Combination Hormonal Birth Control
"The Pill"
Combination birth control pills contain a mix of estrogen and progestin.
These hormones in the pill fool your brain into thinking that the ovary is working so the ovary does not get stimulated to form an egg. It is the hormones in the pill that are now running your cycles.
How does it prevent pregnancy?
- It prevents the ovaries from releasing an egg each month (ovulation).
- It thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg.
- It thins the lining of the womb, so there is a lower chance of a fertilized egg implanting into the womb and being able to grow.
How effective is it?
- If taken correctly, it’s more than 99% effective.
- With “typical use” of the pill, it’s only about 93% effective.
- That means about 7 out of 100 pill users get pregnant each year.
The better you are about taking your pill every day and starting your pill packs on time, the better the pill will work.
Advantages of the birth control pill:
- It’s very easy to use: just one pill at the same time every day.
- It’s safe and effective in preventing pregnancy, if taken correctly.
- It helps control or prevent cramping and decreases menstrual blood loss.
- It helps reduce PMS and PMDD symptoms.
- It improves acne.
- It may reduce the risk of endometrial and ovarian cancer (decreasing the risk of ovarian cancer by up to 50%).
- It may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.
- You have the option to decrease the number and length of your periods (some pills come in a 24 day “on”/ 4 day “off” format) so you get your period just four days per month.
Potential downsides of the birth control pill:
- To prevent pregnancy, you must take your pill every day and some pills at the same time every day.
- Combination pills can cause nausea, breast tenderness and headaches.
- Certain medications and supplements can make the pill less effective (i.e., St. John’s Wort, Rifampin to treat tuberculosis, and certain anticonvulsants).
- Very rarely, some women can develop high blood pressure while on the pill.
- There’s a slightly increased risk of breast and cervical cancer for women taking the pill five years or more.
- Prolonged use can increase a woman’s risk of developing osteoporosis later in life.
The pill isn’t for everyone. It’s not recommended if you:
- Are breastfeeding.
- Are a smoker over 35 (due to increased risk of blood clots, heart attack, and stroke).
- Have poorly controlled hypertension.
- Have migraines with aura (warning symptoms).
- Have a history of breast cancer, stroke, heart disease, liver disease, deep venous thrombosis, or a pulmonary embolism.
- Have advanced diabetes.
- Need to be immobilized for a long-time following surgery.
Starting the pill.
Start the combined birth control on the 1st day of your period. This is when your body is starting the next cycle. If you start the combined pill on the 1st day of your period (day 1 of your menstrual cycle) you will have better cycle control and should be protected from pregnancy straight away. We do, however, recommend a backup birth control until you finish the first pack.
Maintaining a consistent routine is essential when taking oral contraceptives.
While it is generally recommended to take the pill at the same time every day, whether in the morning or at night, what matters most is establishing a routine that works for you. By taking the pill around the same time each day, you help ensure consistent levels of hormones in your body, which maximizes the effectiveness of the contraceptive.
Creating a routine can help make it easier to remember to take the pill and minimize the risk of missing a dose. Some people find it helpful to associate pill-taking with a regular daily activity, such as brushing their teeth or going to bed. Additionally, setting reminders or using alarm apps can be useful tools to help you remember to take your pill consistently.
What to do if you miss a pill?
When you miss pills, the hormone level in your blood decreases and the brain will stimulate the ovary to form an egg and to produce hormones. This can make the pill less effective at preventing pregnancy and controlling your cycle.
If you miss a birth control pill, it’s important to take the necessary steps to ensure contraceptive effectiveness. The specific actions to take depend on the type of pill you’re taking (combination pill or progestin-only pill) and how many pills you’ve missed. Here are some general guidelines:
- If you miss one active pill: Take the missed pill as soon as you remember, even if it means taking two pills in one day. Continue taking the remaining pills at the usual time.
- If you miss two or more active pills in a row (Week 1 or Week 2): Take the most recent missed pill as soon as possible and the next pill at the regular time. Use a backup method of contraception (such as condoms) for the next seven days. If you had unprotected sex within the past five days, consider emergency contraception.
- If you miss two or more active pills in a row (Week 3): Finish the active pills in the current pack. Skip the placebo pills and start a new pack immediately. Use a backup method of contraception for the next seven days.
- If you miss any placebo (inactive) pills: These pills do not contain hormones and are intended to maintain the routine. It’s not medically necessary to take missed placebo pills. Start the next pack on schedule.
Vomiting and Diarrhea
- If you vomit within 3 hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.
- If you continue to be sick, keep using another form of contraception until you’ve taken the pill again for 7 days without vomiting.
- Very severe diarrhea (6 to 8 cases in 24 hours) may also mean that the pill does not work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhea and for 2 days after recovering.