How To Use Birth Control Pills

I usually recommend starting your pill on the Sunday after your next period begins. Starting around the time of your period can make the transition onto the pill a little easier and may help reduce irregular or breakthrough bleeding.

You do not have to wait for your next period, however. Birth control pills can generally be started at any time as long as we are reasonably certain you are not pregnant.

When will my pill start protecting me from pregnancy?

• If you start within the first 5 days of your period: No backup birth control is needed.

• If you start more than 5 days after your period begins: Use condoms or avoid intercourse for the first 7 days after starting your pill. 

If you use a Sunday start, whether you need backup contraception depends on how many days have passed since your period began.  If you're not sure when to start your pill or whether you need backup contraception, please contact our office.

Birth control pills work best when you take them consistently. Try to choose a time that fits naturally into your daily routine and that you are likely to remember.

Some people find it helpful to take their pill with a meal or pair it with something they already do every day, such as brushing their teeth in the morning or getting ready for bed.

A few ways to help you remember:

• Set a repeating daily reminder or alarm on your phone.

• Keep your pill pack somewhere you will see it at the appropriate time.

• Pair your pill with another part of your daily routine.

• Use a medication or birth control reminder app, such as Spot On or Medisafe.

If your pill causes mild nausea, taking it with food or at bedtime may help.

Having trouble remembering your pill regularly? Another birth control method that doesn't require daily dosing may be a better fit. Please let us know if you'd like to discuss other options.

You do not need to have a period every month while taking birth control pills. Many birth control pills can be taken continuously to skip or reduce the number of periods you have.

To skip your period: Take all of the active (hormone) pills in your pack. When you reach the placebo pills, skip them and begin the active pills in your next pack instead.

You can do this occasionally, such as to avoid a period during a vacation or special event, or you can take your pills continuously on an ongoing basis.

Spotting or breakthrough bleeding is common, especially during the first few months of continuous use. This does not necessarily mean that your pill isn't working.

Not every pill formulation is used in exactly the same way. If you aren't sure which pills in your pack are active or whether your pill is appropriate for continuous dosing, please contact our office.

These instructions apply to active (hormone) pills. Missing a placebo pill does not affect your birth control protection.

If you miss ONE active pill:

Take the missed pill as soon as you remember, then continue the rest of your pills at your usual time. This may mean taking two pills on the same day.

You do not need backup birth control after missing only one active pill. 

If you miss TWO OR MORE active pills in a row:

Take the most recently missed pill as soon as you remember. You can discard the other missed pills. Continue taking the rest of your pack at your usual time, even if this means taking two pills on the same day.

Use condoms or avoid intercourse until you have taken active pills for 7 consecutive days. 

If you missed pills near the end of your active pills:
Finish the remaining active pills, skip the placebo pills, and start a new pack the next day. This avoids extending the time you are without hormones. 

If you missed pills during the first week of your pack and had unprotected intercourse within the past 5 days:
Emergency contraception may be recommended. Please contact our office or your pharmacist if you aren't sure what to do. 

Want more Info?  Check out the CDC's Recommendations After Late/Missed Oral Contraceptive Pills

What if I vomit or have diarrhea?

If you have vomiting or diarrhea that continues for 48 hours or longer, continue taking your pill if possible, but use condoms or avoid intercourse until you have taken active pills for 7 consecutive days after the illness has resolved

Many people take birth control pills without significant side effects. Everyone responds to hormones a little differently, however, and it can take some time for your body to adjust to a new pill.

Common side effects can include:

• Nausea

• Headaches

• Breast tenderness

• Spotting or breakthrough bleeding

• Changes in your bleeding pattern

Mild side effects often improve during the first few months as your body adjusts.

A few things that may help:

• If you have nausea, try taking your pill with food or at bedtime.

• Take your pill consistently each day. This can help reduce breakthrough bleeding.

• Give your body some time to adjust if your symptoms are mild and manageable.
  
  

What about weight gain?  Weight gain is a common concern, but studies have not shown significant weight gain from combined birth control pills overall. Some people may notice normal fluctuations in weight or feel temporarily more bloated when starting a new pill, but substantial or persistent weight gain is not expected. 

What about mood? Some people report mood changes while taking hormonal birth control, although it can be difficult to determine whether the pill is the cause. If you notice a significant change in your mood after starting a new pill, please let us know.

If side effects are persistent or bothersome, please let us know. There are many different birth control pill formulations, and sometimes a different dose or type of hormone is a better fit.

Most medications can be taken safely with birth control pills, but a few medications and supplements can affect how well your pill works. Birth control pills can also affect the levels of certain medications.

Antibiotics
Most commonly prescribed antibiotics do not make birth control pills less effective, and you do not routinely need backup contraception while taking them. However, rifampin and rifabutin can decrease the effectiveness of birth control pills. 

Certain seizure medications
Some medications used to treat seizures can make birth control pills less effective, including carbamazepine, oxcarbazepine, phenytoin, phenobarbital/barbiturates, primidone, and topiramate. There is also an important interaction with lamotrigine: estrogen-containing birth control pills can lower lamotrigine levels, which may affect seizure control. 

Tirzepatide (Zepbound or Mounjaro)
Tirzepatide can affect the absorption of oral birth control pills, particularly when you first start the medication or increase your dose. Use condoms or another non-oral method of contraception for 4 weeks after starting tirzepatide and for 4 weeks after each dose increase. 

St. John's wort
This herbal supplement may decrease the effectiveness of hormonal birth control and should be discussed with your healthcare provider. 

Starting a new medication or supplement?

Most medications do not interfere with birth control pills. When you are prescribed a new medication, let the prescribing healthcare professional or pharmacist know that you take birth control pills so they can check for potential interactions.

Most people do well on birth control pills, and mild side effects often improve during the first few months. However, please contact the office if you are experiencing:

• Persistent or bothersome breakthrough bleeding, especially if it continues after the first few months

• Side effects that are significant or aren't improving

• New or worsening headaches, particularly if you develop migraines or new neurologic symptoms

• Difficulty taking your pill consistently or frequently missing pills

• A desire to change your pill or birth control method

Seek urgent medical care if you develop symptoms that could indicate a rare but serious complication, such as:

• New chest pain, shortness of breath, or coughing up blood

• Significant pain or swelling in one leg

• A sudden severe headache, especially with weakness, numbness, difficulty speaking, or other neurologic symptoms

• New vision loss or significant vision changes

Serious complications from birth control pills are uncommon, but estrogen-containing birth control can increase the risk of blood clots and certain cardiovascular complications.