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Combination birth control (COC) pills

Patient Education
Last reviewed

Combination pills

These are pills that have both estrogen and progesterone. They are the most used birth control pills.  

  • COC prevents pregnancy 92 out of 100 times. This means in 1 year, 8 out of 100 people who use COC’s get pregnant.
  • COC does not protect against sexually transmitted infections. Use condoms with new partners.
  • Most 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.
  • Prevents pregnancy.
  • Less acne.
  • Less risk of uterine and ovarian cancer when taken long term.
  • Less symptoms of endometriosis and PCOS.
  • Able to get pregnant right away after stopping. No impact on your ability to get pregnant in the future.


Risks

  • Getting pregnant.
  • Although rare there is a risk of blood clots in the legs or lungs. The risk of getting a blood clot is more than 10 times less than during pregnancy. It is slightly higher than when not on a COC.


When do I start the pill? 

The COC can be started anytime if you are reasonably sure you are not pregnant. You do not need to wait for the next menstrual cycle. You do not need to wait until the Sunday after a period.

Postpartum: Wait to start until instructed by your provider after delivery. Most COC’s are started 6 weeks after delivery. This is due to the risk of blood clots in the postpartum time.  COC’s are safe in breastfeeding and do not decrease milk supply when started 6 weeks after delivery.  

Miscarriage or abortion: If you plan to use COC after miscarriage or abortion, start the first Sunday after the pregnancy passes. You may still have vaginal bleeding at that time. It is ok to start your pills though.  


When does the pill start working? 

  • If the pill is started the first 5 days of a regular period, it works right away. 
  • If started any other time during a menstrual cycle: 
    • Do not have sex for 7 days or 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 from a non-IUD method, such as pill, patch, ring, or shot. 


How do I take the pill? 

This depends on the type of pill you are using.


Cyclic dosing

21-day pill packs

  • Take 1 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 pill packs

  • Take 1 pill at the same time each day for 28 days. 
  • Depending on the brand, the first 21 or first 24 pills have estrogen and progestin. 
  • The remaining pills may be: 
  • Estrogen-only pills 
    • Pills with a dietary supplement, such as iron, but no hormones
    • Inactive pills that do not have hormones or supplements
  • During the days you take the hormone-free pills, you will have your period. 

90-day pill packs

  • 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.

Continuous dosing

  • If the provider prescribes a COC, take the active pills for 3 weeks. 
  • Throw out placebo pills. 
  • Start a new pack of pills right away.

Missed or late combined birth control pills

If you are late taking a pill and it is less than 24 hours since you should have taken it
or
If you missed a pill and it has been 24 to 48 hours since you should have taken it:

  • Take the late or missed pill as soon as possible.
  • Keep taking the pills at the normal time. Even if you must take 2 pills the same day.
  • No need for more contraception protection.

You often do not need emergency contraception if you missed hormonal pills early in your cycle or in the last week of your previous cycle. You may think about taking it though.

If you missed 2 or more pills in a row and it has been more than 48 hours since you should have taken a pill:

  • Take the most recent missed pill as soon as possible. Throw away the other missed pills.
  • Keep taking the rest of the pills at the normal time. Even if you must take 2 pills in the same day.
  • Use back-up contraception, such as condoms, or do not have sex until you take your pills 7 days in a row.

If you missed pills the last week of your hormonal pills (days 15 to 21 for a 28-day pill pack): 

  • Skip the pills in the hormone-free week. Finish your hormone 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 take your pills 7 days in a row.

You may want to take emergency contraception if you missed hormonal pills the first week in the pill pack and you had unprotected sex in the past 5 days. 

For more information if you missed a pill, see this website: Recommended Actions After Late or Missed Progestin-Only Pills (cdc.gov)

 

Go to the Emergency Room (ER) if you have:

 
•    Eye problems, such as vision loss of blurring 
•    Speech problems
•    Severe headaches 
•    Dizziness 
•    Weakness 
•    Numbness
•    Shortness of breath or chest pain
•    Severe leg pain in your thigh or calf and leg swelling


Side Effects

Breakthrough bleeding

  • Light bleeding (spotting) is very common the first 3 months. This is more common with continuous pill use. It is not harmful.
  • If flow is light, keep taking pills. Call your care team if you keep having bleeding after the 3rd cycle of pills. Ask about changing pills.
  • Call your care team if your flow is heavy. This means soaking more than 1 pad in 1 hour.

Nausea

  • This is common the first 2 to 3 months. Try taking the pill at bedtime or on a full stomach.

Headaches

  • This is common the first 2 to 3 months. Keep track of how severe and 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 it is a severe headache.  

Weight gain

  • There is no evidence COCs cause weight gain.  
  • You may have some fluid retention. It should be no more than 5 pounds.

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 the pills. 

Call: 

  • The Obstetrics Gynecology Clinic at 319-356-2294 Monday through Friday from 8 a.m. to 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.