Home > Health Guides by Topic > Sexuality & Sexual Health > Contraception/Birth Control > Birth Control Pills Birth Control Pills:
A Guide for Teens
Birth control pills are also called oral contraceptives. They are a female hormonal birth control method, and are very effective at preventing pregnancy.
| Out of 100 women using combination birth control pills | |
| Typical use: 5 women become pregnant |  |
| Perfect use: 1 or fewer women become pregnant |  |
| Out of 100 women using progestin-only birth control pills | |
| Typical Use: 5 women become pregnant | |
| Perfect Use: 2 women become pregnant |  |
What are birth control pills and how do they work?
Birth control pills, also known as "The Pill," are a
type of contraception in the form of small tablets that you swallow
each day. Most pills contain two type of synthetic (man-made) female
hormones, progestin and estrogen, and are called the "combination
oral contraceptive". The hormones estrogen and progesterone
are normally produced by the ovaries.
There are many different types of the combination oral contraceptives. The estrogen and progestin prevent pregnancy by suppressing your pituitary gland, which stops the development and release of the egg in the ovary, called ovulation. The progestin also helps to prevent the sperm from reaching the egg and changes the lining of the uterus.
One type of pill contains only one hormone, progestin, and is called either the "progestin-only pill," or the "mini-Pill." It works by suppressing ovulation and helping to prevent the male's sperm from reaching the egg.
Which birth control pill should I take?
First of all, your health care provider needs to ask you some questions. If your health care provider decides that you can take the birth control pill, then he/she will need to figure out with you which one fits your needs. There are different doses of hormones in the different birth control pills.
The combined pill is slightly more effective than the progestin-only pill. However, some people's bodies don't react well to the estrogen in the combined pill, so it is better for them to take the progestin-only pill.
How effective is the birth control pill against pregnancy?
The birth control pill is highly effective if you take the pill exactly as you are supposed to. You should be taking one pill each day, at the same time every day. You should also use some sort of back-up contraception such as condoms with the remainder of that cycle of pills when diarrhea or vomiting occur, or when you are taking some other medication that could change the effectiveness of the birth control pill.
Combination Pill
If women take the combination pill every day at the same time, it
is more than 99% effective. This means that if 100 women take the
combination pill every day, less than 1 woman will become pregnant
in a year.
Although it's obvious that the combination pill is most effective against pregnancy when it is taken every day at the same time, perfect use hardly ever happens. That’s why it is often considered 95% effective. This means that if 100 women use the combination pill, but do not take it perfectly, 5 or more women will become pregnant in a year.
Progestin-Only Pill
If women take the progestin-only pill every day at the same time,
it is 98% effective. This means that if 100 women take the progestin-only
pill every day at the same time, 2 women will become pregnant in
a year.
The typical woman does not take the progestin-only pill at exactly the same time every day. That’s why we say it is 95% effective. This means that if 100 women use the progestin-only pill, but do not take it perfectly, 5 women will become pregnant in a year.
How effective is the birth control pill against STDs?
Birth control pills are not effective at all against sexually transmitted diseases! Condoms should always be used.
Are there medical benefits of the birth control pill?
Birth control pills not only prevent pregnancy, but they also have quite a few medical benefits. Many teen girls take the birth control pill just for its medical benefits and not for its protection against pregnancy.
Menstrual Cramps
For girls who experience severe menstrual cramps and over-the-counter
medications do not help, birth control pills may be the solution.
Birth control pills can help to decrease menstrual cramps. Because
the combined birth control pills prevent ovulation, they also get
rid of pain that you experience with ovulation in the middle of
your menstrual cycle.
Irregular Menstrual Periods
For girls whose menstrual periods are irregular (too often or too
late) birth control pills can help to regulate the menstrual cycle.
Birth control pills also can reduce the amount and length of menstrual
bleeding.
