include combined estrogen and progestin patches and the vaginal ring.[22]
    • Other long-lasting, highly effective birth control methods include intrauterine devices (IUDs), contraceptive implants, and contraceptive injections.[23]
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    Keep an eye out for negative reactions to the medication. Stop taking the pills if you experience jaundice, abdominal pain, chest pain, leg pain, severe headaches or eye problems. Be especially alert for problems if you smoke. It's probably best if you quit smoking while taking birth control pills. Doing both significantly increases the chances of health complications, like blood clots.
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    Know when to see a doctor. Birth control pills do present some risks. If you encounter any of the following, contact your doctor as soon as possible:[24]
    • Severe, consistent headaches
    • Change or loss of vision
    • Aura (seeing bright, flashy lines)
    • Numbness
    • Severe chest pain
    • Trouble breathing
    • Coughing up blood
    • Dizziness or fainting
    • Severe pain in the calf or thigh
    • Yellowing of the skin or eyes (jaundice)
Part 4
Part 4 of 4:

Handling a Missed Pill

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    Try not to ever miss pills, but compensate if you do. When you forget a pill, take the pill as soon as you remember and take the next pill at the regular time.[25] Certain combination pills, especially multiphasic pills, may have additional instructions that you should follow.
    • For most pills, if you don’t remember until the next day, you should take two pills on that day.[26]
    • If you forget your pill for two days, take two pills on the first day you remember and two pills on the next day.[27]
    • If you forget a pill at any time during your cycle, you should use a backup form of contraception (such as condoms) until you finish the pill pack.
    • If you forgot a pill during the first week of a pack, you may need to use emergency contraception to prevent pregnancy.
    • If you take progestin-only pills (instead of the more common combination pill), it is extremely important to take it at the same time every day. Even a few hours off can allow you to become pregnant. [28]
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    Contact your doctor. If you are not sure what to do if you have missed a pill, or if you want to know whether you need to consider emergency contraception, contact your doctor. Tell them exactly what happened (how many pills you forgot, for how many days, etc.).
    • How you treat missing or forgetting a pill varies depending on the pill you’re taking, so contacting your doctor is always a good idea.
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    Consider alternative options when you're sick. Use another method of birth control if you are sick and experiencing vomiting or diarrhea because the pill may not stay in your digestive tract long enough to be effective.
    • If you vomit or have diarrhea within four hours of taking a pill, it is likely to be ineffective at protecting from pregnancy. Use a backup form of birth control just as you would for a missed pill.
    • If you suffer from an eating disorder and use vomiting or laxatives, an oral contraceptive is unlikely to be effective. Use a backup form of contraception.[29] Consult with your doctor or a mental health professional for help.

Expert Q&A

  • Question
    How long do you have to wait when switching birth control?
    Jennifer Butt, MD
    Jennifer Butt, MD
    Board Certified Obstetrician & Gynecologist
    Jennifer Butt, MD, is a board certified Obstetrician and Gynecologist operating her private practice, Upper East Side OB/GYN, in New York City, New York. She is affiliated with Lenox Hill Hospital. She earned a BA in Biological Studies from Rutgers University and an MD from Rutgers – Robert Wood Johnson Medical School. She then completed her residency in obstetrics and gynecology at Robert Wood Johnson University Hospital. Dr. Butt is board certified by the American Board of Obstetrics and Gynecology. She is a Fellow of the American College of Obstetricians and Gynecologists and a member of the American Medical Association.
    Jennifer Butt, MD
    Jennifer Butt, MD
    Board Certified Obstetrician & Gynecologist
    Expert Answer
    Any time you're transitioning from one form of birth control to another, it's a good idea to finish out your current contraceptive completely before you switch over to the next. Patients tend to have fewer side effects that way, including a lower chance of having irregular bleeding in the middle of your cycle.
  • Question
    Can I get pregnant the day before my period if I take birth control pills?
    Carrie Noriega, MD
    Carrie Noriega, MD
    Board Certified Obstetrician & Gynecologist
    Dr. Noriega is a Board Certified Obstetrician & Gynecologist and medical writer in Colorado. She specializes in women’s health, rheumatology, pulmonology, infectious disease, and gastroenterology. She received her MD from the Creighton School of Medicine in Omaha, Nebraska and completed her residency at the University of Missouri - Kansas City in 2005.
    Carrie Noriega, MD
    Carrie Noriega, MD
    Board Certified Obstetrician & Gynecologist
    Expert Answer
    If you have been taking your pills regularly you should not be able to get pregnant the day before your period. If you do not take your pills regularly then there is a chance to get pregnant anytime during the month, which is why backup contraception is always recommended for this situation.
  • Question
    I have been on the 2 month contraceptive injection — can I switch to pills?
    Carrie Noriega, MD
    Carrie Noriega, MD
    Board Certified Obstetrician & Gynecologist
    Dr. Noriega is a Board Certified Obstetrician & Gynecologist and medical writer in Colorado. She specializes in women’s health, rheumatology, pulmonology, infectious disease, and gastroenterology. She received her MD from the Creighton School of Medicine in Omaha, Nebraska and completed her residency at the University of Missouri - Kansas City in 2005.
    Carrie Noriega, MD
    Carrie Noriega, MD
    Board Certified Obstetrician & Gynecologist
    Expert Answer
    Yes, you can switch to pills anytime after getting the injectable form of birth control.

