Birth Control Pills: How to take BCPs

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 23, 24, 26, or even 28 active pills. The example shown below is for a 28-day pill pack in which you take 21 active hormone pills, and then seven placebo pills 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 your period. With packages that have 24 active pills, the last 4 are “reminder” pills or 7 with lower amounts of hormones. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as shown below.

1. To take the 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 birth control pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
2. You should take one pill each day, at the same exact atime of day until you finish the pack. Take the Pill when you are doing something regularly so you don’t forget. For example, you could keep your pill pack near your toothbrush, or set your cell phone alarm as a reminder. The best time to take the Pill is ½ an hour after a complete meal such as dinner or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some people who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill at dinnertime may help.
3. After completing a 28-day pack, you should immediately start a new pack of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period will stop once you begin the new pack of pills.

Can I take more than 21 days of birth control pills in a row?

Some teens prefer to take 42 pills (2 packages of pills), 63 pills, or even continuous pills because of cramps, PMS, or convenience. In fact, there is a type of birth control pill that comes in a package with 84 pills and 7 reminder pills, and another with 84 pills and then 7 low dose estrogen pills. Talk to your health care provider about whether extended Pill taking makes sense for you.

Extended pill taking works best with monophasic Pills (all one dose, all one color). The downside is that irregular periods or unexpected spotting may occur and some insurance companies may not allow the extra packages without a medical reason.

What if I forget to take one or more combined birth control pills?

Combined birth control pill packs of 28 pills contain 3 weeks of active hormone pills and 1 week of inactive or “reminder” pills.

If you miss 1 active pill:

• Take the pill as soon as you remember and then continue taking the rest of your pills at the usual time each day.
• You may take 2 pills on the same day (one at the moment you remember and the other at the regular time). It’s also okay to take 2 pills at the same time.

If you miss 2 or more active pills in a row:

• Take the most recently missed Pill as soon as possible.
• Throw away the other missed pills.
• Continue taking the rest of your pills at the usual time each day.
• You may take 2 pills on the same day (one at the moment you remember and the other at the regular time).
• If you missed the active pills in the third week or row (days 15-21 for the 28 day pill pack), throw the inactive pills away and finish taking the active hormone pills.
• Then start a new pack right away.
• If you are sexually active and missed 2 pills, don’t have sex or use condoms every time you do have sex, until you’ve taken active (hormone) pills for at least 7 days in a row.
• Talk to your health care provider about whether you should use emergency contraception (EC), especially if you missed pills during the first week your pill pack, or had unprotected sex in the past 5 days.

What if I forget to take one or more progestin-only birth control pills or “mini pills”?

• If you forget even one progestin-only Pill or are even 3 hours late, take it as soon as you remember and use condoms (or another backup method of protection) for at least 2 days.
• Take the next pill at the usual time (you might take two pills in one day.)
• Continue to take the rest of the pills in the pack as you normally would–at the same time each day! Start the next pack on time. If you have been sexually active within the past 5 days, ask your health care provider if you should take emergency contraception.

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.