December 05, 2012

Hormonal Methods of Birth Control: The Pill

So -- what is it?

Birth control pills -- often referred to as "The Pill" or "oral contraceptives" -- are a hormonal method of birth control. There are actually two types of birth control pills -- pills that contain both estrogen and progestin (these are called "combination pills") and pills that are progestin-only. Most people, however, use the combined pill. 

Birth control pills come in small, discreet packs and you take one every day to prevent pregnancy. The hormones in these pills work to prevent pregnancy in two ways: 
  • preventing ovulation; ie, keeping the ovaries from releasing an egg (if there's no egg, there's nothing for the sperm to fertilize)
  • thickening the cervical mucus, making it difficult for the sperm to swim and preventing them from reaching the eggs
When used properly, the pill is highly effective.
How effective is it/how do you use it?

When taken correctly, the pill is a highly effective birth control method. Less than 1 out of 100 people will get pregnant each year if they always take the pill each day as directed. However, with typical use, about 9 out of 100 people will get pregnant each year because they don’t always take the pill each day as directed. As you'd probably expect, the effectiveness varies greatly depending on whether or not you take them the right way.

"Perfect use" varies slightly in meaning with the pill, depending on the type you're taking. 
  • If you're using progestin-only pills, you have to take it at the same time each day. Same. Time. 
  • Combination pills must simply be taken once a day, with less importance being placed on the time you take it. 
When I was on the pill for two years, I had two daily alarms set on my phone to make sure I took my pill every single day; a primary alarm and a back-up one ten minutes later. While it matters less if you're not on the progestin-only pills, I still personally suggest taking your pill at roughly the same time every day so it becomes a regular and expected part of your routine. This way, you're less likely to accidentally skip a day.
A 28-pack of combination pills, with a week of "inactive" pills at the bottom.
In the photo above, you'll notice that this pill packet has one week of white pills at the bottom. That's a pack of combination pills. The combination pill comes in packs of either 21 or 28. In both of these, the pack contains 21 "active" pills (pills with hormones). In 28-day packs, there are one week of "inactive" pills (pills without hormones) at the bottom, also called "placebos". During the week of "inactive" pills is when you should, roughly, have your period each month. Even though these pills have no hormones in them, you're still protected from pregnancy during this week. The only reason that week of inactive pills are present in 28-day packs are to keep you in the habit of taking it each and every day. In 21-day packs, this inactive week is not present. With those, you simply take your pill daily for three weeks, go without taking it for exactly one week, then start a new pack -- but you really gotta make sure you start taking them on the right day!

Some packs of combination pills come with months worth of active pills. These are specifically designed to reduce the number of periods you have in a year. Some people also continuously take active pills -- that is, they skip their inactive week and immediately start taking their next pack -- to avoid their periods.

However, progestin-only pills only come in 28-day packs. There are no inactive pills with progestin-only packs. With these, several things could happen -- you might get your period during the fourth week, get no periods at all, or have bleeding on and off throughout the month. 


What happens if I don't take my pill correctly?

Oops. Mistakes happen. If you accidentally skip a day, yet again, what you do next varies a little bit depending upon which type of pill you're taking. 

Combination Pills

How at-risk for pregnancy you are depends on when you missed a pill and how many of them you missed. The risk gets a lot higher if you went seven or more days without having any hormones -- this might happen if you don't start your new pack on time, and/or if you forget to take the last one or two pills.

If you have PIV sex during the seven days after one of your missed pills, you'll want to use a back up method, such as a condom. You can also take emergency contraception for up to five days after unprotected sex to prevent pregnancy. This is a great option if you had PIV sex before you realized you missed any pills. The sooner you take emergency contraception, the better it works, so don't stall!

This table tells you what to do if you miss any pills from a 21-day or 28-day pack of combination pills:

Chart from

Progestin-Only Pills

You can become pregnant if you take progrestin-only pills more than three hours later than your regular time. If this happens: 
  • Take the pill the moment you remember.
  • Take the next pill at the usual time (this could mean you take two pills in a day).
  • Continue to take the rest of your pack at your regular time.
  • If you have PIV sex within the next 48 hours, use a back-up method, such as a condom.
  • If you had PIV sex before realizing you missed your pill, you can also use emergency contraception for up to five days after unprotected sex to prevent pregnancy.  Like I said earlier, the faster you take it, the better it works, so hop-to.
Even if you quickly correct your mistake, missing a pill often leads to spotting/irregular bleeding, so don't be alarmed if this happens. Taking two pills in a day can also lead to some nausea and general feelings of crappiness, but don't worry, it'll pass soon.

An important thing to note -- if you vomit shortly after taking one of your pills, you should consider that pill "missed". The general rule of thumb is 30 minutes. Follow the missed-pill instructions above if this happens or contact your doctor and ask them for directions on what to do next. 


Many people love relying on the pill as a means of birth control because it's easy, effective, and offers a range of benefits. For example, both the combined pill and the progestin-only pills reduce menstrual cramps, make your periods lighter, and offer some protection against Pelvic Inflammatory Disease. Combination pills offer many more benefits, such as protection against acne, bone thinning, non-cancerous breast growths, ectopic pregnancy, ovarian cancer, ovarian cysts, irregular periods, and extreme PMS symptoms, such as depression and headaches. 

If you want to use hormonal birth control but don't think you can remember to take a daily pill, you might want to look into another hormonal method, such as the vaginal ring, the Implant, or the IUD

It's important to remember that the pill does nothing to protect you from sexually transmitted infections.  Unless you are in a relationship where you know for a fact that everyone involved has been tested and is free of STIs, you should still use a condom when having sex.

Most times, birth control pills cannot be obtained without a prescription. If you don't have insurance, there are health clinics (such as Planned Parenthood) who are willing to give it to you for a reduced price. To get on the pill, a doctor will give you a brief check-up and ask you questions about your medical and sexual past to decide if this is the right method for you and which of the two sorts of pills would be best for you. 


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  4. I didn't realize that a woman needs to take the pill every day in order to prevent pregnancy. However, it does seem quite efficient. After all, it is over 99% effective. Are there any other alternatives for birth control that you would suggest? I'm only asking because my wife and I think that she may be allergic to the pill.

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