Warnings

  • If you miss a pill, contact your doctor right away. You may become pregnant if you do not follow the directions for your pill.
    ⧼thumbs_response⧽


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References

  1. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807
  2. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807
  3. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807
  4. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807?pg=2
  5. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  6. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  7. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807?pg=2
  8. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  9. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807?pg=2
  1. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807?pg=2
  2. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  3. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/birth-control-pill/art-20045136
  4. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/basics/birth-control-pills/hlv-20049454
  5. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/basics/birth-control-pills/hlv-20049454
  6. ↑ http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm
  7. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  8. ↑ http://youngwomenshealth.org/birth-control-pills-all-guides/
  9. ↑ https://www.webmd.com/sex/birth-control/birth-control-pills#4
  10. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/birth-control-pill/art-20045136
  11. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  12. ↑ http://www.sheknows.com/health-and-wellness/articles/949067/pass-on-the-pill-alternatives-to-birth-control-pills
  13. ↑ http://www.hhs.gov/opa/reproductive-health/contraception/vaginal-ring/
  14. ↑ http://www.mayoclinic.org/healthy-lifestyle/birth-control/basics/seo/hlv-20049454
  15. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  16. ↑ http://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  17. ↑ http://www.webmd.com/sex/birth-control/forgot-to-take-your-birth-control-pills
  18. ↑ http://www.webmd.com/sex/birth-control/forgot-to-take-your-birth-control-pills
  19. ↑ http://www.plannedparenthood.org/health-topics/birth-control/if-forget-take-pill-19269.htm
  20. ↑ https://goaskalice.columbia.edu/answered-questions/do-i-have-bulimia-and-will-it-interfere-my-birth-control-pills

About This Article

Carrie Noriega, MD
Co-authored by:
Carrie Noriega, MD
Board Certified Obstetrician & Gynecologist
This article was co-authored by Carrie Noriega, MD. Dr. Noriega is a Board Certified Obstetrician & Gynecologist and medical writer in Colorado. She specializes in women’s health, rheumatology, pulmonology, infectious disease, and gastroenterology. She received her MD from the Creighton School of Medicine in Omaha, Nebraska and completed her residency at the University of Missouri - Kansas City in 2005. This article has been viewed 463,659 times.
10 votes - 88%
Co-authors: 21
Updated: December 23, 2021
Views: 463,659
Categories: Birth Control and Contraceptives

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Article SummaryX

If you want to use birth control pills, first talk to your healthcare provider about your options since there are different pills available. They’ll be able to help you choose a safe and effective option based on your needs, health, and current medications. For example, you may want to consider a combination pill if you’re okay with taking estrogen and want a more effective birth control option. On the other hand, you may want to go with a minipill if you’re older than 35 or have high blood pressure. Since different pills have different requirements for when you have to take them, remember to always take the medication as instructed to ensure they’re as effective as possible. You should also take the pill at the same time every day to stay well protected. For more help from our Medical co-author, including how to remember to take your pill, read on!

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