The Birth Control Pill: Taking it Correctly (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. As always, remember to read the instruction manual for your specific pill, but these rules generally hold.
Take it at the SAME TIME EVERY DAY
Take your pill every day at the same time. Unlike with 28 pack pills, it does matter that you take your pill at around the same time every day. If you’re more than even 3 hours late, your protection against pregnancy may be reduced. My advice is to take your pill when something else daily happens. For example, I recommend students at Duke take their pills when the chapel bells ring at 5 pm every day. Everyone on campus can hear the bells, and they’re a helpful, effort-free reminder to grab your 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.
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.
Take Every Pill in the Pack in Order
When taking mini pills, you must take every pill in the pack to be protected from pregnancy. Unlike with 28 pack combination pills, mini pills don’t include any “placebo pills,” meaning you will must take a hormonal pill every single day to be protected.
As soon as you finish your pack, you should take pill 1 of your new pack the next day. You must take a mini pill every day at the same time to achieve full efficacy.
Don’t Trust Your Period
Mini pills work a little bit differently than combination birth control pills; mini pills mainly thicken your cervical mucus to stop sperm from moving, whereas combination pills thicken mucus and stop you from ovulating. Because they stop you from ovulating, you can completely control your bleeding with combination pills. (For more info on ovulation and your period, read “How Pregnancy Happens” below).
By choosing to take or not take the last 7 pills of a 28 pill pack, you can either have or skip your period. The only uncontrollable bleeding experienced on combination pills come from missing pill days, which can lead to breakthrough bleeding.
However, because mini pills don’t reliably stop you from ovulating, you have less control over your bleeding. You may get your period regularly, or experience spotting, or may rarely get your period. This means you can’t use your period to make sure you aren’t pregnant. You may not get your period for months and still be fine, or you may see some bleeding and later discover a pregnancy.
For that reason, I recommend considering your priorities and taking semi-regular pregnancy tests if you’re financially able. It sounds extreme, but some people feel that they cannot, under any circumstances, give birth. In many places in the South, abortions are only available for a very small window once someone gets pregnant. People in those states may use a late period as a first sign of pregnancy, so they can consider an abortion as early as possible. However, people using the mini pill cannot use their period to verify anything, because their bleeding is so irregular. If someone is taking the mini pill, they may not see any signs of pregnancy until it’s too late. If you live in a state with limited abortion access/feel very emotionally concerned about pregnancy, consider if you have the funds to take pregnancy tests roughly every month and a half; doing so may make you feel much more mentally secure.
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 the “Birth Control Pill MISTAKES” section below