Birth control pills are a
medication women take every day to prevent pregnancy. They are sometimes called
“the pill” or oral contraception. Most
women using the pill take “combination pills.” These contain two hormones -
estrogen and progestin.
Some birth control pills
contain only one hormone - progestin. These are sometimes called “mini-pills”.
Progestin-only pills are good for women who cannot use estrogen. The
information below includes information about the combined pill only and will be
referred to as “the pill” throughout.
The pill is a very
reliable birth control method. If the pill is used correctly, less than 1 out
of 100 women using the pill will become pregnant (.3 %). If the pill is not
always used correctly, 9 of 100 will become pregnant (9%). To use the pill
correctly, you must:
- Take a pill every day (and
the pill works best if you take it at the same time each day. You might find it
helpful to take the pill when you do something else every day — like brushing
your teeth or eating dinner).
- When you first start the
pill, it takes several days to begin working. Be sure to use backup birth
control (like a condom) for the first 7 days on the pill.
are many combined hormone pills available today, and while each one provides
the same effectiveness against pregnancy when used correctly, there are
variations between brand in the appearance, composition, and directions for use
of each particular pill. Be sure to ask your healthcare provider or pharmacist
if there are different considerations or directions for your pill, such as with
Natazia® and others, than those that are outlined
in this brochure.
BIRTH CONTROL PILLS DO NOT
PREVENT SEXUALLY TRANSMITTED INFECTIONS. USE A CONDOM WITH EVERY ACT OF
INTERCOURSE TO REDUCE YOUR RISK FOR ACQUIRING SEXUALLY TRANSMITTED INFECTIONS.
BEFORE STARTING THE PILL
that you have informed your health care provider if you:
- Take any medications,
herbal products or dietary supplements
- Smoke or
- Have any history of:
- Migraine headaches
- Breast lumps or nodules
- Diseases involving blood clots
- Tumors of the ovaries
- High blood pressure
- Heart attacks
- Cancer of the female organs
- Active gallbladder disease
- Inflammatory bowel disease
- Rheumatoid arthritis
- Blood clots in your family or blood clotting factor
- Bariatric surgery or
- A solid organ transplant.
Women with certain health
conditions should not use combination pills. Others will need closer monitoring
while on the pill to reduce the risk of negative health effects.
Smoking cigarettes with the pill,
especially if you are over the age of 35, increases your risk for several
serious conditions including blood clots, stroke, heart attack, and high blood
pressure. Because of these risks,
women who smoke and are over the age of 35 should not take the combined hormone
birth control pill.
Your health care provider will help you weigh your
particular risks relative to the pill.
HOW DOES THE PILL WORK?
prevents pregnancy mainly by suppressing ovulation (the release of the egg from
the ovary), by thickening cervical mucus, hampering the transport of sperm, and
by other hormonal mechanisms which prevent fertilization and implantation of
WHAT ARE SOME BENEFITS OF THE
- The pill is safe,
convenient, and very effective.
- The pill allows for
- Most women can get
pregnant quickly when they stop using the pill.
- Periods may become lighter
and less painful if you take the pill.
- The hormones in pills
offer health benefits. The pill can offer some protection against non-cancerous
breast growths, iron deficiency anemia, ovarian cysts, pelvic inflammatory
disease, PMS symptoms, and menstrual-related migraine headache. Acne is often improved,
and the pill offers protection from some cancers such as ovarian and
endometrial (the endometrium is the lining of the uterus).
control pills do not protect against sexually transmitted infections (STIs).
Condoms do. Use a condom with every act of sexual intercourse to reduce your
risk of acquiring sexually transmitted infections.
prescription is needed to obtain birth control pills. This requires a visit to
a health care provider.
side effects may occur while using birth control pills.
most common side effects include bleeding between periods, breast tenderness,
and nausea. These side effects typically only last for the first few months.
- Less likely side effects
include a loss of libido (sex drive), vaginal dryness, acne, freckling or
darkening of the skin on your face, or depression.
- Persistent minor side
effects might be eliminated by changing the type of pill you are taking.
may forget to take the pill every day. You may need to use backup birth control
or take emergency contraception if you miss a pill or take it late. See “WHAT
IF I MISS A PILL?”. Ask your health care provider or pharmacist if you have
SOME DISADVANTAGES OF THE PILL?