Acne
Birth control pills also improve acne. For moderate to severe acne,
which over-the-counter and prescription medications can't cure,
birth control pills may be prescribed. The hormones in the birth
control pill can help stop acne from forming. It doesn't usually
matter which type of birth control pills you take, since most of
them can be used to treat acne. Be patient though, since it takes
several months for the birth control pills to work.
Other Medical Benefits
Because there is less menstrual bleeding with the use of birth control
pills, you are less likely to get anemia (low number of red bloods,
which carry oxygen from the lungs to the tissues). Birth control
pills decrease your chance of getting endometrial (lining of the
uterus) cancer and ovarian cancer, ovarian cysts, and breast lumps.
The birth control pill also protects against infections of your
fallopian tubes (Pelvic Inflammatory Disease (PID)) that would need
hospitalization. It also protects against pregnancies that occur
outside the uterus (called tubal or ectopic pregnancy).
Do I need to use other forms of contraception with the birth control pill?
Birth control pills do not protect a woman from getting a sexually transmitted disease. So it is very important to also use a condom when having sexual intercourse. Condoms are an important second method if you miss more than one pill in a row, during the first month of pills (to be extra safe), when you are taking other medications that change the effectiveness of the birth control pill, or when you are sick and diarrhea or vomiting occur. (Anytime you get a new medication, ask if it changes the effectiveness of the birth control pill.)
Where can I get birth control pills?
You can get a prescription for birth control pills from your health care provider. Birth control pills usually cost between $15-$50 for a monthly pill-pack at drug stores, depending on the type you get. Your health care provider will check your blood pressure and weight, ask you about your family and personal history, and ask whether you smoke and whether you use condoms. If you have no problems that would make the birth control pills a problem for your health, your health care provider will probably write you a prescription right then. It is normal to have a follow-up visit with your health care provider after the first 3 months to check your weight and blood pressure. Make sure that you make an appointment way before you run out of birth control pills so that you always have pills on hand.
Do I have to have a pelvic exam before going on the pill?
No. Although it is important for teens to have checkups as part of their general health care, a pelvic exam is not needed to start birth control pills.
How do I take birth control pills?
The combination pill is probably the easiest birth control method to use. For the combination pill, there are two kinds of Pill packs: the 28-day pack and the 21-day pack.
. 
With the 28-day pack, you take 21 active hormone pills first, then seven placebos that contain no active hormones. These last seven pills are just "reminder" pills in most pill brands. They are taken during the fourth week, including during menstruation. There is one pill type of which 26 of the pills are active so you need to take all the pills. Ask your health care provider.
With the 21-day pack, you take one pill each day for three weeks and then for the fourth week, when menstruation usually occurs, you do not take any pills for 7 days. The cycle is then repeated.
Progestin-only pills come only in 28-day packs. All progestin-only pills are active, meaning they contain hormones and you need to take all of them.
To take the birth control pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the pills on a Sunday, on the first day of your menstrual period, or the day you are in clinic.
If you start taking the pills on a Sunday, take the first active pill of the pack on the Sunday after your menstrual periods starts, even if you are still bleeding. If your menstrual period begins on Sunday, start the pack that same day. Take the pills daily until the pack runs out (for the 28-day pack) and then start a new pack on the next day. If you are using a 21-day pack, take one every day until the pack runs out and then take seven days off before starting the new pack. (Use another method of birth control during the first week of pill use from the Sunday you start your first pack until the next Sunday.)
If you start taking the pills on the first day of your menstrual period, take it at the time you have scheduled for pill-taking. Because you start the pill on the first day of your menstrual period, you will have two periods your first package (1st week and 4th week), and only one period each package after the first one (during the 4th week). (You don't need a back-up method of birth control, since protection starts right away. But it's always a good idea to use condoms!)
