Instructions for Using Birth Control Pills

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Written by Allen Lawrence, M.D.

Instructions for Using Birth Control Pills

Starting Birth Control Pills

While we would like to tell you that you can just start using your birth control pills today or tomorrow it is likely that this would not be the right thing to do. Basically to make it as simple as possible you should start your birth control pills on the first Sunday after your next menstrual period.

To be safe until then we strongly suggest that you use a back-up method of birth control (such as foam and condoms) until your start your first package of pills and for the first three weeks after you have started these pills. Even when you start your pills exactly when you are supposed to and you are using them perfectly correctly your new birth control pills may not fully protect you from pregnancy during the first month of use. Make sure your back-up method is available at all times so you take no chances.

We suggest that you learn to use the back-up method in case you run out of pills or experience pill danger signals, miss one or more pills or stop taking your pills before the end of your cycle for any reason.

Your First Cycle of Birth Control Pills

There are several methods to begin taking your pills. At the beginning of this information paper we suggested that you use the most common method, that is starting your first package of pills on the first Sunday after your next menstrual period begins. If your period should start on that Sunday, start pills that very day. If it starts any other day, wait until Sunday and start then. Thereafter, every fifth Sunday, for as long as you are using birth control pills, you will start a new package of pills.

There are two types of packaging of birth control pills. They are packaged as 28-Day Pills or 21-Day Pills. In the next section we will discuss both but you can determine which type you are to be using by looking at the prescription and seeing is it is labeled as 28 or 21 day packages. Secondly, you can just look at the pill packaging it self it should either say or you should easily see only 21 pills in the 21-Day Pills or you will see 28 pills in the 28-Day pills. It really does not matter which type is prescribed for you. I tend to use the 28 day packaging more commonly as using 28 pills means that you never have to stop taking pills and therefore will less likely forget when to start your next package of pills.

28-Day Birth Control Pills

The 28-day pack contains 21 active pills and seven blank or inert pills. The seven blank pills serve as memory aids or spacers; you will take one pill every day and do not have to think about when to start a new pack. After starting the pills, you will take one pill a day until you finish the pack. You will finish the pack on a Saturday and will start your next pack the very next day, Sunday.

Usually you will have your period while you are taking the last seven pills. You are still protected from pregnancy while taking the seven blank pills.

21-Day Birth Control Pills

The 4-5 pack contains 21 active pills. If you are using a 21-day pack, you will take one pill every day until you finish the pack. If you started the pack on a Sunday, you should finish this pack on a Saturday. You will then wait one week and start your next pack on the following Sunday. You will usually have your period during the week between pill packs. It differs from the 28-Day pills in that you will not be taking any pills (spacer or active) for the next seven days. During the week that you take no pills, you are still protected from pregnancy.

Tri-Level Birth Control Pills

Tri-level birth control pills act in exactly the same way as the 21-Day or 28-Day pills and are taken in exactly the same manner as the 28-Day pills. Their only difference is that they have three different types of pills in the 21-day pills and four different types of pills in the 28-Day pills. The in each there are three sets of seven pills with varying dosages of active hormones, the exact amount depends on the specific brand. In the 21-Day tri-level there is no spacers or inactive pills, however, in the 28-Day variety the last seven pills are once again spacers an inactive. All of the instructions about pills work exactly as we have already described.

Create a Birth Control Pill Habit

It is important to create a system or habit of taking your pills everyday at approximately the same time. Birth control pills work best if taken at about the same time every day in order to keep a steady level of hormones in your system. It may help to associate taking your pill with something else you do at about the same time every day - like going to bed, eating a meal or brushing your teeth. Having a strong habit will help you to insure not missing any pills and hence increasing your risk of birth control pill failure and unwanted pregnancy.

Problems You Should Know About:

1. Bleeding Between Periods

You may have spotting or bleeding between periods. This us usually referred to as breakthrough bleeding. This is best reduced by taking your pills at the same time every day. If you have breakthrough bleeding, continue to take your pills as usual. If the spotting continues for two or more cycles you should call your health care provider and make an appointment as there may be a correctable reason for the bleeding. If you have been taking medications such as antibiotics or vitamin C along with your pills you may experience breakthrough bleeding because of these medications. If so do not stop antibiotics early finish them up and see what happens. If you are taking vitamin C and think that it is causing your bleeding stop the vitamin C for a while and se if the bleeding goes away. If it does then it is the likely cause. Next you can restart the vitamin C but you may have to live with the bleeding if you want to continue using it. Whenever antibiotics are prescribed for you use a back-up method (foam and condoms) for that cycle to be absolutely safe.

2. What Happens If You Should Forget a Pill?

If you forget one pill, take it as soon as you remember and take today's pill at the regular time. You probably won't get pregnant. If you want to be sure, use a back-up method for seven days. If you miss two pills in a row, take two pills as soon as you remember and two the next day. You may have some spotting. Again, use a back-up method for the next seven days. When you have missed pills, despite your catching up, you may experience breakthrough bleeding which can last even for the rest of the pill pack.