If you are experiencing
problems, contact your health care provider BEFORE you stop taking the pill.
Serious side effects are rarely seen because of the lower
dose of hormone in pills used today. Serious
side effects that are possible but not likely include:
- Migraine headaches
- Elevated blood pressure
- Blood clots (in the rare case these occur they
tend to happen in the leg, arm, or lung)
- Nonmalignant liver tumors
- Gall bladder disease
- Heart attacks and
Early Pill Warning Signs listed below may be an indication of the more serious
problems listed above. Immediately
contact a health care provider if you experience any of the Early Pill Warning
Signs. An easy way to remember these Early Pill Warning Signs is to note
that the first letter of each symptom spells out ACHES.
pain (severe), yellow skin or eyes
problems (vision loss, vision disturbances)
leg or arm pain or swelling (in the calf or thigh or upper arm)
WHAT ARE THE DIFFERENCES BETWEEN THE
DIFFERENT COLOR PILLS IN EACH PACK?
In most packets, the first 21
days of pills contain the active hormone. These pills are often called the
“active pills”. They may be all one color or three colors if you are using a
triphasic pill. Each color indicates a different amount of either the estrogen
or progestin or both depending on what brand of pills you take. The last 7 days
of 28-day packs contain inactive “reminder” pills. You are protected from
pregnancy while using the reminder pills. If the last week’s pills are brown, they may
be iron tablets. The purpose of the
“reminder” pills is to continue the habit of taking a pill each day. Some
people choose not to take the “reminder” pills. Do not stop taking the pill
during the hormone pill weeks, unless directed by your health care provider.
You should expect your
menstrual bleeding to occur during the week when you are on the “reminder”
pills. It can start on any one of those days and it may or may not end before
you start your new pack. Start your new pack immediately after finishing your
last packet of pills, even if you are still bleeding.
HOW DO I START TAKING THE PILLS?
There are three ways you
can start taking the pills.
- Quick Start (recommended): Start
your first packet any day of your menstrual cycle if you are reasonably sure
you are not currently pregnant.
- Sunday Start: Start
your first packet of pills on the first
Sunday after your menstrual flow begins.
- Day 1 Start: Start
your first packet of pills on the first
day of your menstrual flow.
Regardless of which method
you use, take one pill each day
until you finish the packet. Upon completion of the packet, begin the next
packet of pills immediately the next day.
HOW SOON WILL I BE PROTECTED AGAINST
When you begin your first
pack of pills, you should use a backup method of birth control, such as
condoms, for the first 7 days of the pack if you use the Quick Start or Sunday Start method. If
you begin taking your pills on the first day of your menstrual flow, you do not
need to use a backup method for the first 7 days.
Remember, the pill, when
used correctly, only protects against pregnancy. It does not protect against sexually
transmitted infections. Use a condom with every act of sexual intercourse to
reduce your risk of acquiring a sexually transmitted infection.
WHEN SHOULD I TAKE MY PILL?
Take your pill at
approximately the same time each day. Try to associate taking your pill with a
regular daily activity, like eating a meal or going to bed. The effectiveness
of the pill depends upon your consistency. If you do not take your pill at
approximately the same time each day, your pill will be less and effective and
you may be more likely to experience side effects such as irregular bleeding.
IF I DON’T WANT TO HAVE MY
WITHDRAWAL BLEEDING (“PERIOD”) AT A PARTICULAR TIME, CAN I JUST SKIP THE
the advantages of the pill is that you are potentially able to both predict and
manipulate your cycle. Consult with your health care provider before taking the pill other
than as directed. If you simply take two packs of hormone or active pills
consecutively (and skip the “reminder” pills), you may still experience
irregular bleeding. For information about how to avoid your withdrawal bleeding
on a particular date, consult your health care provider with as much advance
timing as possible.
The pill may be used
safely in extended regimens (24, 42, 63, or 84 days of active pills or
continuous active pills). Consult your health care provider if you have
questions about extended regimens. See www.noperiod.com for more information.
WHAT IF I
MISS A PILL?
