Birth Control Pills: All Guides

Birth Control Pills: General Information

birth control pills

Birth control pills

Birth control pills (also called oral contraceptive pills and the “Pill”) are a type of female hormonal birth control method and are very effective at preventing pregnancy. The Pills are small tablets that you swallow each day. Most pills contain two types of synthetic (man-made) female hormones: estrogen and progestin. These are similar to the estrogen and progesterone normally made by the ovaries. These pills are called “combination oral contraceptives,” and there are many different kinds.

The hormones in the pills prevent pregnancy by suppressing the pituitary gland, which stops the development and release of the egg in the ovary (ovulation) (see female reproductive anatomy image below). The progestin also helps to prevent the sperm from reaching the egg and changes the lining of the uterus.

Another type of pill contains only one hormone (progestin) and is called either the “progestin-only pill,” or the “mini-Pill.” It works by stopping ovulation and by helping to prevent the male’s sperm from reaching the egg.

Which birth control pill should I take?

First, talk with your health care provider about whether the Pill is right for you. If it is, discuss which pill and what dosage is best for you.

The combined pill with both estrogen and progestin is slightly more effective than the progestin-only pill. However, some women can’t take estrogen, so it’s better for them to take the progestin-only pill.

How effective is the Pill at preventing pregnancy?

The Pill is very effective if you take it exactly as you are supposed to – one pill a day, taken at the same time each day. You should also use back-up contraception such as condoms if you have diarrhea or vomiting, or are taking a medication that could change the effectiveness of the birth control pill. Using condoms is always important to decrease your chances of getting a sexually transmitted infection (STI).

Out of 100 women using Combination or Progestin Only BCP’s
Typical Use: 9 Women Become Pregnant icon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant womanicon representing 1 pregnant woman
Perfect Use: 1 or Less Women Become Pregnanticon representing 1 pregnant woman
Female reproductive anatomy

Female reproductive anatomy

If you take the Pill at the same time every day (perfect use), it’s 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 Pill is most effective against pregnancy when it’s taken at the same time every day, perfect use can be difficult for both teens and adults. That’s why it’s often considered 91% effective. This means that if 100 women use the Pill, but don’t take it perfectly, 9 or more women will become pregnant in a year.

What are the possible side effects of birth control pills?

Most women have no side effects when taking the oral contraceptive pill. However, it’s possible to have irregular periods, nausea, headaches, or weight change especially during the first few months. Each type of oral contraceptive pill can affect a young woman differently.

  • Irregular periods: Spotting (you don’t need to use a regular pad, just a panty shield) or very light bleeding may occur during the first 1-3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, keep taking the pill and talk with your health care provider.
  • Nausea: Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
  • Headaches: Headaches may occur because of stress at school or home, too little sleep, sinus infections, or migraines. The Pill can make headaches better or worse. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe an oral contraceptive pill with a lower amount of estrogen or have you go off the Pill for a short time. If you have migraine headaches, talk to your health care provider about whether the Pill is right for you.
  • Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercise and a healthy diet may help, along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
  • Sore or enlarged breasts: Very occasionally, your breasts may become tender and/or get larger, but usually your breasts will stay the same. Breast tenderness usually goes away after a few months.
  • Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. Try to remember to watch your portion sizes, avoid fast food, and eat 5-13 servings of fruits and vegetables each day. Drink lots of water and don’t forget to exercise! Just in case you were wondering, there are no calories in the Pill.

If side effects occur, they’re usually mild and go away in the first three to four months of taking the birth control pill. If you do have side effects, talk with your health care provider. If the side effects are uncomfortable or if they don’t go away, your health care provider may switch you to a different kind of birth control pill or a different method.

Are there any serious side effects of birth control pills that I should be worried about?

Most young women who take birth control pills have few or no problems. If you do have any of the following problems, call your health care provider right away.

