The birth control pill works primarily by blocking ovulation
(release of an egg). If there is no egg to meet the sperm,
pregnancy cannot occur. The pill also works by making cervical
mucous thick and unreceptive to sperm, slowing tubal function
which has to move the egg down the tube to meet the sperm, and
by making the lining of the endometrium unreceptive to
implantation of a fertilized egg should one get as far as the
uterus. In general, women do not ovulate until at least 10 days
after stopping birth control pills.
For women who follow these directions carefully, the pill is the
most effective reversible contraceptive currently available.
Starting birth control pills the first time
Choose a backup method of birth control (such as condoms,
diaphragm, or foam) to use with your first pack of pills
because the pill may not fully protect you from pregnancy
during the first week that you start taking them. Keep this
backup method handy and use it in case you:
Run out of pills
Forget to take your pill
Discontinue pill use
Need protection from transmission of sexually
transmitted diseases, particularly the virus that causes
AIDS (the condom is recommended)
There are several ways to start taking your pills. Use one of
the following approaches:
First approach: Start your first pack of pills on the
day your period begins.
Second approach: Start your first pack on the first
Sunday after your period begins. This
will result in your menses almost
always beginning on a Tuesday or
Wednesday every 4 weeks
Third approach: Start your first pack on the fifth day
after your period begins.
Fourth approach: Start your pill today if there is
absolutely no chance that you could be
pregnant. Use a backup method of
contraception until your first period.
Take one pill a day until you finish the pack. Then:
If you are using a 28-day pack, begin a new pack
immediately. Skip no days between packages.
If you are using a 21-day pack, stop taking pills for 1
week and then start your new pack.
Try to associate taking your pill with something you do at
about the same time every day, like brushing your teeth in
the morning, eating a meal, or going to bed. Keep the pill
near the place where you engage in the selected activity.
Establishing a routine will make it easier for you to
remember. The pills work best if you take one at about the
same time every day. Check your pack of pills each morning
to make sure you took your pill the day before.
Continuing on the Pills - What If...
If you have bleeding between periods, try to take your pills
at the same time every day. If you have spotting (light
bleeding between periods) for several cycles, call the
doctor's office for advice.
If you forget your pills for a day or two, follow the
instructions below:
If you miss one pill, take the forgotten one
(yesterday's pill) as soon as you remember it, and take
today's pill at the regular time. Although you probably
will not become pregnant, use your backup method until
your next period to be safe.
If you miss two pills in a row, take two pills as soon
as you remember and two pills the next day. You may
have some spotting. Use your backup method of birth
control until your next period.
If you miss three or more pills in a row, start your
backup method of birth control immediately. Your
ovaries may produce an egg (ovulation), and without a
backup contraceptive you could become pregnant. Ask
yourself, "Am I a good pill user?" Another method of
contraception may be better for you.
To continue your pills:
Take two pills for 3 days and use your backup method of
birth control until you have your next period, OR Stop
taking pills from your old pack of pills. Start a new
pack of pills the Sunday after you missed three or more
pills, even if you are bleeding. Use your backup method
of contraception for the first 2 weeks that you are on
your new pack of pills.
If you have severe diarrhea or vomiting lasting several days,
begin using your backup method of birth control on your first
day of diarrhea or vomiting and continue using it until your
next period. The pills may not absorb from your
gastrointestinal tract when you are sick like this.
Periods tend to be short and scanty on pills, and you may see
no fresh blood at all. A drop of blood or a brown smudge on
your tampon or underwear is considered a period. This is
because combined estrogen and progestin birth control pills
suppress the formation of uterine tissue. Therefore there is
very little tissue to slough each month. The scant or absent
period is not due to blockage or pregnancy.
If you have not missed any pills and you miss one period
without any signs of pregnancy, pregnancy is unlikely.
Do a home pregnancy test or call the doctor if you are
worried.
If you forgot one or more pills and miss a period, run a
home pregnancy test or contact your doctor about a
pregnancy test.
If you miss two periods in a row and feel pregnant or
if you miss three periods in a row, contact the doctor
for an examination, even if you took your pills every
day and even if a home pregnancy test is negative.
If your doctor has you on continuous pills (21 days of active
pills followed by 21 days of active pills with no 7 day break
of non-hormone, inactive pills) in order to suppress your
menses because of endometriosis or premenstrual syndrome, you
will very likely have break through bleeding. If the spotting
persists through more than 3 packs of pills, contact your
doctor to confirm that you should stay on that brand of pills.
Pills may cause pregnancy symptoms when you first start
taking them. Breast soreness, upset stomach, mild headaches,
mild edema of the legs and mood irritability are common. If
you can bear these symptoms, try to continue taking the pills
as best you can because most of these mild symptoms go away
after the 2nd month of taking the pills. If you still have
annoying symptoms in your 3rd month of taking birth control
pills, contact your doctor to see if a change in formulation
or brand of the pills is indicated.
Break-through spotting or bleeding follows the same
principles as above, i.e., try to stick with the pills you
are taking but if it persists in the third cycle, contact
your doctor to see if a change in pill is indicated.
Some women with persistent mood or physical symptoms find
that these symptoms are on the days when they are NOT taking
the active hormone pills. Keep a diary of your symptoms and
if this is the case with you, check with your doctor to see
if you can take the non-hormonal, placebo pills for only 4
days instead of 7 or if you can be placed on a pill that has
small amounts of estrogen during the 7 spacer days.
If you see a physician or any health-care provider for any
reason, be sure to mention that you are on birth control pills.
Most antibiotics do not decrease the effectiveness of pills.
There are some anti-tuberculosis drugs that do. Check with
your doctor or pharmacist if a given medication is known to
interfere with birth control pill effectiveness.
The question always comes up could I get (or be) pregnant if:
I missed one or two pills
I was late in taking my pills
I had breakthrough spotting after missing two pills
I was sick and had the flu
I took another prescription or non prescription medicine or
hormone or antibiotic etc.
I had sex during the days of the inactive pills
The answer is always, it is possible but very unlikely. You
should always use back up protection if you are not sure and
perform a home pregnancy test at the time of your first
missed menses or light bleeding. Home pregnancy tests are
positive approximately 12-15 days after ovulation or at the
time of the first missed menses.
Complication Signs
Contact the doctor immediately if any one of these danger
signs (or "aches") appears:
Abdominal pain (severe)
Chest pain (severe), cough, shortness of breath
Headaches (severe)
Eye problems -- blurred vision or vision loss
Severe leg pain--calf or thigh
Yellow jaundice
Learn the pill danger signs. If you smoke more than 14
cigarettes a day, you should be especially careful. You
should STOP SMOKING. If you are over age 35 and still
smoke, you have a significantly increased chance of serious
vascular problems if you also take birth control pills.
