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Combination birth control pills, or the pill for short, are oral contraceptives that prevent pregnancy.
If you’re considering your birth control options, the pill is one of the most common and most effective. According to Planned Parenthood, birth control pills are 99 percent effective when taken perfectly.
Birth control pill prescriptions are relatively easy to get and are typically covered by health insurance. Many online birth control services will deliver the pill straight to your doorstep each month.
The combination pill is a type of birth control pill that contains both estrogen and progestin, which are two hormones used to prevent pregnancy.
Many brands of combination pills are available. Experts like the National Health Service (NHS) usually divide them into three categories, including:
- Monophasic 21-day pills. This is the most common type of combination pill, which provides the same amount of hormones in each pill. It is usually taken daily for 21 days, followed by 7 days without taking any pills.
- Phasic 21-day pills. This type has two to three different colored pills per pack, each of which contains varying levels of hormones and must be taken in order. Like monophasic pills, phasic pills should be taken daily for 21 days, followed by 7 days without taking any pills.
- Every day pills. This type of birth control contains 21 active pills and 7 placebo pills per pack. Each pill should be taken in order once per day, without any breaks between packs.
The combination pill can be used by people who want to prevent pregnancy.
It may also be prescribed to treat other conditions like acne, unwanted hair growth, endometriosis, and polycystic ovary syndrome.
However, combination birth control pills may not be suitable for people who have any of the following health conditions:
- breast cancer
- high blood pressure or vascular disease
- heart disease
- migraine headaches with aura
- certain liver diseases
According to the
If taken perfectly, the combination pill is 99 percent effective at preventing pregnancy, according to Planned Parenthood.
However, many people forget to take pills at the right time or may occasionally miss a dose. Because of this, it’s estimated that the combination pill is around 91 percent effective for most users.
This means that for every 100 people who use the combination pill, approximately 9 will get pregnant each year.
The pill contains a combination of synthetic hormones — that’s why it’s called the combination pill. These hormones work in two main ways.
First, the pill stops the ovaries from releasing an egg each month, a process known as ovulation. The pill also thins the lining of the uterus and thickens cervical mucus, both of which work to make implantation less likely.
Estrogen and progestin are the two main hormones in the combination pill. The estrogen in birth control pills may result in better control over your period, though it’s also associated with some risks.
“Taking estrogen continuously throughout the active pills suppresses the ovarian formation of a mature follicle (the sac within which the egg grows), thereby suppressing ovulation,” explains Rashmi Kudesia, MD, a fertility doctor in Houston.
“The hormonal components of combination pills also keep the cervical mucus unfavorable — reducing sperm entry into the uterus and fallopian tube — and keep the uterine lining thin — reducing chances of implantation.”
The amount of estrogen in combination pills may vary. Low dose pills are available and quite common.
Pros
- 99 percent effective when taken perfectly
- can be used to improve gynecological conditions, like polycystic ovary syndrome and endometriosis
- may be prescribed to treat acne and unwanted hair growth
- lighter, predictable periods or no periods at all
- may lower the risk of ovarian, colorectal, and endometrial cancers
Cons
- must be taken daily, around the same time for maximum effectiveness
- side effects may happen, including nausea and irregular bleeding
- may pose a risk of blood clots, high blood pressure, and more
- prescription is required
- slightly increases risk of breast cancer
Birth control pills are taken orally every day. For maximum effectiveness, take the pill around the same time every day.
There is no specific time of day that you have to take your pill. However, taking the pill in the evening or with a meal may decrease nausea.
As long as you meet the medical eligibility, there is no limit on how long you can be on the pill. If you want to become pregnant, you can stop taking the pill.
The chance of becoming pregnant while taking the pill is low. Planned Parenthood estimates that 9 percent of birth control pill users get pregnant. When taken perfectly, the chance of pregnancy while on the pill is 1 percent or less.
Aside from pregnancy, there are other combination pill side effects and risks to consider.
“The most common side effect… is irregular bleeding in the first few months of use,” says Katharine White, MD, a gynecologist and associate professor of OB-GYN at the Boston University School of Medicine.
“Your bleeding patterns will regulate with time — but if irregular bleeding doesn’t improve by your fourth pack, talk with your doctor about changing which pill you’re taking. A different combination of hormones may work better for you.”
If you want to switch birth control pills, chat with a medical professional about how to switch without having gaps in your birth control plan.
According to White, the risks of the combination pill are much lower than the risks of pregnancy. Pregnancy risks include blood clots, high blood pressure, heart attack, stroke, and liver tumors.
The pill may be right for you if you menstruate, meet the medical eligibility, and can remember to take the pill on a daily basis.
“Anyone who meets medical eligibility is a good candidate,” Kudesia explains. “Those who may not be good candidates would include those with a personal or family history of blood clots, or those with high blood pressure, migraines with aura, or who use tobacco.”
Kudesia says your physician can review your eligibility in more detail, but most people who menstruate are eligible for combination pills.
The best way to determine if the pill is right for you is to discuss it with your doctor or healthcare professional.
