Starting the Pill Correctly: Combination Pills + Mini Pills
With a little planning, taking the pill correctly is not difficult. There are three main types of birth control pills, and your doctor will consider your individual circumstances when they decide which pill to prescribe you. All three require similar levels of responsibility. It may be annoying to think about all these rules, but remember that the pill brings a 99% efficacy rate when taken correctly. Obviously, PLEASE READ THE SPECIFIC INSTRUCTIONS THAT COME WITH YOUR PILL. Each pill brand is different, and there might be minor differences in how you’re meant to take it. Nevertheless, the following rules generally apply.
28 Pack Combination Pills
28 pack combination pills include both 21 “active” pills, which deliver a combination of both estrogen and progestin, and 7 “inactive” pills, which do not contain any necessary hormones for pregnancy prevention.
You have a few options when it comes to starting 28 pack pills: a day 1 start, Sunday start, or anytime start. Each option has pros and cons.
1) Day 1 Start
Get your hands on a pill pack, wait until you start your period, and then take pill 1 of your pack on the first day of your period. Use midnight as your mark for a day, so even if you get your period at 11 pm, take your pill that day.
Pros: Because you start introducing hormones at the very beginning of your cycle, you are immediately protected from pregnancy.
Cons: Pill packs are labeled to start on Sunday, as seen in the above image; if your period starts on any other day, a Day 1 start will make you “unsynced” from your pack. That means the labels on your pack will be incorrect, and it will be up to you to count the days yourself. Also, you risk starting your period during the weekend, which is a bummer.
2) Sunday Start
Get your hands on a pill pack, wait until you start your period, and then take pill 1 on the next closest Sunday. If you start your period on Tuesday the 21st, take pill 1 on Sunday the 26th.
In my experience, most people I know chose a Sunday start, mostly because it’s a pain to have to relabel the days in a pill pack if you choose a Day 1 start.
Pros: Pill packs start on Sunday, so you’ll be taking the pill exactly as listed on the pack, and thus the process of taking the pill and moving between packs will be very simple. Also, you’ll never start your period on the weekend; you’ll likely start your period on Wednesday or Thursday, and your flow will be lighter by the weekend.
Cons: You’ll have to use another form of birth control (like condoms) for seven days after you take pill 1, since Sunday Starts are not immediately effective.
3) Anytime Start
Get your hands on a pill pack and take pill 1 the day you get the pack. It is worth noting that I personally cannot find a brand of birth control pill that even mentions this method; pill pack instructions almost universally recommend either the Day 1 or Sunday start. However, trustworthy sources like Planned Parenthood and Flo Health consider it a useful option, so I’ve chosen to include it. Starting the pill any time in the first five days of your period is a good option and leads to solid pregnancy protection; it just isn’t specifically recommended.
Pros: It’s easy, and you don’t have to do any thinking. Get the pack, pop a pill, and you’re on BC.
Cons: Since pill packs are labeled to start on Sunday, taking pill 1 on any other day will “unsync” you from the pack, meaning the labeled days will no longer match when you take the pills. It will be up to you to count the days yourself. More importantly, if you start the pill in the middle of your cycle, you are introducing hormones at an unideal time and are at risk for a good deal of “breakthrough bleeding,” which is when changes in hormone levels make you bleed even though it’s not your period. You will need to use another form of contraception (like condoms) for at least seven days after starting the pack.
In theory, you are protected from pregnancy immediately if you choose a day 1 start and are protected 7 days after taking pill 1 if you start any other day. However, in the American South, I urge you to be cautious. Your first pill pack is complicated, since it’s interrupting your body’s natural cycle and replacing the hormones. So, you should only consider yourself fully protected once you have taken pill 1 of your 2nd pack, because then you have fully transitioned to the pill’s hormonal protection. To avoid any anxiety (and to truly be 99% protected), it’s recommended you use condoms until you take pill 1 of your 2nd pack.
21 Pack Combination Pills
21 pack combination pills include only 21 “active” pills, which deliver a combination of estrogen and progestin, and zero “inactive pills”, which contain no hormones. These pills are basically 28 packs without the placebo pills; this means every pill in the pack must be taken to prevent pregnancy effectively.
Because 28 packs and 21 packs are basically the same hormonally, you have the same options when it comes to starting them: Day 1 Start, Sunday Start, and Anytime Start. You should scroll up for pros and cons, but in general, Day 1 provides immediate protection, Sunday makes following instructions easier, and Anytime isn’t a great idea overall.
1) Day 1 Start
Get your hands on a pill pack, wait until you start your period, and then take pill 1 of your pack on the first day of your period.
2) Sunday Start
Get your hands on a pill pack, wait until you start your period, and then take pill 1 on the next closest Sunday. If you start your period on Tuesday the 21st, take pill 1 on Sunday the 26th.
3) Anytime Start
Get your hands on a pill pack and take pill 1 the day you get the pack.
Mini Pills
“Mini” pill packs are so-called because they only contain the hormone progestin, which makes them smaller than combination pills. Mini pills come in packs of 28, all of which contain the hormone progestin. This means every pill in the pack must be taken in order to effectively prevent pregnancy. Taking the mini pill correctly can take a bit more planning than the combination pill; you can read more below.
Starting the Mini Pill:
Based on pill instruction manuals, there’s one ideal way to start taking the pill. Take pill 1 of your pack on the first day of your period. You’ll be immediately protected from pregnancy.
However, if you want to start having sex in the middle of your cycle, don’t worry! You can start taking the mini pill at any time; just use a backup method (like condoms) for 48 hours after you take your first pill. It’s a short period before you reach full efficacy, so it’s best (and easiest!) for a lot of people to take the mini pill as soon as they get it.