Birth control pills are a kind of medication that women can take daily to prevent pregnancy. They are also sometimes called “the pill” or oral contraception. Birth control pills are some of the most popular contraceptives. And for good reasons they’re effective and easy to use. The variety of birth control pills available, though, can seem daunting. It’s a feminist icon that’s been letting women live life on their own terms for 50+ years. And if you’re thinking about using it, here’s everything you need to know to find the right one.
The pill is made of synthetic hormones like those that occur naturally in your body. There are basically two different kinds of pills, the combination pill and the mini-pill.
Combination pills contain two types of hormones, estrogen and progestin. They prevent pregnancy in three ways: by suppressing ovulation (meaning your eggs stay put in your ovaries); by thickening cervical mucus (making it harder for sperm to move); and by thinning the lining of the uterus (making it harder for an egg to attach there). This type of pill is more widely used than the mini-pill.
- Combination pill names: Alesse, Apri, Aranelle, Aviane, Enpresse, Estrostep, Lessina, Levlen, Levlite, Levora, Loestrin, Mircette, Natazia, Nordette, Lo/Orval, Ortho-Novum, Ortho Tri-Cyclen, Yasmin and Yaz. Lybrel, Seasonique and Seasonale (generic names: Jolessa or Qualsense) are combo pills that can minimize periods to just a few times a year or less.
- Benefits: Combination pills are linked to less crampy, lighter, shorter periods. (That can also mean less chance of anemia.) These pills may also clear up acne. The combo pill may reduce the risk of ovarian and endometrial cancer.
- Combination pills might not be right for you if: you are sensitive to estrogen. You can try lower-dose combination pills, which contain less estrogen, but they might cause more between-period bleeding (a.k.a. spotting).
- Other concerns: You shouldn’t take the combination pill if you have certain health conditions. For example, if you have high blood pressure, get migraines with aura, or smoke and are over 35, you probably shouldn’t use it. The bottom line is it’s always important to talk to a health care provider about your medical history before starting a new birth control method. One more thing: If you’ve given birth recently, you should avoid combination pills and other methods with estrogen.
- Heads up! The combo pill can be less effective against pregnancy if you use it while taking any of the following: the herbal supplement St. John’s Wort; HIV and seizure medicines; topamax/topiramate, which can be used to treat seizures or migraines; or the antibiotic rifampin, which is used to treat tuberculosis. (Other antibiotics are fine to take with the pill.) These medicines limit your body’s ability to adequately absorb the pill’s pregnancy-preventinga hormones. If you take these meds, consider a birth control method that doesn’t contain estrogen, such as the mini-pill, an IUD, the shot, or the implant.
- Inactive pills: There are typically four to seven inactive or placebo pills in each monthly pack. These are the pills that have no or a low-dose of hormones. You take these to maintain your daily habit of taking your pill at about the same time each day.
Mini-pills contain only progestin. They prevent pregnancy by thickening your cervical mucus and thinning the lining of the uterus. Some mini-pills suppress ovulation, but that’s not the main way they work. The mini-pill was developed for women who are sensitive to estrogen.
- Mini-pill names: Camila, Errin, Jolivette, and Mircronor.
- Benefits: Aside from being very effective at preventing pregnancy (when taken correctly), the mini-pill is safe for women who are at risk of heart disease or strokes, or are heavy smokers. It’s also safe for breast-feeding women.
- Inactive pills: Unlike the combo pill formulas, every mini-pill in your pack is active. Take one every single day, at about the same time each day.
Are all kinds of birth control pills appropriate for everyone?
No. Your health care provider will ask about your medical history and any medications you take to determine which birth control pill is right for you.
Your health care provider may discourage use of combination birth control pills if you:
- Are breast-feeding
- Are older than age 35 and smoke
- Have poorly controlled high blood pressure
- Have a history of or current deep vein thrombosis or pulmonary embolism
- Have a history of breast cancer
- Have a history of stroke or heart disease
- Have diabetes-related complications, such as nephropathy, retinopathy or neuropathy
- Have liver disease
- Have unexplained uterine bleeding
- Will be immobilized for a prolonged period due to major surgery
- Take St. John’s wort, or anticonvulsant or anti-tuberculous agents
Your health care provider may discourage use of the minipill if you:
- Have breast cancer
- Have unexplained uterine bleeding
- Take anticonvulsant or anti-tuberculous agents
How Do I Start Birth Control Pills?
