How to Use Combination Birth Control Pills

Woman holding birth control pills, mid section
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Combination birth control pills are oral contraceptives that combine estrogens and progestins, similar to the natural sex hormones produced in a woman's body.

When using combination birth control pills, a woman should make sure that her health care provider fully explains how to start taking the pill and what to do if she accidentally forgets to take a pill.

How Combination Birth Control Pills Should Be Used

Tips for Using Combination Birth Control Pills

The following tips are meant to be general guidelines.

  1. A woman should pick a time of day to take the pill that is easy to remember. Taking the pill at the same time each day makes it more effective.
  2. Take the first active pill in the pack within five days after the start of one's period. If a woman starts her pack on the first Sunday after her period begins, it will result in her period almost always beginning on a Tuesday or Wednesday every 4 weeks. If the pill pack is started during the woman’s period, she will be protected against pregnancy immediately and will not need to use a backup method of birth control.
  3. A female can decide to take the first active pill in the pack at any time during her cycle. However, if the pill pack is started during any other time during the menstrual cycle (and not during her period), protection will begin after seven days. A woman should use an additional method of birth control if having sexual intercourse during the first week of combination pill use.
  1. Take the pill at the same time, every day, for the first 3 weeks of each pill pack. It may be helpful to check the pack of pills each morning to make sure that yesterday's pill was taken.
  2. A woman can choose whether or not to take the "reminder" pills during week 4. The hormones contained in the active pills (during weeks 1 to 3) prevent pregnancy throughout the month, so even during the fourth week (regardless if she is taking reminder pills or no pills at all), a woman is protected against becoming pregnant.
  1. Continue to take one pill a day until the pack is finished.
    • If a female is using a 28-day pack, she should begin a new pack immediately and not skip any days between packages.
    • If she is using a 21-day pack, she should stop taking pills for 1 week and then start her next pack.
  2. Be sure to read and follow the instructions inside the pill package.
  3. If a woman wants to become pregnant (or does not want to use the pill anymore), she can just stop taking it. It typically can take anywhere from one to three months for a woman's period to return to the cycle she had before starting the pill. However, she can still become pregnant during this time.
  4. A woman also can choose to skip her withdrawal bleed (period) by using the pill. This is extremely easy and safe to do. Follow steps 1 to 4, above. Instead of taking week 4's pills, begin your next pack. See: How to Skip Your Period Using the Pill (for more specific directions).
  5. If pills are missed, the best thing to do is to refer to the particular pill’s package insert because the instructions can be more complicated with the newer, lower dose and extended regimen pills
  1. The woman should always keep one copy of her package insert in a place where she can find it easily.

Tips for Taking Combination Birth Control Pills

The following tips are meant to be general guidelines.

  1. If a woman misses one pill, she should take the forgotten one (yesterday's) as soon as she remembers it. She should then take today's pill at her regular time. If she does not realize that a pill was missed until her regular time, she can take both pills at that time.
  2. Although one probably will not become pregnant, use a backup method (like an over the counter option) for the next 7 days, just to be cautious.
  3. If a woman misses two pills in a row, she should take two pills as soon as she remembers and two pills the following day. Some spotting may occur. She also should use a backup method of contraception until her next period and pill cycle.
  4. If a woman misses three or more pills in a row, she should use a backup method of birth control immediately.
  5. Some research has indicated that women who miss three pills most likely will not ovulate, but one should still be cautious and take the necessary precautions to prevent pregnancy.
  6. Once a woman has missed three or more pills, she can:​
    • Begin a new pack of pills the following Sunday (after missing the pills), even if she has started bleeding. She should continue to use an additional contraceptive method for the first 14 days of the new pack of pills.
    • Take two pills for 3 days to get back on track (while using a back-up birth control method).
    • Choose to stop taking the remainder of the pills and discard the pack.

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