You should take one Pill each day at the same time of day until
you finish the pack. Take the Pill at the same time as something
that you do regularly and routinely so you don't forget. The best
time is 1/2 hour after a good meal or snack or at bedtime. You may
have slight nausea the first month, but this usually goes away with
time. Some women like to take the pills first thing in the morning
but they are more likely to have nausea, especially if they skip
breakfast. Set up a time when it will be easy for you to take the
Pill and put a reminder in your calendar, set an alarm, or do something
that will remind you to take it. 
You could keep them near your toothbrush
so you will see them each day and be reminded to take them. You
could put a sticker on your bathroom mirror as a reminder or keep
them in your underwear drawer.
After completing a 28-day pack, you should immediately start a new packet of pills the next day. Do not skip any days between packets of pills. Most women prefer the 28-day regimen because they find it easier to remember to take the pill every day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period should stop once you begin the new packet of pills.
Can I take more than 21 days of hormone pills in a row?
Some girls prefer to take 42 pills (2 packages of hormone pills), 63 pills, or even continuous pills because of cramps, PMS, or convenience. In fact one new pill type comes in a package with 84 pills and 7 reminder pills. Talk to your health care provider about whether extended pill taking makes sense for you. The extended pill taking works best with monophasic pills (all one dose, all one color). The downside is that some girls get more irregular spotting and the insurance company may not allow the extra packages without a medical reason.
What if I forget to take one or more birth control pills?
If you forget to take one active combination pill at your usual time, take it as soon as you remember. Take your next pill at the regular time. Also, use a back-up type of contraception such as condoms for the 7 days after the missed pill. If you do not remember until the next day, then take two pills that day.
If you miss more than 1 pill, see the instructions below, but if you haven't used a condom and you missed pills, you should talk to your health care provider about emergency contraception. If you miss two active combination pills in a row in the first two weeks, take two pills as soon as you remember and take two the next day. Stay on your regular schedule after this but use a back-up type of contraception (condoms) for 7 days after the two missed pills. Call your health care provider if you do not get your menstrual period.
If you miss 2 active combination pills in a row in the third week, or you forget three or more active combination pills in a row during the first three weeks, you may get an extra menstrual period. Call your health care provider to talk about taking emergency contraception.
If you forget even one progestin-only pill, take it as soon as your remember. Take the next pill as usual, so you might take two pills in one day. Continue to take the rest of the pack as usual and use a back-up method for the rest of the month. Start the next pack on time.
If you don't know what to do about pills you have missed, take one active pill each day until you talk to your health care provider. Make sure you use a back-up method every time you have vaginal intercourse. If you continue to miss pills, you may want to consider using a different form of birth control.
Does it mean I'm pregnant if I don't get my menstrual period while I'm on "The Pill"?
Not usually. At times, you may not get your menstrual period while using birth control pills. This can be normal. If you miss one menstrual period and you have not missed any pills and have used a back-up method if and when it was required, everything is probably fine. Just start a new pack of pills at the usual time. But if you are concerned, check with your health care provider and get a pregnancy test.
If you miss one or more pills and miss a menstrual period, keep taking your pills but see your health care provider for a pregnancy test.
If you miss two menstrual periods in a row, you should see your health care provider to see if you are pregnant, even if you missed no pills. Keep taking your pills in the meantime.
Missing menstrual periods or having a very light menstrual flow is extremely common and does not mean there is anything wrong with you.
What if my period is very, very light while I'm taking the birth control pill?
Your period may be so light when you are on the birth control pill that you may have only a brown smudge on a tampon, pad, or underwear. The hormone doses in the pills are very low. Therefore, not much uterus lining builds up, so very little blood needs to come out each month. If you have not missed any pills and it is time for you to get your period, and you have used a back-up method when recommended, this counts as your menstrual period.
What are the side effects of the birth control pill?
Most women have no side effects when taking the birth control pill, but some women do experience some side effects. Each type of birth control pill can affect each woman differently.
Some women have some nausea, but this can go away if the pill is taken with a meal or a snack at bedtime. Sometimes a pill with less estrogen is prescribed if the nausea doesn't go away.