Women used to be told that they could only start the pill on the first day of their period or on the first Sunday after the start of their period. It’s also perfectly fine to start the pill on any day of the month. Talk with your health care provider about what day is best for you to start taking the pill.
You may start the combination pill at any time. If you start within five days after the start of your period, you are protected against pregnancy right away. You will not need to use a backup method of birth control. That means that if your period starts on a Wednesday morning, you can start the pill up to Monday morning to be protected right away. If you start at any other time during your menstrual cycle, you will be protected from pregnancy after seven days. Use another method of birth control like a condom, female condom, diaphragm, or sponge — if you have vaginal intercourse during the first week of use.
You may start the progestin-only pill at any time. Use another method of birth control if you have vaginal intercourse during the first 48 hours of progestin-pill use protection will begin after two days.
Taking the progestin-only pill at the same time each day is essential. If you take it more than three hours past the regular time, you need to use a backup method of birth control for 48 hours after taking the late pill.
Starting the Pill After Pregnancy
It’s possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women. And many of these women choose the pill.
You can start taking the combination pill after waiting at least three weeks after giving birth vaginally. You should wait at least six weeks after birth if you are nursing or if you have an increased risk of blood clots. Women have a higher risk of blood clots if they:
- are obese
- are over age 35
- had a cesarean section (C-section)
- had heavy bleeding after delivery
- had preeclampsia
- have certain inherited blood clotting disorders
- have had blood clots in the past
- have a close family member who has had blood clots
- need prolonged bed rest
- received a blood transfusion at delivery
You can start using the combination pill right after an abortion or miscarriage.
You can start taking the progestin-only pill right after an abortion, miscarriage, or childbirth.
Breastfeeding and Birth Control Pills
Progestin-only pills will not affect your milk during nursing.
You should wait to start using combination pills if you are nursing because they may reduce the amount and quality of milk in the first six weeks of breastfeeding.
Breast milk will contain traces of the pill’s hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth.
Helpful Tips About Birth Control Pills
Taking the pill at the same time each day makes it more effective. Pick a time of day that is easy to remember. You might find it helpful to take it when you do something else you do every day like brushing your teeth or eating dinner. Many women set an alarm on their cell phones or watches. A missed period does not always mean you are pregnant, especially if you have not skipped any pills. Even though the chance of pregnancy is very low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the pill.
There is a very slight chance that you will become pregnant even if you take the pill as directed. It is unlikely that taking the pill during early pregnancy will increase the risk of birth defects. However, the likelihood of ectopic pregnancy is greater if you become pregnant while taking the progestin-only pill.
If you decide you want to become pregnant, stop taking the pill. It’s possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before taking the pill.
Almost all women on the pill forget to take it at some time. The pill works best when taken on time, every day but knowing what to do when you forget could save you from having an unplanned pregnancy. Talk with your health care provider for more information.
What to do depends on the kind of pill you take. Some birth control pills have two hormones estrogen and progestin. These are called combination pills. Some are progestin-only pills. Most women on the pill take combination pills. Ask your health care provider if you are not sure what kind of pill you are on.
You could become pregnant depending on when you miss pills and how many of them you miss. There is a highly increased chance of pregnancy if you go without hormones for seven or more days in a row. This could happen if you don’t start a new pack on time and/or forget to take the last one or two pills in the pack.
You may need a backup method of birth control if you have vaginal intercourse during the seven days after a missed pill. Some backup methods are the condom, female condom, diaphragm, or sponge.
You can also use emergency contraception (morning after pill) up to five days after unprotected intercourse. This is a great option if you have vaginal intercourse before you realize you have missed pills. The sooner you take emergency contraception, the better it will work.
You could become pregnant if you take your progestin-only pill more than three hours past your regular time. If you do
- Take a pill as soon as you remember.
- Take the next pill at the usual time.
- Continue to take the rest of the pack on schedule.
- Use a backup method for 48 hours after taking the late pill. Some backup methods are the condom, female condom, diaphragm, sponge, or emergency contraception. Emergency contraception is a great backup method if you had vaginal intercourse before you realized you missed pills.
Many women have spotting or light bleeding when they miss a birth control pill — even if they make it up later. Women also sometimes feel a little sick to their stomachs if they take two pills to make up for a missed pill. If you do feel a bit sick after taking two pills in a day, don’t worry. The nausea won’t last long.
What’s the bottom line?
You have many options for birth control. If you choose to take birth control pills, work with your health care provider to decide which type of birth control pill is right for you.