If you miss three pills in a row, you will probably begin your period. Whether or not you are menstruating throw away the rest of the pack and begin your next pack as you did when you started taking pills.. For example, if you are a "Sunday starter" begin your next pack on Sunday. Once again, even though you are bleeding if you are sexually active, use a back-up method for your safety

If the only pills you miss are from the fourth week of a 28-day pill pack, that is the spacer or inert pills, all you will have to do is throw away the missed pills. The pills in the fourth week contain no hormones. Missing these pills does not increase your risk for pregnancy at all.

3. What Happens If I Have Severe Diarrhea or Vomiting While I Am on the Pills?

If you become sick for several days or more and experience severe diarrhea or vomiting use your back-up method of birth control until your next period. Start using the back-up method the first day of your illness. If you can continue taking your pills and if you cannot act as if you had never been on them at all and continue to use a back-up method until the fist Sunday after your next menstrual period when you restart you next pack of pills.

4. What Happens If I Miss a Period?

If you did not miss any pills and did not take any other medications along with the pill, and have no signs of pregnancy, you are not likely to be pregnant. Many women taking birth control pills miss an occasional period. If you are worried, contact your doctor. If you are fairly certain that you are not pregnant then you go ahead and start a new package of pills at the regularly scheduled time and be fairly safe.

If you have missed one or more pills and miss a period, complete you pills as described above and whether or not you have a period start taking your next cycle of pills as we have described above on the appropriate Sunday. If you have any question about having become pregnant either take a home pregnancy test or see your doctor for a pregnancy test.

5. What About Taking Other Medications?

The effectiveness of birth control pills may be slightly decreased by a number of drugs that change the way your liver manages the birth control pill's hormones. Some can also decrease your body's ability to absorb the hormones in birth control pills. Be sure to tell your health care provider if you are taking rifampin, dilantin (phenytoin), carbamazepine, ampicillin or tetracycline. If you are not sure about taking any of these medication ether bring all of your medications and vitamins to your doctor's office or call and tell him or her what you are taking. Once again, use a back-up contraceptive method while taking these medications.

Vitamin C may increase the level of estrogen in your blood and may lead to increased spotting. If you need to take vitamin C daily (especially one gram or more), take it at least four hours apart from taking your birth control pill. This will prevent any interaction between the vitamin C and the birth control pills. Using vitamin C will not increase your risk of getting pregnant only for bleeding.

6. What Kinds of Things Should I Do's Or Not Do When Using Birth Control Pills?

Do not run out of pills; make your doctor's appointment before you end your last pack or after you have stopped your period before having to start the next pack.
Do plan for a yearly Pap smear, breast examination and general physical exam.
Do not give your pills to anyone or exchange them with your friends. Your pills are prescribed for you only, what is good for you may be dangerous or even life-threatening for someone else.
If you experience any problems which may possibly be complications of pill use such as severe headaches, sudden blurring of vision or loss of vision, leg pains, chest pains or shortness of breath call your doctor and see him or her immediately. If your doctor is not immediately available, go to the emergency room. Use another method of birth control if you stop pills.

7. What Will Happen to Me If I Stop My Pills Before the End of a Cycle?

Pill use can be discontinued at the end of any cycle. Consider yourself at risk for getting pregnant as soon as you stop using your pills. Begin using another method for protection against unwanted pregnancy immediately (you can buy foam and/or condoms at any drugstore!) If you intend to get pregnant, it is best to stop your pills at least three months before having unprotected intercourse. It is not unusual for a woman to miss a period or two after stopping pills (although most women begin normal cycling right away).

Should you miss any periods after stopping your birth control pills, do not assume, however, that you are missing your periods because of having stopped the pills. If you've been having intercourse and miss your first one or two periods off the pills, consider the possibility that you have become pregnant and do a home pregnancy test or see your doctor and have a pregnancy test done, even if you have been using another method.

8. What About Sexually Transmitted Diseases?

The pill is a very convenient and very effective contraceptive method. The pill does not, however, does not provide protection women from viruses and bacteria that cause sexually transmitted infections. Condoms, along with birth control pills, help protect against sexually transmitted diseases such as HIV, chlamydia, herpes, gonorrhea, syphilis and genital warts. Condoms and foam or a nonoxydol product such as spermicidal cream or jelly provide even more protection against some STD's. For the best protection, use condoms and a nonoxydol product every time you have sex.

The condom should be placed on the penis before it has contact with the vulva or vagina. Nonoxydol products should also be used internally or within the condom prior to having intercourse. These intravaginal spermicidal products and condoms do provide documented extra protection. The spermicide is thought to kill bacteria and viruses as well as sperm. Natural membrane (skin) condoms are less effective in preventing disease.

In Summary:

Birth control pills are an effective method of preventing pregnancy, but only if used correctly. In the information provided above we have tried to hit the highlights of how you can maximize the effectiveness of oral contraceptives. Start them on the right day, use back-up methods if you miss pills, are sick or using certain medications.

Never take birth control pills for granted.

They will only work effectively, if they are used according to their specific instructions recommended for their use.