Womens Health

Instructions for Birth Control Pill Use

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.

  1. 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)
  1. 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.
  1. 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.
  1. 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...

  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. If you see a physician or any health-care provider for any reason, be sure to mention that you are on birth control pills.
  1. 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.
  1. 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
  • 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

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:

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.


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