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Guidelines for Taking the Combined Oral Birth Control Pill (Estrogen/Progesterone)

This handout explains the combined (estrogen/progesterone) oral birth control pill and how to take it.

How the Pill Works

Birth control pills are a safe and effective method to avoid getting pregnant. When taken as advised, the pill:

  • Stops the ovary from releasing an egg.

  • Thickens cervical mucus to stop the sperm from joining an egg.

  • Changes the lining of the uterus.

How Effective the Pill is

With typical use, meaning the pill is not always taken as directed, 9 out of 100 patients will become pregnant in the first year.

With perfect use, meaning the pill is always taken as directed, fewer than 1 out of 100 women will become pregnant in the first year.

Other Benefits of the Pill

  • Periods may be less heavy, shorter and you may have less cramping.

  • Decreased risk for ovarian and uterine cancer.

  • Decreased risk of ovarian cysts.

  • May improve acne.

  • Decreased risk of benign breast conditions.

  • Protects against osteoporosis, endometriosis, and rheumatoid arthritis.

How to Take the Birth Control Pill

  • Take your pills as directed.

  • Take your pill at the same time every day.

  • Be sure to use a condom or abstain from sex for the first 7 days of taking your pills to help prevent pregnancy.

  • Do not skip pills even if you are spotting or bleeding between periods.

  • Do not skip pills if you feel nauseous. Try switching your pill to a different time of day or take with a light meal.

Taking Birth Control Continuously

This means you will take active pills only. You will skip the placebo week to avoid having a period.

Some packs will have 3 weeks of pills and some packs will have 4 weeks of pills.

If your pack has 3 weeks’ worth of pills, complete the entire pack and wait 1 week before starting a new pack. During the week you are not taking pills, this is when you should have your period.

If your pack has 4 weeks’ worth of pills, take one active pill by mouth each day through the first 3 weeks of the pack. When you get to the 4th week (inactive pills), throw away the pack. Start the first active pill of the next pack.

Your provider will tell you how often you should take a break to have a withdrawal period.

Forgetting to Take a Pill

If you missed one pill (within the past 24 hours), take the missed pill as soon as you remember. Take your next pill at the normal time. It is okay to take two pills at the same time if you need to catch up. A back-up method of birth control is not needed.

If you missed two pills (within the past 48 hours), take the most recent pill you missed right away. If you missed other pills before that, throw them away. Take the next pill on time. This may mean taking 2 pills at one time. Take the rest of the active pills in the package on time. Throw away the inactive pills that you normally take (cycle method) and start your new pack the next day.

Use condoms or do not have intercourse for the next 7 days. Since you did not take a pill for over 48 hours, you are not safe against pregnancy again until you take it every day for 7 days in a row.

If you already had sex since missing your pill, think about taking emergency birth control. It works up to 5 days after unprotected sex. You can get it from a pharmacy or call your provider for a prescription.

If you miss more than 2 pills (or greater than 48 hours since missed pills), call your clinic for further instructions.

Pills and Your Periods

Your period should start by the third day of taking the inactive pills. Some women have some bleeding between periods, most often during the first three months of taking the pills. There is no reason to worry if you have been taking the pills the same time each day. Keep taking the pills as told.

Call your clinic if you still have bleeding between periods after the first three months or if bleeding becomes heavy or lasts longer than normal.

Some women will skip a period while on the pill. This is not a concern if you have not missed any pills or taken any late. If you miss two periods in a row, call your clinic.


If you are taking antibiotics while on the pill, you may have some bleeding. A back-up form of birth control is not needed while on antibiotics. Call your clinic with concerns.


The pill does not protect you from sexually transmitted diseases, including HIV.

If you smoke while taking the pill, you are at an increased risk of stroke, heart attacks, and blood clotting problems.

Rare but serious side effects include increased risk for blood clots in legs, chest, and stroke.

When to Call

Contact your clinic or local ER right away if you have any of the ACHES symptoms of blood clots or stroke.

  • Abdominal (stomach) pain that is severe or prolonged

  • Chest pain or shortness of breath

  • Severe Headaches

  • Eye problems, like blurred vision, flashing lights or blindness

  • Severe leg pains (calf or thighs)

Who to Call

After hours and weekends, please call your clinic. A nurse or paging operator will help you talk to the doctor on call.

Talk to your clinic about how often you need an exam and pap smear. Tell all your health care providers that you are taking birth control pills.