What is the pill?
The pill (also known as an oral contraceptive or OC) like other contraceptives that contain both an estrogen and a progestin, is called a combination hormonal contraceptive (CHC).
Most combination OCs come in 21-pill, 28-pill and 91-pill packages. The 21-pill pack contains 21 active tablets (tablets with hormone), the 28-pill pack contains 21 active tablets and 7 inactive tablets (tablets that contain no hormones), and the 91-pill pack contains 84 active tablets and 7 inactive tablets. The active tablets typically contain 20–50 micrograms of estrogen and varying levels of a progestin. The inactive tablets help keep you in the habit of taking a pill every day.
The pill is administered once-daily and must be taken at approximately the same time each day. Some women may find it convenient to include the pill as part of their daily routine. Incorrect use of any hormonal contraceptive is associated with an increased risk of unintended pregnancy.
How does it work?
Like other CHCs, the combination pill works in two ways:
- By inhibiting the monthly release of an egg by the ovaries.
- By changing the mucus produced by the cervix. This slows the movement of the sperm through the mucus and through the uterus (womb).
Questions about the combination pill:
Is it important that I take the pill at the same time every day?
Yes, you should take the pill at the same time every day.
Will I experience unusual bleeding patterns while I’m on the pill?
Unexpected bleeding occurs in 10-30% of women in the first month of use but this appears to improve with time.
Factors to consider about the pill
- When used as directed, the combination pill provides reliable contraception for a full month, or 3 months in the case of the 91-pill pack.
- Use an extra method of birth control (barrier method) such as condoms or spermicides for the first 7 days when you start taking the combination pill.
- Some products deliver a low dose of hormones.
- It does not protect against sexually transmitted infections (STIs)
Factors to consider about combined hormonal contraceptives
- They are effective and reversible
- Combined hormonal contraceptives do not protect against sexually transmitted infections (STIs)
- Common side effects associated with combined hormonal contraceptives include: headaches, nausea, breast tenderness, and bleeding between periods
- They may increase the risk of blood clots
Several health advantages other than contraception have been reported for combination hormonal contraceptives:
- a reduction in the incidence of cancer of the endometrium and ovaries
- a reduction in the likelihood of developing benign breast disease
- a reduction in the likelihood of development of functional ovarian cysts
- less menstrual blood loss and more regular cycles, thereby reducing the chance of developing iron-deficiency anemia
- a potential decrease the severity of dysmenorrhea and premenstrual syndrome
- a potential decrease the incidence of acute pelvic inflammatory disease, thereby reducing the incidence of ectopic pregnancy potential beneficial effects on endometriosis
- potential beneficial effects on endometriosis
The Mini Pill
The mini pill (or progestin-only pill) is a birth control pill that contains 0.35 milligrams of norethindrone, a progestin.
How Does It Work?
The mini-pill works mainly by thickening your cervical mucus to prevent the sperm from reaching the egg, though it sometimes stops ovulation. You must take it every day at about the same time or the effectiveness could be reduced. There are no days of inactive pills, so the hormone is taken on a continuous basis.
Questions about the progestin-only pill:
Is there a pill-free interval?
There is no pill-free interval. A pill containing active hormone is taken every day.
Will I experience unexpected bleeding?
In the first month of use, spotting occurs in about 12% of users, but this typically decreases to less than 3% at 18 months.
Factors to consider about the mini-pill
When used as directed, the mini-pill provides reliable contraception for a full month. You’ll need to use a backup method of contraception during your first month of taking the mini-pill, if you miss a pill or are more than 3 hours late in taking a pill. It does not protect against sexually transmitted infections (STIs)
Factors to consider about progestin-only contraceptives
- They are effective and reversible
- They may have slightly different side effects than combined hormonal contraceptives because they do not contain estrogen
- They may decrease menstrual bleeding and cramping
- They can be used by women who are sensitive to estrogen-containing contraceptives
- They can be used by breastfeeding mothers and have no effect on breast milk production
- Progestin-only contraceptives do not protect against sexually transmitted infections (STIs)
- Common side effects associated with progestin-only contraceptives include: headaches, nausea, breast tenderness, dizziness, and bleeding irregularities
Inform yourself and talk to your doctor
There are many choices of hormonal contraceptive available. Do your own research and speak with your doctor about the advantages and disadvantages of the different available types of hormonal contraceptive and choose the one that best fits your needs.
For tips on how to get the most out of your doctor’s visit, see Talking to your doctor.
Cigarette smoking increases the risk of serious adverse effects on the heart and blood vessels. This risk increases with age and becomes significant in hormonal contraceptive users over 35 years of age. Women who use hormonal contraceptives are strongly advised not to smoke.