- If you are less than 12 hours late taking your pill, take it now and take your next pill at the time you
usually would. No further action is needed.
- If you are more than 12 hours late, take your missed pill now and any other pill you are supposed
to take today. Finish taking all other pills in your pack on time. If you have had sex in the last 5 days
without extra protection, use Emergency Contraception. Use abstinence
or condoms with every act of sex until you have taken 7 active pills in a
WHAT IF I MISS A “REMINDER” PILL?
are using a 28-day pack of pills and you forget any of the 7 “reminder” pills
(without hormones) in week 4, discard the pills you missed and keep taking one
pill each day until the pack is empty. You do not need a backup method of birth
TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT PREGNANCY?
- The first 7 days of your first packet if you use the
Sunday or Quick start methods
- If you miss active pills. Get more info about this
situation by reading “WHAT IF I MISS A PILL?” above.
- If you vomit within 1-2 hours after taking an active pill
consider it a missed pill and refer to the previously provided instructions
- If you have severe diarrhea (> 3 loose stools in 24
hours) consider it a missed pill and refer to the previously provided
- If you take other medications that may decrease the
effectiveness of the pill (see “ARE THERE ANY DRUG INTERACTIONS WITH THE PILL?”
WHAT IS EMERGENCY CONTRACEPTION
AND WHEN MAY IT BE NEEDED FOR A WOMAN ON THE PILL?
contraception (also called “the morning-after pill”) is given as soon as
possible within 120 hours of intercourse without effective contraception.
Emergency contraception is meant for emergency use only and is not an effective
method of birth control for routine use. Sometimes when you are on the pill you
need to also use a backup method of birth control (see “WHEN ARE TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT
PREGNANCY?” above). If you are in a situation where you need a backup method,
have had intercourse and either your backup method failed or you didn’t use a
backup method, you should consider emergency contraception. Some types
of emergency contraception are available over-the-counter. Other types don’t
require a prescription but are kept behind the pharmacy counter. Ulipristal
(ella) is an emergency contraceptive pill that is available only by
prescription. For more information, you may call (919) 966-2281 or consult our Emergency Contraception information. To be prepared, you may request emergency contraception
to keep on hand (if needed) at any pharmacy, including CHS Pharmacy, or ask
your health care provider.
WHAT DO I DO IF I MISS A PERIOD?
If you took all your
active pills and skip a period, it is unlikely that you are pregnant. It is
common for pill users to occasionally miss periods and for their periods to be
very light and last only one day or less. If you skip a period and are
concerned about your risk of pregnancy, contact your health care provider and
ask for a pregnancy test. Even if you did not have a period, you should start a
new package of pills at the regularly scheduled time. If you skip two periods
in a row, contact your health care provider.
WHEN SHOULD I BE SEEN AGAIN BY MY
HEALTH CARE PROVIDER?
See your health care
provider once a year for a well woman visit if you are under 21. A well woman exam is recommended yearly if
you are 21 or older. If you will run out of your pill prescription, you should
make an appointment with your provider before the refills on your pill
prescription run out. Do not wait until the last minute to make your appointment.
If you have problems at any time, contact your health care provider.
WHAT SHOULD I DO IF I RUN OUT OF MY
First, make sure you have
enough pills/prescription refills to last through the holidays, semester
breaks, and summer recess before you leave the campus. If you miscalculate or
lose your pills, contact your pharmacy immediately. If you cannot get more
pills, use a backup method of birth control such as condoms. If your backup
method fails, consider taking emergency contraception.
SHOULD I TELL OTHER MEDICAL
PROVIDERS THAT I AM TAKING THE PILL?
Yes. Birth control pills
are a medication. Make sure that all of your health care providers know about
all of the medications you are taking, including the pill.
DO I NEED TO TAKE A REST FROM THE
Current data indicates
that there is no need to stop the pills at intervals. You should not stop
taking the pill without using alternative contraception if you want to avoid
pregnancy. Many women become pregnant soon after they stop taking the pill.
WHAT DO I DO IF I DECIDE I WANT
TO GET PREGNANT?
If you decide you want to
get pregnant, call 919-966-2281 to make an appointment for preconception
counseling with the Prenatal Nurse in Women’s
Health before you stop taking the pill. This counseling will provide you with
important information before conception. For example, you should take at least 400mcg
of folic acid daily, preferably for at least three months before you stop the
birth control pill.
