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  3. Birth control

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How to Take Birth Control Pills: Step-by-Step Instructions

Here’s a detailed info on how birth control pills work, the different types of pills, and their effectiveness.

In the middle of the 20th century, oral contraceptives, commonly known as birth control pills or just "the pill", began to be produced. Over the last five decades, they have revolutionized women's health.

Today, women around the world take different birth control pills to prevent pregnancy. These pills can be up to 99.9% effective if you take them correctly. There’s a wide range of contraceptives available today to allow women to choose the type that best fits their lifestyle and budget. 

If you're new to the pill, this is everything you should know before you swallow one.

Birth control pills contain amounts of man-made estrogen and progestin hormones. These hormones inhibit the woman’s body natural cyclical hormones to prevent pregnancy. 

There are many factors at play that prevent women from carrying a child. The combination of hormones stops the body from ovulation. What’s more, the pill also thickens the mucus around the cervix, making it difficult for the sperm to enter the uterus and reach any eggs. 

Hormonal contraceptives can also affect the lining of the uterus and make it difficult for an egg to be implanted.

You should use the pill as your primary birth control method if you want to:

Birth control pills can also:

  • treat menstrual migraines
  • help you deal with the symptoms of perimenopause
  • treat the symptoms of endometriosis
  • control your PCOS  (polycystic ovary syndrome)
  • treat acne

You can start taking birth control pills in three different ways:

  1. On the first day of your period: you can start your pills on the first day of your period and take one every day, at the same time. With this method, you don’t need to use any backup pregnancy protection.
  2. On a day that best works for you: you can start taking your pills on any day that’s good for you. If you take your first pill today, continue to take one every day, at the same time. With this method, you need to use backup pregnancy protection for at least 7 days. 
  3. On a Sunday: the third suggestion is to start taking the pill on the first Sunday after the start of your period. Take one pill every day, at the same time, continuously. With this method, you need to use backup pregnancy protection for at least 7 days. 

Although you can take the pill at any time during the day, it’s better if you take it before breakfast or at bedtime since it’s easier to remember.

The most common birth control pills are the combination pills. They are a mix of estrogen and progestin hormones. Most of the combination pills come in 28-day, 21-day, or 91-day packs. 

Most pills in a pack are active, which means they contain hormones. There can be inactive pills in a pack, which means they don’t contain hormones. These non-hormonal birth control pills also called placebo pills. Taking the placebo pills will result in a withdrawal bleed (similar to period bleeding).

Today, women can choose between different options, including regiments that are all active pills or regiments that are a mix of active pills and placebo or non-hormonal birth control pills. 

28-day packs

These common birth control pills come packaged in a thin case. The case contains 21 active pills and 7 inactive pills. To remind you to take your pill every day, the pill packs are marked with the days of the week. Some pills have no non-hormonal birth control pills (placebo) or only two. 

21-day packs

Twenty-one-day pill packs contain 21 active pills. If you’re planning on using these pills, take one pill every day for 21 days. Then, for seven days, don’t take any. This is when you’ll get your period. 

91-day packs

The 91-day packs are extended-cycle pills. They are used in 13-week cycles where you take active pills for 12 weeks. During the last week, you take the placebo pills (or low-dose estrogen pills) and have your period.  Women who take these have their period only three to four times in a year. 

Progestin-Only Pills (Mini-Pills)

The progestin-only pills are common birth control pills that contain only one hormone (progestin). These pills don’t contain estrogen and are often prescribed to:

  • women who experience side-effects of estrogen
  • women who are over 35 and smoke
  • breastfeeding women
  • women who have high blood pressure
  • women who have dermatitis that seems to be related to their menstrual cycle

Just like with the combination pills, you need to take a pill once a day every day. The mini pills come in a pack of 28, without a row of inactive or non-hormonal birth control pills. If you happen to take the mini pill more than 3 hours outside of your usual time, it may not work as well to prevent pregnancy. If this happens, use a condom or don't have sex for 2 days.

According to CDC (Centers for Disease Control and Prevention), the mini pills and the combination pills have 9% failure rates with typical use. This means that 9 out of 100 women would get pregnant. The failures mostly happen because of women forgetting to take the pill regularly. In the perfect case, the failure rate would be around 1%.

It’s important to know that the mini pills must be taken within the same three-hour window every day. If not, you’re risking getting pregnant. 

With the combination pills, you have slightly more flexibility. You should try to take them at the same hour every day. If you miss an active pill, take it as soon as you remember — even if it means taking two active pills in the same day. You should also use a backup method of contraception for seven days if you missed your pill by more than 12 hours.

  1. Take one pill daily, at the same hour.
  2. Take the pills out of the pack from left to right. 
  3. If you’re taking 21-day pills, don’t take any pills during the fourth week. 
  4. If you’re using 28-day pills, once you get to the placebo pills at the end of the pack, start taking them the same way. 
  5. For 91-day combination pills, take one pill at the same time every day for 84 days. During the last week, take one non-hormonal birth control pill, or one that only contains estrogen, at the same time every day for seven days. 
  6. If you’re taking mini-pills, take one pill each day. Take your pill at the same hour, daily. When you finish your pack of pills, start a new pack the next day. You shouldn't have a day without a pill.
  7. As long as you take the pills, you are protected from getting pregnant.

When you stop taking birth control pills, it can take time for your body to return to normal. 

Most women report ovulating again a few weeks after stopping birth control pills. For other women, it might take a few months before they return to regular ovulation cycles. 

If you stop taking the pill but are still not ready to get pregnant, you might want to consider other birth control methods. 

Today, there’s a wide range of different birth control pills. Before taking one, it’s best to talk to your doctor first. Make sure to ask your doctor any questions you have in mind, including:

  • What type of birth control pills would be best for me?
  • I am taking certain medications. Can they cause problems with taking birth control pills?
  • What are the side-effects of birth control pills? 
  • Is there anything I should know about stopping birth control pills?
  • Should I use other types of contraceptive methods along with birth control pills?
Centers for Disease Control and Prevention:

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