Remember: ACHES

  • Abdominal or stomach pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headache (severe), dizziness, weakness, or numbness
  • Eye problems (vision loss or blurring), speech problems
  • Severe leg pain (calf or thigh)

Blood clots: A blood clot in your leg or lung is a very rare but serious side effect. If you suddenly have pain or swelling in your leg and/or shortness of breath and/or chest pain, see your health care provider right away or go to the emergency room. If you have a history of blood clots, you should not take the Pill. Tell your health care provider if anyone in your family (blood relative) has ever had blood clots, especially when they were young. The Pill increases the risk of blood clots by three to fourfold, which is less than with pregnancy. Blood clots are more likely to develop if you’re also a smoker, overweight, having surgery, or sitting on a plane for a long time. To lessen your chances of blood clots, don’t smoke, and if you’re on a long plane trip, get up, walk around, and drink lots of water. If you do smoke, it is important that your doctor knows about your smoking before you start the pill. If you’re scheduled for surgery, and won’t be able to move around much after surgery, ask your health care provider about stopping the Pill for 3-4 weeks before surgery and after the surgery until you are walking around normally.

Health Benefits

Adolescent girls and young women are frequently prescribed birth control pills just for the medical benefits. BCP’s are a safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.

Are there any medical benefits with taking birth control pills?

Birth control pills not only prevent pregnancy, but they also have medical benefits. Many teen girls take the birth control pill just for its medical benefits and not for its protection against pregnancy.

  • Regular and lighter periods: Oral contraceptive pills can help to regulate the menstrual cycle so your period comes about every 28 days. The Pill usually causes lighter periods too. You may only have a brown smudge on a tampon, pad, panty shield or underwear. The hormone doses in BCPs are very low. When you are taking the birth control pill, the lining of your uterus doesn’t become very thick so very little blood needs to come out each month. For the extended cycle pills, you might have a period every 3 months or even less.
  • Clearer skin: Birth control pills can improve acne. The hormones in most types of BCPs can help stop acne from forming. Be patient though, as it can take a few months to see an improvement.
  • Less cramps, or no cramps: Birth control pills can help to decrease menstrual cramps.
  • Other medical benefits: Because there’s less menstrual bleeding with the use of birth control pills, girls taking the pill are less likely to become anemic (have too few red blood cells). Birth control pills also lessen your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts. BCPs also protect against pregnancies that occur outside the uterus (tubal or ectopic pregnancies).

Can anybody take birth control pills?

Almost all teens and young women can take birth control pills. There are only a few reasons why your health care provider might feel that you need to choose other methods of birth control. These reasons are called “contraindications.”

Contraindications for taking combined birth control pills include:

  • You have a genetic condition(s) that increases your risk of blood clots or a history of blood clots.
  • Migraine headaches with aura (spots and wavy flashing lights or trouble seeing that occur 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
  • Certain kinds of heart disease
  • High blood pressure that is not controlled with medication
  • Surgery or any other condition that prevents you from moving or getting up and walking (immobilized)

Birth Control Pills: How to take BCPs

birth control pills

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 pills 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 time 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 young women 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.

How to take birth control pills



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

Some girls 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 some girls get more irregular periods or unexpected spotting 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.
If you find that you are often forgetting to take your birth control pills, talk to your health care provider about using another type of birth control method that is more convenient for you.

Birth Control Pills: Frequently Asked Questions

birth control pills

Are there different kinds of birth control pills?

Yes. There are many different kinds of birth control pills (there are different doses of hormones in different hormonal pills). Your health care provider may prescribe a progestin-only pill (if there’s a medical reason why you shouldn’t take estrogen). If you don’t have any medical problems that would put you at risk for medical complications, your health care provider will decide which birth control pill is the best one for you.

What if I’m not happy with the birth control pill that I’m taking?

If you’re not happy with the birth control pill 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 them. Your provider can give you a prescription for a different type of pill. There are many types, and they affect people differently. Some you’ll like, and some you won’t. You may have to try a few different kinds of birth control pills before you find the one that works best for you. There are also lots of other methods to prevent pregnancy, so you can talk to your provider about other options.

How long can I be on birth control pills?

As long as there is no medical reason to not take the Pill, many women are on it for years, whether it is to regulate their menstrual cycle, treat cramps, protect against pregnancy, or for hormone replacement therapy.

Do I need to use other forms of contraception with the Pill?

Birth control pills don’t protect a woman from getting sexually transmitted infections. It’s very important to use condoms every time you have sexual intercourse or when using a sex toy. Condoms are also an important second method of protection against pregnancy if you miss more than one birth control pill, especially during the first month of pills (to be extra safe), when you are taking other medications that change the effectiveness of the Pill, or when you are sick with diarrhea or vomiting. Anytime you get a new medication, ask your health care provider if it changes the effectiveness of the birth control pill.