Once you have completed
the last pill pack, it is best to use another reliable method of contraception until
you have had one to two normal menstrual periods before attempting to conceive.
There is no evidence that the pill decreases subsequent fertility, and the
return to fertility is usually rapid. Usually women go back to the pattern of
menstruation that was normal for them before they took the pill. Reports have
confirmed that inadvertent pill use during early pregnancy does not increase
the risk of fetal malformations.
WHAT IF I
SWITCH FROM THE PILL TO A DIFFERENT KIND OF HORMONAL CONTRACEPTIVE?
When switching from one
kind of pill to a different pill, it is not necessary to use a back-up method
of contraception as long as you begin the new pill pack at or before the time
you would have started a new pack of your current pill. However, when switching
from the pill to other hormonal methods (e.g. NuvaRing®, OrthoEvra® patches, or
Depo-Provera® injection), timing is critical. Ask your health care provider if
or for how long you might have to use a back-up method of birth control, such
as condoms, if you switch from the pill to a different hormonal method.
ANY DRUG INTERACTIONS WITH THE PILL?
Yes, some medications may
decrease the effectiveness of the pill and pregnancies have been reported. The
pill may also change the effects of other medications.
DRUGS THAT REDUCE THE EFFECTIVENESS OF THE PILL
Some drugs induce liver enzymes,
resulting in lower hormone levels. If you must take one of these medications
for only a short time, use a backup method of birth control, such as condoms,
while you are taking the interfering drug and for 4 weeks after finishing the
drug. If you must take the interfering medication on a long-term basis, you
should check with your health care provider because you may need to consider an
alternative form of contraception. Some of these drugs may be more likely to
reduce the effectiveness of the pill than others; consult your health care
provider. Note: this is not an all-inclusive list.
- Some Antibiotics: [rifampin (Rifadin, Rimactane)]
- Seizure medicines/mood stabilizers: carbamazepine
(Tegretol), felbamate (Felbatol), lamotrigine (Lamictal), Oxcarbazepine
(Trileptal), phenytoin (Dilantin), primidone (Mysoline), topiramate (Topamax)
- Antifungals: griseofulvin (Gris-Peg)
- Barbiturates: phenobarbital (in Donnatal), secobarbital
(Seconal), butalbital, (Fiorinal, Esgic Plus)
- Some Antivirals for HIV infection: lopinavir (Kaletra),
nelfinavir (Viracept) and others
- Some Herbal Products: St. John’s Wort
- Others: modafinil (Provigil)
Reduced effectiveness of the
pill caused by antibiotics has been a controversial topic. There are anecdotal
case reports of women who were taking the pill who became pregnant after taking
an antibiotic. There have been conflicting recommendations from health care
resources regarding this possible interaction, many based on legal concerns
rather than scientific evidence. The latest recommendation from the World
Health Organization, American College of Obstetrics and Gynecology, the20th
Edition of Contraceptive Technology, and the US Medical Eligibility Criteria
state that antibiotics (except rifampin) do NOT reduce the efficacy of oral
DRUGS WHOSE EFFECTS MAY BE CHANGED BY TAKING THE PILL
This is not an all-inclusive
list. If you are taking any medications for these medical problems and want to
begin taking the pill, you should talk to your health care provider to decide
whether any changes need to be made.
- Drugs for seizure, mood disorders (e.g. lamotrigine-Lamictal),
blood clotting disorders, diabetes mellitus, high blood pressure, anxiety,
depression, or immune suppression
WHAT IF I HAVE MORE QUESTIONS?
If you have any questions
or concerns regarding the pill or other birth control methods, consult your
health care provider or a Sexual Wellness Specialist in Student Wellness. You
can have a confidential online chat with a Sexual Wellness Specialist or make an appointment by calling 919-962-WELL.
While any health care
provider at Campus Health can help you with your birth control questions and
needs, Campus Health Service has a Women’s Health specialty clinic offering
gynecologic and obstetric care. If you would prefer a Women’s Health
practitioner, specify your request when making an appointment at 919- 966-2281.
Last update: December 2013