• Dr. Sally

Combination Pills "The Pill"

The combination pill is a method of hormonal contraception that is taken by mouth every day. The pill contains two active ingredients: estrogen and a progestin. It is commonly called "the pill." The pill has lots of benefits beyond birth control. Many women use them to get rid of acne, PMS, or their periods.

How does it work?

The hormones in the pill prevent pregnancy in several ways. Estrogen suppresses ovulation while progestin increases cervical mucus and thins the uterine lining. These actions hinder sperm travel and prevent egg release and implantation.

How well does it work?

When used correctly, the pill is 99% effective in preventing pregnancy. However, most people do not take it perfectly and may be late or miss pills, resulting in a 91% efficacy with typical use.

Note that the pill does not prevent the spread of sexually transmitted diseases (STDs).

How do I take it?

The pill is taken by mouth at the same time every day. Most combination pills come in packs of 28, where the last four or seven days are placebos that do not contain any hormone. You should expect to get your period during the hormone-free days.

What if I forget to take it on time?

It’s very important to take all the active pills -- pills with the hormones in them -- on time.  

- If you are late or miss one pill and remember before your next pill is due, take the late pill as soon as possible and resume your normal pill schedule. It is okay to take two pills in one day.

- If you miss two or more pills, take the most recent missed pill as soon as soon as you remember and resume your normal pill schedule. It is okay to take two pills in one day. Discard any other pills that were missed. Use a backup method of birth control for the next seven days until the pill is reliably preventing pregnancy.

- If pills were missed in the last week of hormonal pills (example: days 15-21 for 28-day pill packs), skip the hormone-free period by finishing the hormonal pills in the current pack and starting a new pack the next day.

- Consider using emergency contraception except Ella (ulipristal acetate).

Missing any or all of the placebo pills is okay; no further action is needed to prevent pregnancy.

What are some side effects I might experience?

Though rare, there are serious side effects that can occur when using the pill. These include blood clots, heart attacks, and strokes. If you experience sudden and/or severe pain in your abdomen, chest, head, or legs that may be accompanied by dizziness, nausea, vomiting, difficulty catching your breath, or changes in vision or mental status, call your healthcare provider right away and/or get to an emergency room.

Other potential side effects are headaches, breast tenderness, nausea or vomiting, changes in mood, libido, and bleeding patterns. These typically resolve within three months of using the pill. The pill may help with acne and can make periods lighter and more regular.

What if I want to get pregnant soon?

The pill is a great option if you would like to get pregnant within the next year. You can get pregnant as soon as you stop taking the pill.

Is it right for me?

The combination pill is safe for most women. Some health conditions make it unsafe to use the pill but the minipill can be used instead (examples: history of blood clots, high blood pressure, and smoker over age 35).

Connect to learn more about our work to expand access to birth control. Or email us.

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