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The type of birth control you use is a personal decision, and there are many options to choose from. If you’re a sexually active person who menstruates, you may want to consider birth control pills.

Birth control pills, also called oral contraceptives, are medications you take by mouth to prevent pregnancy. According to the Food and Drug Administration (FDA), they’re an effective method of birth control with a success rate of about 91 percent (or a failure rate of 9 percent).

Find out how they work and what side effects they can cause, as well as other factors to help you decide whether birth control pills are a good choice for you.

Birth control pills are oral contraceptives that contain small amounts of hormones. The hormones in birth control pills work to prevent pregnancy by stopping ovulation, or the release of an egg from the ovary. Some birth control pills also temporarily change the lining of the uterus so it’s less likely a fertilized egg will implant.

Birth control pills come in a pack, usually a 28-day cycle, with one pill assigned to each day. You take a birth control pill daily, typically during the same time frame each day, depending on the pill. This keeps certain hormones elevated, so you’re less likely to get pregnant.

Combination pills

Combination pills contain synthetic forms of the hormones estrogen and progesterone (called progestin in its synthetic form). Estrogen controls the menstrual cycle.

Estrogen levels are naturally highest in the middle of your cycle and lowest when you have your period. Progesterone prepares the uterus for pregnancy after ovulation by thickening the endometrium. High progesterone levels also prevent ovulation.

Combination pills come in a 28-pack. Most pills in each cycle are active, which means they contain hormones. The remaining pills are inactive, which means they don’t contain hormones. There are several types of combination pills:

  • Monophasic pills. These are used in 1-month cycles. Each active pill gives you the same dose of hormone. During the last week of the cycle, you can take (or skip) the inactive pills, and you still have your period.
  • Multiphasic pills. These are used in 1-month cycles and provide different levels of hormones during the cycle. During the last week of the cycle, you can take or skip the inactive pills, and you still have your period.
  • Extended-cycle pills. These are typically used in 13-week cycles. You take active pills for 12 weeks, and during the last week of the cycle, you can take or skip the inactive pills and have your period. As a result, you have your period only three to four times per year.

Examples of brand-name combination pills include:

  • Azurette
  • Beyaz
  • Enpresse
  • Estrostep Fe
  • Kariva
  • Levora
  • Loestrin
  • Natazia
  • Ocella
  • Low-Ogestrel
  • Ortho-Novum
  • Ortho Tri-Cyclen
  • Seasonale
  • Seasonique
  • Velivet
  • Yasmin
  • Yaz

Progestin-only pills

Progestin-only pills contain progestin (synthetic progesterone) without estrogen. This type of pill is also called the minipill.

Progestin-only pills can help reduce bleeding in people with heavy periods. They may be a good choice for people who can’t take estrogen for health or other reasons, like a history of stroke, heart disease, peripheral vascular disease, and/or deep vein thrombosis.

You should also avoid estrogen if you’re over 35 and smoke, as this combination can increase your risk of developing a blood clot.

With progestin-only pills, all pills in the cycle are active. There are no inactive pills, so you may or may not have a period while taking progestin-only pills.

Examples of brand-name progestin-only pills include:

  • Camila
  • Errin
  • Heather
  • Jencycla
  • Nor-QD
  • Ortho Micronor

Deciding on a type of birth control pill

Not every type of pill is a good fit for every person. Talk with your doctor about which pill option would work best for you. Factors that can affect your choice include:

  • Your menstrual symptoms. If you experience heavy bleeding, you may do better with a progestin-only birth control pill instead of a combination pill.
  • Whether you are breastfeeding. If you’re breastfeeding, your doctor may recommend avoiding birth control pills that contain estrogen.
  • Your cardiovascular health. If you have a history of stroke, blood clots, and/or deep vein thrombosis, your doctor may recommend a progestin-only birth control pill.
  • Other chronic health conditions you may have. If you have chronic health conditions, such as active breast or endometrial cancer, migraine with aura, or heart disease, you may not be a good candidate for oral contraceptives. Talk with your doctor and make sure to give your full health history.
  • Other medications you may take. If you’re taking antibiotics or herbal remedies, such as St. John’s Wort, combination birth controls may not be a good fit for you. Certain antiviral drugs and epilepsy medications can also interfere with birth control pills, and vice versa.

Combination pills work in two ways.

First, they prevent your body from ovulating. This means your ovaries won’t release an egg each month.

Second, these pills cause your body to thicken your cervical mucus, the fluid around your cervix that helps sperm travel to your uterus so it can fertilize an egg. The thickened mucus helps prevent sperm from reaching the uterus.

Progestin-only pills also work in a few different ways. Mainly, they work by thickening your cervical mucus and by thinning your endometrium.

Your endometrium is the lining of your uterus, where an egg implants after it’s fertilized. If this lining is thinner, it’s harder for an egg to implant in it, which will prevent a pregnancy from growing.

Progestin-only pills may also prevent ovulation.

Combination pills come in a variety of formats. These include monthly packs, which follow 21-, 24-, or 28-day cycles. Extended regimens can follow 91-day cycles. With all these formats, you take one pill each day at the same time of day.

If you start taking your combination pill within 5 days after your period starts, you’ll be protected against pregnancy right away. If you start at any other time, you’ll need to take the pills for 7 consecutive days before you’re protected. During this time, you should use a barrier method of birth control, such as an external condom.

Progestin-only pills, on the other hand, come in only packs of 28. As with combination pills, you take one pill at the same time every day.