Sometimes, women may experience headaches when they start taking birth control pills. Usually headaches occur because of stress or other reasons, but if your health care provider thinks they are related to the pill, he/she may prescribe a birth control pill with a lower dose of estrogen or prescribe progestin-only birth control pills. If the headaches still continue, your health care provider may take you off the birth control pill and suggest that you use another type of contraception.
Mood changes can occur while taking the birth control pill. Exercise and a healthy diet may help, but if they don't, you may need to get a change in the type of pill you are taking.
Usually the pill helps cure acne, but a few women feel they get acne from the birth control pill. Your breasts may become tender or may get larger. Your appetite may increase, and a few teens feel bloated.
Some teens gain weight, some lose weight, but most teens stay exactly the same when they are taking the birth control pill. Many times a young woman thinks she has gained 5-10 pounds, but when weight is actually measured, there is no change. If you think you may have gained weight due to the Pill, you should see your health care provider and get your weight measured. If you do gain weight, or you want to prevent gaining weight, you should make sure that you eat a healthy diet. You should eat 5 servings of fruits and vegetables a day and avoid fast foods. Also, get enough exercise! If these ideas don't help, talk to your health care provider.
Spotting between periods may occur while taking the first three weeks of hormone pills, but this is not serious. This usually occurs during the first two or three cycles. You should call your health care provider if the bleeding is heavier than a light flow or lasts more than a few days.
Side effects usually go away in the first three to four cycles. If you do have side effects, you should talk to you health care provider. If the side effects are really bad or if they don't go away after three cycles, your health care provider may switch you to a different pill.
What if I'm not happy with the birth control pill that I'm taking?
If you are not happy with the birth control pills that you are taking and the effects they have on you, talk to your health care provider. Don't just give up and stop taking the pills. Your provider can give you a prescription for a different type of birth control pill. There are many types of pills and they affect people differently. Some you will like and some you won't. You may have to try a few different types before you find the type that works best for you.
Are there any risks if I take the birth control pill?
Birth control pills with estrogen may cause a slight increase in the risk of developing blood clots in the legs, but much less than the risk during pregnancy. Among women who do not take the Pill, 5 per 100,000 women per year develop blood clots. Among women who do take the pill, the risk increases slightly to 15-20 per 100,000 women per year. Find out if anyone in your family (blood relative) has had blood clots, especially when they were young. And if you are a smoker, try to quit as soon as possible.
Are there side effects I should watch out for while taking the birth control pill?
Most young women who take the birth control pill have few or no problems. But if you have any of the following problems, call your health care provider right away.
Remember: ACHES
Can anybody take the birth control pill?
Almost all teens and young women can take the birth control pill. There are only a few reasons that your health care provider will feel that you need to choose other methods of birth control. These conditions are called "contraindications to the combined birth control pill" and include:
Can I smoke and take the pill?
The pill is much safer in women who do not smoke. So if you were thinking of quitting, this is a great reason. Smokers who are over 35 years old are 40 times more likely to have a heart attack and stroke than nonsmokers. So teens who are smokers can take the pill but you will be much healthier and safer if you quit. (Click here for information on how to quit.)
How do I talk to my parents about the Pill?
If you are going on the Pill, it's good to share the information with your parents. They will be a good source to go to if you have any questions or concerns about taking the pill. If you are starting on the pill for cramps, irregular periods, or acne, the pills are simply a medication that you are taking to treat your problem. Talk with your parents about how the pills will help your medical problems. If you parents still have concerns, have them read Oral Contraceptive Pills and Teens: A Guide for Parents. If you are taking oral contraceptives as birth control to protect yourself from getting pregnant, talking to your parents may be more difficult since you will be talking about having sex. But even though it may be hard to tell them, it is usually helpful for them to know so that you will be able to go to them whenever you have a question or a problem with the Pill or with your relationships. Some teens, though, decide that keeping the decisions confidential (or private) is better for them.
Updated 5/12/2005
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