Combination birth control pills

Combination pills

These are pills that have both estrogen and progesterone.

  • Most combination oral contraception pills (OCPs) 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.

When to start the pill

The oral contraceptive pill (OCP) 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.)

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.

Combined oral contraceptives can be started within the first 7 days after first-trimester or second-trimester pregnancy loss.

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.

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.

If you are late taking a pill or miss a pill as previously defined, then 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.

Then 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

Combination birth control pill 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.
Last reviewed: 
March 2020
Alternative Names: 
Combination oral contraception pills
OCPs

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