Pediatric and Adolescent Gynecology

Using the pill

[See also: Using the pill; not for contraception]

How does the pill work?

Without birth control pills, estrogen and progesterone are released from your ovaries. When you are on birth control pills (“the pill”), your body knows that estrogen and progesterone are coming from somewhere else (from the pills). Because your ovaries don’t need to release hormones, they “take a little nap.” While they’re “napping,” they don’t release hormones, and don’t release an egg, which is how they work for birth control.

Forgetting pills or taking them at different times of the day can cause the ovaries to “wake up.” When that happens, the ovaries release hormones, which can cause irregular periods and may release an egg, which can cause women to get pregnant.

How to use the pill

  • Start your first pack of pills as directed - You may be told to start on the first day of your next period, or - on the Sunday after your next period begins, or- on the day you are in the clinic or office.
  • After starting the pill, continue taking one pill every day. There should not be any days that you don’t take a pill.
  • With birth control pills the first 21-24 days are hormone pills and the last 4-7 are usually sugar pills (placebo). Most people start their bleeding on the 2nd or 3rd day of the placebo pills.
  • If you are taking the pills with an extended cycle, your doctor or nurse practitioner will tell you when to expect bleeding.

What to do if you forget to take a pill

  • If you forget to take a hormone pill at your usual time, take your pill as soon as you remember. Then take the next pill at the usual time. You will be taking two pills that day.
  • If you forget to take a hormone pill for 1 whole day, take 2 hormone pills the next day at the regular time.
  • If you forget to take a hormone pill for 2 days, take 2 hormone pills for each of the next 2 days.
  • If you forget to take the pill for 3 days, your ovaries may “wake back up.” Start a new pack of pills.
  • Forgotten placebo pills do not need to be made up.
  • If you have questions about what to do with missed or late pills, call the triage nurse.

Most people don’t have any side effects with birth control pills

However, during the first three months you may experience:

  • Bleeding or spotting during the hormone pills. This is called breakthrough bleeding and is usually worst during month 1, less during month 2, and by month 3 most people have regular periods during the last week of pills. If breakthrough bleeding continues after month 3, you may need a different pill.
  • Other problems are not common, but you may have nausea, breast tenderness, headaches, or mood changes. If they occur, they are usually mild and don’t last long.
  • If you are having problems that are making you feel miserable, do not stop taking your pills, but call the triage nurse.
  • Birth control pills do not cause weight gain.

Danger signs on the pill

Call the office immediately if you have:

  • Dizziness
  • Vision changes

Consider immediate evaluation if you experience the following

  • Severe headaches (the worst headache you’ve ever had)
  • Chest pain
  • Pain in the calf of one leg


  • Birth control pills do not protect against sexually transmitted diseases. Use condoms every time you have sex.
  • Never run out of pills. You can always call the triage nurse and ask for a refill.
  • If we gave you samples of pills and you will run out of pills before your next visit, call the triage nurse and we will call a prescription to your pharmacy.
  • Never take someone else’s birth control pills or share yours with anyone else.
  • If you are having a problem, don’t just stop taking the pill. Call the triage nurse.
  • There are about 50 different birth control pills. If you are miserable on the one you’re on, call the triage nurse and we can change you to another pill that might be much better for you.