How to use birth control pills

doctor explains birth control use to young woman

How birth control pills work

Combination type oral contraceptives contain synthetic (man-made) hormones (estrogen and progesterone) which block the release of your own hormones which could normally lead to ovulation. If there is no ovulation, there is no egg present to become fertilized. These synthetic hormones also cause changes in the cervical mucus and the lining of the uterus to make it unsuitable for a fertilized egg to implant and grow.

How to take pills.

This is a Sunday start package. The first pill should be taken on the first Sunday after the menstrual period begins. If your period begins on Sunday, begin taking the pills that day. Take one pill at about the same time each day for 21 consecutive days. Then take one of the spacer pills daily for seven days, during which time your period usually occurs. Spacer pills do not contain hormones, however, they keep you in the habit of taking a daily pill and they will help you to remember when to begin the next package of pills.

During the first cycle, it is important to use a backup method of birth control (condoms, diaphragm, abstinence, etc.) until you have completed the first package of pills.

How to continue taking the pills

Begin taking the next package of pills the day after finishing the previous package. If you have taken all of the pills correctly, this will always be Sunday. If you have not finished your menstrual flow before starting the new package do not be concerned, begin the new package on schedule.

Take your pills at the same time each day (give or take an hour). Try to associate taking the pill with a regular daily activity like a meal or brushing your teeth.

Your period should occur during the last seven (spacer) pills. This may be slightly different from your previous periods and is sometimes known as a “pill period” or, more correctly, “withdrawal bleeding.” It is normal for periods to be lighter in flow and shorter than your normal periods.

Any bleeding, even spotting, during the last seven pills should be counted as a period.

Even if you skip a period, take the pills as directed for the next cycle. A “silent period” may occur occasionally; however, if you miss two periods in a row, call the office.

NOTE: If you forget to take a pill during the month and miss a period, you should call the office.

What should you do if you forget a pill?

  • Take it as soon as you remember; to be safe, use another method of birth control until you finish that package of pills.
  • If you miss more than one pill, take two pills per day for the next two days.
  • Use a backup method of birth control for the rest of the cycle.
  • If you miss more than two pills, please call the office for instructions.


Of one hundred women using the pill about two may become pregnant during the first year of actual use. The chance of becoming pregnant may be reduced by taking pills correctly and never forgetting a pill. Many women become pregnant because they discontinue the pill before beginning another method.

What if you have some spotting or bleeding between periods?

This is called “breakthrough” bleeding. To be safe use a backup method, i.e.. foam and condoms.

  • Be sure that you are taking the pills at the same time every day (including weekends).
  • Breakthrough bleeding is common during the first few cycles of birth control pills and should stop after the initial two or three cycles.
  • If breakthrough bleeding persists, consult your doctor.

What are some of the side effects of the pill?

Minor side effects include breast tenderness, fluid retention, and nausea. To prevent nausea try taking your pill at bedtime or with food. Those side effects frequently go away after one or two cycles on the pill.

Problematic side effects include weight gain, headaches, skin pigmentation, acne, irritability, increased incidence of vaginal infections with discharge and itching. If these side effects are occurring consult your doctor, often a different brand of pills with different amount of hormones can correct the problem.

Major and rare side effect:

Thrombophlebitis (blood clots) – this may occur in the legs or elsewhere. Report any tenderness, reddening, or swelling in the legs, chest pain, coughing up blood, severe headaches, or any visual disturbances – no matter how minor, go to the doctor immediately. If the office is not open, go to the nearest hospital or emergency room.

Post-pill Amenorrhea – your period does not resume after going off the pills. Six weeks to three months is an average time to wait for your body to regain its own hormonal functioning. Consult your physician if you have questions about the return of menstruation.

Drug interactions

There are several drugs, primarily antibiotics (tetracycline, amoxicillin), antihistamines, tranquilizers and seizure medications which can reduce the effectiveness of the pill. It is important to check with your doctor before taking any medications and the pill. (If in doubt, a backup method of birth control is a good idea.)