Adolescent Health Clinic: Birth Control Pills

Article Translations: (Spanish)

What is “the pill” or birth control pills?

Birth control pills are medicines that contain hormones to protect against pregnancy.  The combination birth control pills contain both an estrogen and progestin hormone.  The pill is about 90% effective in preventing pregnancy, and that number is higher if the pill is taken every day as prescribed.

What are the benefits of the pill?

• Lighter and less painful periods, which is great for people who have anemia or are missing school or activities due to pain
• Improvement in acne or bothersome facial hair
• Options to skip or not have periods
• Prevention of ovarian cysts and pain with ovulation
• Contraception (pregnancy prevention), which allows people with a uterus to delay pregnancy until they are ready

What side effects are normal?

Common side effects include:

• Nausea
• Mild headaches
• Breast tenderness

This usually gets better after you have been on the pill for a while. If you have nausea, mild headaches or breast tenderness that doesn’t get better with time, talk to your provider about different birth control pills that might cause less nausea.

Almost everyone will have unpredictable bleeding or breakthrough bleeding when they first start birth control pills – this is normal!  Bodies take some time to adapt to the birth control pill.  If you have unpredictable bleeding or spotting and you are in the first 3 months of starting birth control pills, keep taking your pills – this will almost always get better with time.

If you miss birth control pills, you may have spotting or breakthrough bleeding.

The pill should NOT cause weight gain.

The pill does not usually cause emotional changes, but always talk to your provider if you have concerns about emotions or mental health.

Are birth control pills safe?

• Birth control pills are very safe. However, like all medications, birth control pills have some risks.  These risks are much less than the risks that you would experience if you become pregnant.
• There is a slightly increased risk of a blood clot, stroke, or heart attack in people who take birth control pills. These are very rare, especially in young people, but your doctor will ask you about your medical and family history to make sure birth control pills are safe for you.

When should I call the doctor?

• You are bleeding heavily, soaking a large tampon or pad every hour for more than 2 hours
• You are bleeding more than 7 days
• You have chest pain or shortness of breath
• You have severe leg pain
• You have annoying side effects (like nausea, stomach upset, mild headaches) that do not resolve within a month of starting the pill
• You have unpredictable bleeding or spotting after you’ve been on the pill for 3 full months

What time should I take the pill?

• You can choose what time of day you want to take the pill. As long as you take 1 pill every day, you will be protected from pregnancy. Try to take it roughly at the same time each day because that can make it easier to remember.  There are lots of apps that are free that can send reminders if remembering to take the pill every day is a challenge. 

Why are the pills different colors?  Does it matter which one I take?

• Yes! Some pills are active and some pills are “placebo” or “reminder” pills.
• Combination pills often come in 28 or 21 day packs.
• If you have a 28 day pack: Take 1 pill every day for 28 days (four weeks in a row) and then start a new pack on day 29.  The last pills in 28-day packs do not have hormones in them.  These are “reminder” or “placebo” pills – they help you remember to take your pill every day and start your next pack on time.  How many days you take hormone-free reminder pills depends on the brand of the pill.  These pills are usually a different color than the active, or hormone-containing, pills.  You will typically get your period during the week you take reminder pills.  You will still be protected from pregnancy even if you don’t take the reminder pills, as long as you take the active pills on time and start your next pack on time.

When should I start the pill?

• If you start pills within 5 days after your period starts, you are protected from pregnancy right away. For example, if your period started Monday, you can start the pill anytime until Saturday morning and be protected right away!
• If you start birth control pills any other time, you will need to take the pill for 7 days before you are protected from pregnancy. Use another method of birth control (like a condom) if you have any penis-in-vagina sex during the first week on the pill.

What happens if I forget to take the pill?

• If you missed one pill, take it as soon as you remember. If you don’t remember until the next day, still take it right away, even if it means you take 2 pills on one day.
• If you miss 2 or more active pills in a row, take the most recently missed pill as soon as possible, even if it means taking two pills on one day. Throw away the other pills you missed.  
  • If you are having penis-in-vagina sex, you will be at higher risk of pregnancy if you miss 2 active pills. To prevent pregnancy, you should use back-up contraception for 7 days.  If you have had penis-in-vagina sex in the previous 5 days, talk to your provider about if emergency contraception would be helpful for you. 

Questions?

This information is not specific to your child but provides general information. If you have any questions, please call your clinic.

Reviewed 7/2023

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