The Birth Control Pill: Taking it Correctly (Combination Pills)

When taken correctly, birth control pills have an efficacy rate of 99%, meaning that only 1 couple on the pill out of a hundred will become pregnant within a year. But taking the pill correctly means following certain steps. Remember to read the instructions on your individual pill pack, but these rules in general will help you reach maximum efficiency. Ideal use looks different for every type of pill, so scroll until you see the type you’ve been prescribed.

28 Pack Combination Pills

1)    Take it every day

Take your pill every day at roughly the same time. This is a little confusing, and I’ll be honest: there isn’t much medical data on exactly how late you can take your pill and still be protected. With combination pills, you can generally be a few hours late and be fine. But you shouldn’t make lateness a habit: the pill needs to be taken every 24 hours, and “perfect use” was defined in the lab as taken every day at the same time. 15 minutes won’t kill you, but consistently taking the pill a few hours late every day will decrease your efficacy. If you’re worried about abortion access in your state and you’re using the pill as your only form of contraception, you should take it at the same time every day.

In addition, taking the pill at the same time every day ensures you won’t forget to take it; missing even a single day may increase your chances of pregnancy, and taking the pill at the same time helps you remember to take it. My advice is to take your pill when something else daily happens. For example, I recommend students at my university take their birth control when the chapel bells ring at 5 pm every day. Everyone on campus can hear the bells, and it’s a good physical reminder to go ahead and grab a pill. Think about other things in your life that happen at the same time every day and try to take your pill alongside them. Another strategy is to take your pill when it’s physically easy. Some friends I know keep their pill next to their makeup and take it in the morning, or in their lunchbox and take it at noon.

2)    Consider Your Lifestyle

Remember to account for life’s irregularity when deciding your pill strategy, because you must take your pill every day. Every day you miss leads to a higher chance of pregnancy. For example, if you regularly sleep in places that are not your bedroom (ie, college girls on Friday nights!,) I don’t recommend you take your pill when you sleep, since you’ll often find yourself sleeping far away from your pill pack. If your routine is going to be different than usual, you need to change your pill strategy . For example, if you keep your pill next to your bed, but you’re going to live at your Dad’s place this week, you need to remember to pack them. If you keep your pills in the car glovebox but your boyfriend drives you to school one morning, you must remember to grab them.

Constantly moving your pill pack around can get confusing. For that reason, I suggest keeping your pill in something you almost always have on you, like your purse or backpack. If you think about it, there’s probably something you have with you every single day at a certain time, no matter what. For instance, no matter how crazy the day is, Duke students are almost all working, studying, or attending class at 5pm. Everyone who keeps their pill in their backpack can easily reach in and take it as soon as the bells chime.

3)    Take Your Pills in Order

For the first three weeks of your 28 pill pack, take every pill in the correct order every day. Do not take them out of order. After you finish the first three weeks (21 pills), you do not have to take the last week of pills. These are placebo pills that contain no hormones. Most girls continue to take these pills so that they keep track of their pack, but you don’t need to take them at all. Just remember to count correctly and take the first pill of your next pack on the 8th day after you take the last hormonal pill in your current pack. Taking your next pill 1 on the right day is essential, as failing to take pill 1 will make your body think it is time to start ovulating. If you make any mistakes during this process, read more in the “Birth Control Pill MISTAKES”.

Birth Control Pill MISTAKES

If you take 0 pills during week 4 or take the placebo pills at the end of the pack, you will get your period during this week, most probably on day 2, 3 or 4. If you choose to take the first pill next pill pack as soon as week 3 ends, you will skip your period, which is entirely safe but inadvisable in the South.

4)    Check Your Medications (and Try Not to Puke)

Some things which decrease the efficacy of your pill may surprise you, but it’s important that you’re aware of them. “Perfect Use” means that, during the month, you never had severe diarrhea, took certain medications (common ones listed at this link!), or vomited within three hours of taking the pill (like after a crazy night out). You can read more about what to do in these situations in “Birth Control Pill MISTAKES”

Birth Control Pill MISTAKES

21 Pill Combination Packs

As mentioned, 21 pill packs are hormonally the same as 28 pack pills; the only difference is that 21 pack pills don’t have any of the hormone-free placebo pills at the end of the pack. This means that every pill in a 21 pill pack needs to be taken.

All the same rules as above apply for 21 pill packs; your pill must be taken at the same time daily, you must take them in order, and you must avoid activities that reduce the pill’s efficacy. However, the rules are slightly stricter with 21 pill packs. For example, taking a 21 pill pack pill even 12 hours late has been noted to affect your chances of pregnancy. Therefore, you must carefully follow all the listed rules under the 28 pill pack section, as there is less wiggle room with 21 pill packs.

The biggest difference between 28 pill packs and 21 pill packs, however, is that you don’t have any placebo pills to take to help you track the time between packs. When taking 21 pill packs, you have two options; you must either carefully count 7 days between the end of your current pack and the beginning of your next, or you must start your next pill pack immediately after your last.

If you want to get your period (which I recommend), count 7 days of taking 0 pills before starting your next pill pack. You’ll get your period on a day when you aren’t taking any pills. If you want to skip your period, take the day 1 pill of your next pack immediately after the last pill of your current pack.

In general, follow all the above rules of taking the 28 pill pack combination pill correctly.