Progestin-only pills tend to work more quickly than combination pills, which means you’ll be protected against pregnancy after taking 2 consecutive pills within 48 hours. If you don’t want to wait the 48 hours to have sex, you should use a barrier method of birth control.

If taken correctly, birth control pills are very effective in preventing pregnancy. Both the combination pill and the progestin-only pill have 9 percent failure rates with typical use. That means out of 100 people with a vagina using the pill, 9 would get pregnant.

To be fully effective, progestin pills must be taken within the same 3-hour time period every day. If you miss this time window, you should take your pill as soon as you remember and use a different method of contraception, like a condom, for 2 days.

There is slightly more flexibility with combination pills. In general, you should try to take combination pills at the same time each day, but you can take them within the same daily 12-hour window and still have pregnancy protection.

Certain medications may make either type of pill less effective, including:

  • rifampin (an antibiotic)
  • certain antiretroviral and HIV medications such as efavirenz
  • certain antiseizure medications such as carbamazepine, levonorgestrel, oral norethindrone, and the subdermal etonogestrel implant
  • St. John’s wort

The pill may also be less effective if you experience diarrhea or vomiting. If you’ve had a stomach illness, check with your doctor to see whether you’re at risk of pregnancy. In that case, you should use a backup method of contraception, such as a condom.

Depending on which pill you’re taking, there are different routes to take when you’ve missed one or more doses.

Number of missed pillsActionEmergency contraception (EC)2-day backup birth control7-day backup birth control
1 active combination pillTake the missed pill ASAP, even if that means you take 2 in 1 day. Continue taking the rest of your pills on a normal schedule.Unless you missed the pill early in your cycle (5–7 days) or late in your previous cycle, EC isn’t usually needed.none needednone needed
2+ active combination pillsTake 2 missed pills ASAP, even if that means you take 2 in 1 day. Continue taking the rest of your pills on a normal schedule.If you missed your pills during the first week of your cycle and had sex without a condom or other barrier method, consider using EC.Use backup BC or abstain until you’ve taken the active pills for 7 consecutive days.
If you missed pills in your third week, take the active pills in the pack daily until you run out, then start a new pack the next day.
Don’t take the inactive pills.
Use backup BC or abstain until you’ve taken the active pills for 7 consecutive days.
If you missed pills in your third week, take the active pills in the pack daily until you run out, then start a new pack the next day.
Don’t take the inactive pills.
1+ active progestin-only pillsTake 1 pill ASAP. Continue taking your pills on a normal schedule.If you had sex without a barrier method within the past 5 days, consider using EC.Use backup BC or abstain until you’ve taken pills for 2 consecutive days.Use backup BC or abstain until you’ve taken pills for 2 consecutive days.
1+ inactive pillsDiscard the missed inactive pill(s) and continue on your normal schedule.
You should never leave more than 7 consecutive days between taking active pills.
none needednone needednone needed

While birth control pills are safe for most people, they do come with some side effects and risks. Everyone reacts differently to the hormones in birth control pills. Some people have side effects such as:

  • decreased sex drive
  • nausea
  • headaches
  • spotting or bleeding between periods
  • breast tenderness
  • abdominal cramping
  • increase in vaginal discharge

If you have these side effects, they will likely improve after a few months of using the pill. If they don’t improve, you should talk with your doctor. They may suggest you switch to a different type of birth control pill.

Risks

A serious risk of using birth control pills, especially combination pills, is an increased risk of blood clots. This can lead to:

Overall, the risk of a blood clot from using any kind of birth control pill is low.

According to the American College of Obstetricians and Gynecologists, out of 10,000 people taking birth control pills, about 10 will develop a blood clot after taking a combination pill for a year. This risk is still lower than the risk of developing a blood clot during pregnancy and immediately after giving birth.

However, the risk of a blood clot from the pill is higher for certain groups. This includes those who:

  • live in larger bodies
  • have high blood pressure
  • are on bed rest for long periods

If any of these factors apply to you, talk with your doctor about the risks of using a birth control pill.

Considerations

Many birth control options are available today, and the birth control pill is an excellent one. But the best birth control choice for you depends on many factors. To find an option that works for you, talk with your doctor. Be sure to ask any questions you have. These might include:

  • Which type of birth control pill might be better for me?
  • Am I taking any medications that could cause problems with a birth control pill?
  • Am I at higher risk of blood clots from the pill?
  • What should I do if I forget to take a pill?
  • What other birth control options should I consider?

With increasing demand for contraceptive options, access to birth control pills is becoming easier than ever.

You can go the traditional route and schedule an in-person visit with a doctor. Once you go through your medical history and discuss your family planning goals, your doctor will provide a prescription that you can then fill at your local pharmacy.

There are also several ways to get birth control pills online without an in-person visit to a doctor.

Telehealth services, like Nurx, Lemonaid, SimpleHealth, and The Pill Club offer online consultations, some via video and some through messaging or a medical questionnaire, with licensed doctors and healthcare professionals who review your medical history and then provide a prescription for a recommended birth control.

Once the prescription is filled, the birth control pills are shipped directly to your home.

Birth control pills are oral contraceptives that help prevent pregnancy. Each pill contains small amounts of the hormones estrogen and/or progesterone (in its synthetic form, called progestin). When taken correctly, they have a 91 percent success rate.

There are two types of birth control pills, combination and progestin-only. Combination pills are more common, but progestin-only pills, which don’t contain any estrogen, may be a better fit for certain groups of people, such as those who have a history of blood clots or have heavy periods.

Before taking birth control pills, talk with your doctor or a licensed medical professional to determine which type is right for you.