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 people can’t take estrogen, so it’s better for them to take the progestin-only pill.

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).

If you take the Pill at the same time every day (perfect use), it’s more than 99% effective. This means that if 100 people take the combination pill every day, less than 1 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 people use the Pill, but don’t take it perfectly, 9 or more will become pregnant in a year.

Most people 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 the person taking it 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, they 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.

Most people 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 3-4 times, which is less than the risk 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

Many people are prescribed birth control pills for their medical benefits. It is a safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.

Birth control pills not only prevent pregnancy, but they also have medical benefits. Many people take the birth control pill just for its medical benefits and not for 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. Because the hormone doses are very low, 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 the Pill 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, people taking the pill are less likely to become anemic. Birth control pills also decrease your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts. They also protect against pregnancies that occur outside the uterus.

Almost everyone assigned female at birth 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)

Some people 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 people get more irregular periods or unexpected spotting and some insurance companies may not allow the extra packages without a medical reason.

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 useemergency contraception (EC), especially if you missed pills during the first week your pill pack, or had unprotected sex in the past 5 days.

• 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.