Birth Control Pills

Deciding on the birth control pill (BCP) that is best for you can be difficult. There are pros and cons for all the different types. However, there are lots of options and one of them will be right for you. 

Different Kinds of Birth Control 

There are two kinds of birth control pills – a combination pill combining estrogen and progestin, and a minipill which contains progestin, only. 

Combination birth control pills mix active and inactive pills: 

Conventional pack: These typically contain 21 active pills and seven inactive pills or 24 active pills and 4 inactive pills. You will have bleeding every month during the week you are taking the inactive pills. 

Continuous dosing or extended cycle: These typically contain 84 active pills and seven inactive pills. You will have bleeding four times a year during the week you are taking the inactive pills. 

Combination birth control pills come in different formulations: 

Monophasic: Each active pill contains the same amount of estrogen and progestin. 

Multiphasic: The amount of hormone contained in each active pill is varied. 

Some combination birth control pills contain low doses of hormones. This can be of benefit to women that are sensitive to hormones, but there is a greater chance of breakthrough bleeding (bleeding and spotting between periods) than with higher dose pills. 

Minipills: All pills in the pack are active. 

How Does the Birth Control Pill Work? 

BCPs work by suppressing ovulation (stop your ovaries from releasing an egg). It also causes changes to the cervix and lining of the uterus to prevent fertilization. 

Who Shouldn’t Take BCPs? 

Women with the following health issues are usually advised not to take the pill: 

Are breast-feeding Are older than age 35 and smoke Have a history of blood clots, stroke, or breast, liver or endometrial cancer Have a history of deep vein thrombosis, pulmonary embolism or heart disease Have kidney, liver or adrenal gland problems Have migraines with aura Have diabetes-related complications, such as a damaged retina (retinopathy) Have blood-clotting problems Are about to be immobilized for a prolonged period due to major surgery Have unexplained uterine bleeding Are taking St. John’s wort or anticonvulsants Suspect you might be pregnant 

The minipill may not be right for you if you: 

Have breast cancer Have unexplained uterine bleeding Are taking medications that contain anticonvulsants or anti-tuberculosis agents Suspect you might be pregnant 

How Effective are the Different Kinds of Pills? 

The numbers show that an estimated 8 out of 100 women who use combination birth control pills for one year will get pregnant. An estimated 13 out of 100 women who use the minipill for one year will get pregnant. Given the low dose of progestin, the failure rate of the minipill in highly fertile women is higher than that of other hormonal contraceptive methods. 

What Happens if you Forget to Take it? 

Combination BCPs work best when taken at the same time every day. If you miss the pill, take two at the same time the next day and use another form of contraceptive for seven days following. You might experience breakthrough bleeding. 

The minipill must be taken at the same time every day. If you miss taking it by three hours or less, take the pill as soon as you remember and use birth control for at least two days. It’s ok to take two pills in one day but use backup birth control for at least two days after. 

The Benefits and Risks of BCPs 

Combination Pill: 

The Good: It reduces the risk of some reproductive organ cancers, ectopic pregnancies, ovarian cysts and iron deficient anemia. It can offer considerable relief from premenstrual syndrome and severe menstrual cramps. Periods are shorter and lighter. It can improve acne and rosacea. 

The Bad: It will not protect from STIs. It increases the risk of heart attack, stroke, cervical cancer, deep vein thrombosis and pulmonary embolism (blood clots). It can also raise blood pressure and cause nausea, bloating, breast tenderness, mood changes, headaches, decreased libido, an increase in vaginal secretions, breakthrough bleeding or spotting, and changes in contact lens tolerance. 


The Good: Can be used during breast-feeding. Doesn’t carry the side effects of birth control pills containing estrogen. Can be taken if you have certain health problems, including a high risk of heart disease, blood clots, or a history of high blood pressure or migraines. Fertility returns quickly if you hope to get pregnant. 

The Bad: Doesn’t offer protection from STIs. Can cause irregular menstrual bleeding, ovarian cysts, depression, weight gain or loss, decreased libido, headache, nausea, breast tenderness, fatigue, or acne. If you conceive while taking the minipill, there’s a slightly higher chance that the pregnancy will be ectopic — when the fertilized egg implants outside of the uterus, usually in a fallopian tube. 

In Conclusion: 

There are lots of birth control options. If you decide to use birth control pills, discuss with your health care provider the best ones for you.