Do I need to take a break from the Pill?

There is no medical reason that you need to take a “break” from the Pill.

Will I have trouble getting pregnant after using the birth control pill?

There is no change in fertility with the use of birth control pills. However, if your periods were irregular before you started taking the Pill, it’s likely that your periods will be irregular again when you stop taking it.

Does the birth control pill cause birth defects to an unborn baby?

No, the Pill does not cause birth defects nor does it affect the health of future children.

Does the birth control pill cause cancer?

No. The Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she takes the Pill. Most experts believe that taking oral contraceptive pills does not cause an increased risk of developing breast cancer. Even girls with a family history of breast cancer can take the Pill. Users of the Pill have been shown to have increased risk of cervical cancer (the cervix is the lower part of the uterus), as compared to nonusers, but cervical cancer is caused by the HPV virus, so it is important to get the HPV vaccine and use condoms every time you have sex. Smoking increases the risk for cervical cancer, so quit smoking (or don’t start) to keep your body healthy.

Can I smoke if I’m taking the Pill?

For lots of reasons, it’s much better to not smoke. By quitting smoking (or never starting), you lower your risks on the Pill. Smoking increases your risk for heart disease, blood clots, and stroke. The more you smoke and the older you are, the higher the risk.

Do birth control pills protect against STIs?

Birth control pills do NOT protect you from sexually transmitted infections. Not have sex (abstinence) is the only 100% effective way to avoid STIs. Condoms help to prevent most sexually transmitted infections.

What if I forget to take my birth control pill(s) and I’m sexually active?

Talk to your health care provider. Emergency contraception (EC) is usually recommended if you’ve had unprotected intercourse during the time you have missed your birth control pills. In the United States, women of all ages can  without a prescription.

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, everything is probably fine. Just start a new pack of pills at the usual time. But if you are concerned, or skip 2 periods in a row, you’re still probably fine, but check with your health care provider and get a pregnancy test. If you miss any pills and miss your period, keep taking your pills, but see your health care provider for a pregnancy test.

Should I tell my friends that I’m taking birth control pills?

It depends. You may or may not want to tell your friends that you are taking birth control pills. Even if you’re taking birth control pills as hormonal treatment for a medical condition, someone hearing that you are taking “the Pill” may assume it’s because you are having sex. However, you may want to share with your friends so they can help you with ideas on how to avoid missing pills. Just think about what’s best for you.

How do I talk to my parents about taking the Pill?

If you decide to tell your parent(s) that you are taking birth control pills, you’ll want to put some thought into how to tell them. They may assume you are sexually active which may cause them to ask you questions that might make you feel uncomfortable at first. However, at the same time it’s a good idea to have a calm and open conversation as they can be a good resource for you if you have any questions or concerns about the Pill. Talk about the benefits of the Pill as well as their concerns. If your parent(s) or guardian(s) have questions, tell them about our parent’s guide to birth control pills.

Where can I get birth control pills?

Girls may take birth control pills for bad cramps, irregular periods, and contraception. You can get a prescription for birth control pills from your health care provider. Your health care provider will check your blood pressure and weight, ask you about your medical history and your family’s medical history, and ask whether you smoke and if you use condoms. If you don’t have any medical issues that would make taking birth control pills a problem, your health care provider will probably write you a prescription right then. You can buy birth control pills at a pharmacy or by mail order depending on your insurance plan. Your birth control pill should be free in almost all circumstances if you have health insurance. It’s normal to have a follow-up visit after you have been on the Pill for 3 months to check your weight and blood pressure. Make sure that you make an appointment long before you run out of pills so you never miss any.

Have you heard that if you have intercourse during your menstrual period, you won’t get pregnant?

This isn’t true. If you have a long menstrual period and a short cycle, you can still be ovulating at the end of your menstrual period. Some women have a small amount of bleeding during ovulation and may mistake it for a menstrual period. This means that you can still get pregnant during your period.

Have you heard that if you stand up immediately after having sex, you won’t get pregnant?

This is definitely not true! Standing, sitting, lying down—no physical position can prevent pregnancy.

Have you heard that the first time you have sex, you can’t get pregnant?

Not true! No matter when or how many times you have sex, you still run the risk of getting pregnant.