Many other birth control options are available besides the combination pill.
Here is a closer look at how the combination pill compares with a few other methods of birth control:
| Basics | Frequency of use | Effectiveness | |
|---|---|---|---|
| Combination pill | pill taken by mouth, which contains estrogen and progestin | daily | 91% |
| Minipill | pill taken by mouth, which contains progestin | daily | 91% |
| Vaginal ring | ring inserted vaginally, which contains estrogen and progestin | 3–5 weeks | 91% |
| Birth control patch | patch attached to skin, which contains estrogen and progestin | weekly | 91% |
| Depo-Provera shot | shot administered, which contains progestin | 3 months | 94% |
| Intrauterine device (IUD) | device inserted into the uterus, which may contain progestin or copper | 3–12 years | 99% |
| Implant | rod inserted into the arm, which releases progestin | 5 years | 99% |
| Spermicide | chemical inserted into vagina before sex, which kills sperm or prevents it from reaching an egg | before sexual intercourse | 72–86% |
| Diaphragm | small cup inserted into vagina before sex, which acts as a barrier to stop sperm from reaching an egg | before sexual intercourse | 88% |
| Condoms | external condoms are inserted onto penis before sexual intercourse internal condoms are inserted into vagina before sexual intercourse | before sexual intercourse | external condoms: 85% internal condoms: 79% |
| Sponge | sponge inserted into vagina before sex, which contains spermicide and acts as a barrier | before sexual intercourse | 76–88% |
| Fertility awareness method | involves tracking menstrual cycles to predict ovulation by using a calendar or tracking changes in body temperature or cervical mucus | daily | 76–88% |
The combination pill requires a prescription.
If you don’t have health insurance or don’t want to make an in-office appointment, these online birth control services make it easy to get combination pills delivered to you.
Nurx
- Price: $0 with insurance or $15 per pack out of pocket.
- Insurance accepted: Yes.
- Physician support included: Yes. A licensed medical professional will review your health history and write a prescription if medically appropriate.
- Discreet packaging: Yes.
- Other notes: Automatic refills and renewals are available, so there are no gaps in birth control. Other services are offered, including acne treatment, retinoid cream, and sexually transmitted infection (STI) testing.
Pandia Health
- Price: $0 with insurance or $15 out of pocket.
- Insurance accepted: Yes.
- Physician support included: Yes. A doctor will review your health form and determine if they’re going to write a prescription.
- Discreet packaging: Yes.
- Other notes: Free shipping is available to all 50 states.
Favor
- Price: $0 with insurance or $15 per pack out of pocket.
- Insurance accepted: Yes.
- Physician support included: Yes. A doctor will review your consultation and write a prescription accordingly.
- Discreet packaging: Yes.
- Other notes: Free goodies come in every delivery.
SimpleHealth
- Price: $0 with insurance or $9 to $10.66 per pack out of pocket.
- Insurance accepted: Yes.
- Physician support included: Yes. A doctor will review your consultation to determine your prescription.
- Discreet packaging: Yes.
- Other notes: Student discounts are offered.
Do combination pills work right away?
You can start taking combination pills at any time if you meet medical criteria.
According to Planned Parenthood, starting within 5 days of your period offers immediate protection. If you start at any other time in your menstrual cycle, the pill is effective after 7 days of daily use.
What brands are combination pills?
Some combination pill brands include:
- Alesse
- Apri
- Aranelle
- Aviane
- Azurette
- Beyaz
- Caziant
- Desogen
- Enpresse
- Estrostep Fe
- Gianvi
- Kariva
- Lessina
- Levlite
- Levora
- Loestrin
- Lybrel
- Mircette
- Natazia
- Nordette
- Ocella
- Low-Ogestrel
- Lo Ovral
- Ortho-Novum
- Ortho Tri-Cyclen
- Previfem
- Reclipsen
- Safyral
- Seasonale
- Seasonique
- TriNessa
- Velivet
- Yasmin
- Yaz
Do you get your period on a combination pill?
Skipping your period is only possible with combination birth control pills. You can skip your period by continually taking the birth control pills and skipping the hormone-free placebo pills.
Which combination pill is best?
In addition to preventing pregnancy, some combination birth control pills may also offer other benefits for issues like acne or painful period cramps.
Consider which secondary benefits are most important to you, along with other factors like the price and potential side effects, to find an option that fits your needs and preferences.
According to the
Online birth control services are accessible and affordable resources for people interested in the pill.
However, birth control is not one-size-fits-all. Many people who menstruate are great candidates for the pill, but there are risks, side effects, and contraindications. To determine if the combination pill is right for you, talk with a doctor.
Lacey Bourassa is a health, wellness, and beauty writer based in Southern California. She holds a BA in English. Her work has appeared in digital publications like Livestrong, Verywell, Business Insider, Eat This Not That, and others. When she’s not writing, Lacey is likely pursuing her other interests: skin care, plant-based cooking, pilates, and traveling. You can keep up with her by visiting her website or her blog.