Combination pills
These are pills that have both estrogen and progesterone. These are the most commonly used birth control pills.
- COC prevent pregnancy 92% of the time. This means in 1 year of use 8% of people who use COC's get pregnant.
- COC do not protect against sexually transmitted infections. Condoms should be used with new partners.
- Most combination oral contraception pills (COCs) have 3 rows of hormonal pills and 1 row of placebo pills.
- Some have less than 7 placebo pills.
- Some have placebo pills every 3 months.
Benefits
- Patient controlled
- More predictable periods
- Lighter and less painful periods
- Pregnancy prevention
- Decreased acne
- Decreased risk of uterine and ovarian cancer when taken long term
- Decreased symptoms of endometriosis and PCOS
- Rapidly able to get pregnant after stopping. No impact on the ability to get pregnant in the future.
Risks
- Getting pregnant
- Blood clots in the legs or lungs. The risk of getting a blood clot on a COC is more than 10 times less then during pregnancy, but slightly higher then when not on a COC.
When to start the pill
The combined oral contraceptive pill (COC) can be started anytime if it is reasonably certain the patient is not pregnant. You do not need to wait for the next menstrual cycle. (There is no need to wait until the Sunday following a period.)
Postpartum
Patients should wait until instructed by their providers to start birth control pills after delivery. Most of the time COC's are started at 6 weeks after delivery due to the risk of blood clots in the postpartum period.
Miscarriage or abortion
If you plan to use COC after miscarriage or abortion you should start them on the first Sunday after the pregnancy passes. You may still be having vaginal bleeding at that time. But it is ok to go ahead and start your pill.
Patients should wait at least 3 weeks from time of delivery to begin estrogen-containing pills. It is recommended to wait 5 weeks if breastfeeding as OCPs may lower milk supply.
When does the pill start working?
If the pill is started within the first 5 days of a regular period, it will work right away.
If started any other time during a menstrual cycle:
- Do not have sex for 7 days or be sure to use another birth control method (such as condoms) for 7 days. If switching from an IUD, do not have sex or use a back-up birth control method for 7 days.
- You do not need to use a back-up method if you switch directly from a non-IUD method (such as pill, patch, ring, shot) to an oral contraceptive pill.
How to take the pill
This depends on the type of pill you are using.
Cyclic dosing
21-day pills
- Take one pill at the same time each day for 21 days.
- Wait 7 days before starting a new pack.
- During the week you are not taking the pill, you will have your period.
28-day pills
- Take one pill at the same time each day for 28 days.
- Depending on the brand, the first 21 pills or the first 24 pills have estrogen and progestin.
- The remaining pills may be:
- Estrogen-only pills
- Pills that contain a dietary supplement, such as iron, but no hormones
- Inactive pills that do not have hormones or supplements
- During the days you are taking the hormone-free pills, you will have your period.
Continuous therapy
- If the provider prescribes a continuous oral contraceptive, take the active pills for 3 weeks.
- Throw out placebo pills.
- Start a new pack of pills right away.
90-day pills
- Take 1 pill at the same time each day for 84 days.
- Depending on the brand, the last 7 pills either have no hormones or have estrogen only.
- With both brands, you will have a period during the last 7 days every 3 months.
Missed or late combined birth control pills
- If you are late taking a pill
- It is less than 24 hours since you should have taken it.
- If you have missed a pill
- It has been 24 to 48 hours since you should have taken a pill.
you should:
- Take the late or missed pill as soon as possible.
- Keep taking the remaining pills at the normal time. Even if you have to take 2 pills in the same day.
- No need for more contraception protection
You do not normally need emergency contraception.
If you missed hormonal pills earlier in your cycle or in the last week of your previous cycle, you may think about taking it.
If you have missed 2 or more pills in a row
It has been more than 48 hours since you should have taken a pill.
you should:
- Take most recent missed pill as soon as possible.
- Throw away any other missed pills.
- Keep taking the remaining pills at the normal time. Even if you have to take 2 pills in the same day.
- Use back up contraception (such as condoms) or do not have sex until you have taken your pills for 7 days in a row.
If you missed pills in the last week of your hormonal pills (such as days 15 to 21 for a 28-day pill pack):
- Skip the pills in the hormone-free week and finish your hormonal pills in your current pack.
- Start a new pack the next day.
- If you cannot start a new pack right away, use back up contraception (such as condoms) or do not have sex until you have taken hormonal pills from a new pack for 7 days in a row.
Consider taking emergency contraception if you missed hormonal pills during the first week in the pill pack and if you had unprotected sex in the past 5 days.
Go to the Emergency Room (ER) if you have:
- Eye problems
- Such as vision loss or blurring
- Speech problems
- Severe headaches
- Dizziness
- Weakness
- Numbness
- Shortness of breath or chest pain
- Severe leg pain in your thigh or calf and/or leg swelling
Side Effects
Breakthrough bleeding
- Light bleeding (spotting) is very common in the first 3 months. This is more common with continuous pill use. This is not harmful.
- If flow is light, keep taking pills. If you keep having bleeding after the third cycle of pills, call back to ask about changing pills.
- Call your health care provider if your flow is heavy (more than 1 pad per hour.)
Nausea
Common in first 2 to 3 months–try taking pill at bedtime or on a full stomach.
Headaches
- Common first 2 to 3 months–check how severe or often you have them.
- Try over the counter pain relievers such as naproxen sodium, ibuprofen, or Tylenol.
- Get medical attention if you have headaches with:
- Dizziness
- Weakness
- Numbness
- Visual changes
- Speech problems
- Or if it is a severe headache
Weight gain
- There is no evidence OCPs cause weight gain.
- You may have some fluid retention. (No more than 5 lbs).
No period during placebo pills
- If you have not missed any pills, this may be normal. Take a home pregnancy test if you think you might be pregnant.
- If negative, keep taking pills.
Call:
- The Obstetrics Gynecology Clinic at 319-356-2294 Monday through Friday from 8 a.m. - 4:30 p.m.
- For urgent questions or concerns:
- Call toll-free at 800-777-8442, 24 hours a day
- Ask for the gynecology resident on call.
- You may be asked some questions when using the toll-free number.
- Send a MyChart message for non-urgent questions or concerns.