Birth Control Pills

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.

It's pretty common for people to be confused about how birth control pills work. Here’s what it boils down to: birth control pills are made of hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work.

Some birth control pills contain two hormones — estrogen and progestin. These are called combination pills. Some are progestin-only pills.  Most women on the pill take combination pills.

The hormones in the pill work by

• Keeping eggs from leaving the ovaries. Pregnancy cannot happen if there is no egg to join with sperm.
• Making cervical mucus thicker. This keeps sperm from getting to the eggs.

Effectiveness is an important and common concern when choosing a birth control method. Birth control pills are very effective. Combination pills work best when taken every day. Progestin-only pills must be taken at the same time every day. That keeps the correct level of hormone in a woman’s body.

• Less than 1 out of 100 women will get pregnant each year if they always take the pill each day as directed.
• About 9 out of 100 women will get pregnant each year if they don’t always take the pill each day as directed.

The pill may be slightly less effective for women who are very overweight. Talk with your health care provider if you are concerned about how well the pill may work for you.

Certain medicines and supplements may make the pill less effective. These include

• the antibiotic rifampin — other antibiotics do not make the pill less effective
• the antifungal griseofulvin — other antifungals do not make the pill less effective
• certain HIV medicines
• certain anti-seizure medicines
• St. John's wort

Vomiting and diarrhea may also keep the pill from working. Ask your health care provider for advice. Use a backup method of birth control — like a condom, female condom, diaphragm, sponge, or emergency contraception (morning after pill) — until you find out you don’t need to.

Keep in mind the pill doesn’t protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.

Most women can use birth control pills safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Certain conditions increase the risk of serious side effects. Some of these conditions may even rule out using the pill. Talk with your health care provider to find out if the pill is likely to be safe for you. 

You should not take any kind of birth control pill if you have had breast cancer or think you might be pregnant. 
 
You should not take the combination pill during prolonged bed rest or if you 

• get migraine headaches with aura 
• have certain inherited blood-clotting disorders 
• have or are being treated for blood clots or vein inflammation 
• have had a heart attack, stroke, angina, or other serious heart problems
• have had serious heart valve problems 
• have lupus with certain conditions 
• have serious liver disease or have had liver cancer 
• have very bad diabetes or have had diabetes for longer than 20 years
• have uncontrolled high blood pressure 
• smoke and are 35 or older 
• smoke and have high blood pressure 
• have had complications after organ transplant
• need to stay in bed for a long time   

Warnings About Birth Control Pills That Contain Drospirenone 

The progestin in YAZ, Gianvi, YASMIN, Ocella, Syeda, and Zarah, Beyaz, and Safyral is different from other birth control pills. It may be linked to a higher risk for blood clots than other birth control pills. It can also raise potassium levels in your blood. This could cause heart and health problems. Make sure you tell your doctor or nurse if you ever had a disease of the kidneys, liver, or adrenal glands. Some medicines are not safe to take with these pills.

If you have a condition that makes it unsafe to take the pill, don’t worry. There are many other methods of birth control that may be safe for you if you cannot take the pill. Read about other methods to find one that may be right for you.

Taking the pill is simple, safe, and convenient. It does not interfere with having sex. Many women say it improves their sex lives because it helps them feel more spontaneous. 

Women who do not need birth control often choose to take the pill for the other benefits it offers. Combination and progestin-only pills

• reduce menstrual cramps
• make periods lighter 
• offer some protection against pelvic inflammatory disease, which often leads to infertility when left untreated

The combination pill offers many other benefits, including some protection against

• acne
• bone thinning
• breast growths that are not cancer
• ectopic pregnancy
• endometrial and ovarian cancers
• serious infection in the ovaries, tubes, and uterus
• iron deficiency anemia
• cysts in the breasts and ovaries
• premenstrual symptoms, including headaches and depression
• bad cramps
• heavy and/or irregular periods

Combination pills can be used to control when and how often you have your period. Some pills are specially packaged for women to have only a few periods a year. Other pills can also be used continuously to prevent having periods. With these pills, women take an active pill every day to keep from getting their periods. It is normal for them to have spotting or bleeding the first 6 months. It may get less over time. Some stop having any bleeding at all. This is normal and will not harm your body. But it’s a good idea to get tested if you think you might be pregnant.

Some women may have undesirable side effects while taking birth control pills. But many women adjust to the pill with few or no problems.  

Some of the most common side effects usually clear up after two or three months. They include

• bleeding between periods (most often with progestin-only pills)
• breast tenderness
• nausea and vomiting

Nausea and vomiting may be helped by taking the pill in the evening or at bedtime. But do not stop taking the pill because you feel sick to your stomach — you will be at risk of pregnancy if you do.

The hormones in the pill may change a woman’s sexual desire. 

It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after taking the pill for three months, talk with your health care provider about changing your prescription. 

After stopping the pill, it usually takes one or two months for a woman’s periods to return to the cycle she had before taking the pill. Once in a while, a woman may have irregular periods or no periods at all. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before starting the pill.

Serious Side Effects of the Pill

Many women have concerns about the possible risks of taking birth control pills. Serious problems do not occur often. And progestin-only pills have a lower risk of serious side effects than combination pills.

Combination pill users have a slightly greater chance of certain rare, but serious, problems than nonusers. These problems, that may be fatal in very rare cases, include heart attack, stroke, having a blood clot in the legs, lungs, heart, or brain, or developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice).  

The risk for these problems increases if you

• are age 35 or older
• are very overweight
• have certain inherited blood-clotting disorders
• have diabetes
• have high blood pressure
• have high cholesterol
• need prolonged bed rest
• smoke

Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:

• a new lump in your breast
• a sudden very bad headache
• achy soreness in the leg
• aura — seeing bright, flashing zigzag lines, usually before a very bad headache
• bad pain in your abdomen or chest
• headaches that are different, worse, or happen more often than usual
• no period after having a period every month
• trouble breathing 
• yellowing of the skin or eyes

See the insert from your pack of pills for more information about possible side effects.

It depends on what kind of pill you are taking. Most combination pills come in 28-day or 21-day packs. Both types have 21 "active" pills that contain hormones. The last seven pills in 28-day packs of combination pills are called "reminder" pills. They do not contain hormones. 

In 21-day packs, one pill is taken every day for three weeks in a row. No pills are taken for the next week, and then a new pack of pills is started.

Some combination pills contain a few months’ worth of active pills. They are specially packaged to reduce the number of periods a woman has each year. Women can also take the active pills in 21-day or 28-day packs continuously to reduce how often they have periods. 

Progestin-only pills come only in 28-day packs. All progestin-only pills are active.

With combination pills, you’ll get your period during the fourth week — unless you choose to avoid menstruation by using active combination pills during the fourth week, as well.

With progestin-only pills, you may

• get your period the fourth week
• get no periods
• have bleeding on and off throughout the month

The hormones in birth control pills prevent pregnancy throughout the entire month — even during the fourth week.

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. We now know that 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.

Combination Pills

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.

Progestin-Only Pills

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
• smoke

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.

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. Here are some general instructions. 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.

Combination Pills

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.

This table tells you what to do if you miss any pills from a 21-day or 28-day pack of combination pills.

Progestin-Only Pills

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.

First, you’ll need to get a prescription. Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $0–$250.

Birth control pills may be purchased with a prescription at a drugstore or clinic. They cost about $0–$50 a month. 

Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. 

Call your local Planned Parenthood health center to get specific information on costs.