Starting Combined Oral Contraceptive Pills (OCPs): Patient Education Guide
You can start your birth control pills today—no need to wait for your next period—and you'll need to use backup contraception (like condoms) or avoid sex for the first 7 days. 1
How to Start Your Pills
You have two options for starting:
- Day 1 Start (Preferred): Begin on the first day of your next menstrual period. This is more effective because you don't need backup contraception. 2
- Quick Start (Same Day): Start today if you're reasonably certain you're not pregnant. Use backup contraception (condoms) or avoid sex for 7 days. 1, 3
Take one pill at the same time every day. Set a daily alarm on your phone to help you remember.
What to Expect in the First Few Months
Irregular bleeding or spotting during the first 3-6 months is completely normal and not harmful. 1 This usually improves as your body adjusts to the hormones. Don't stop taking your pills because of spotting—this can actually make bleeding worse and increase your risk of pregnancy.
Other common side effects that typically improve include:
- Breast tenderness
- Headaches
- Nausea
If You Miss Pills: Critical Instructions
One Pill Late (Less than 24 hours)
- Take the late pill as soon as you remember
- Continue taking remaining pills at your usual time (even if this means two pills in one day)
- No backup contraception needed
- Emergency contraception usually not needed 1
One Pill Missed (24-48 hours late)
- Take the most recent missed pill immediately (discard any other missed pills)
- Continue taking remaining pills at usual time (even if two pills same day)
- Use backup contraception (condoms) or avoid sex for 7 days
- If pills were missed in Week 3 (days 15-21): Skip the hormone-free week and start a new pack immediately
- Consider emergency contraception if you missed pills in Week 1 AND had unprotected sex in the previous 5 days 1, 4, 1
Two or More Pills Missed (48+ hours late)
- Take the most recent missed pill immediately (discard other missed pills)
- Continue taking remaining pills at usual time
- Use backup contraception (condoms) or avoid sex for 7 days
- If pills were missed in Week 3: Skip the hormone-free week and start a new pack immediately
- Consider emergency contraception if you missed pills in Week 1 AND had unprotected sex in the previous 5 days 1, 4, 1
Important: Lower dose pills (20 mcg ethinyl estradiol) have less margin for error with missed pills compared to 30-35 mcg pills. 1
If You Vomit or Have Diarrhea
Within 24 hours of taking a pill
- No need to take another pill
- Continue taking pills daily
- No backup contraception needed 1
Vomiting/diarrhea continuing 24-48 hours
- Continue taking pills daily
- Use backup contraception or avoid sex until you've taken pills correctly for 7 consecutive days after symptoms resolve
- If this occurs in Week 3: Skip the hormone-free week and start a new pack 1
Vomiting/diarrhea continuing 48+ hours
- Same instructions as 24-48 hours
- Consider emergency contraception if symptoms occurred in Week 1 AND you had unprotected sex in the previous 5 days 1
When to Consider a Different Method
If you frequently miss pills or have trouble remembering daily pills, consider switching to a more effective method that doesn't depend on daily use, such as an IUD, implant, or injection. These methods have failure rates under 1% compared to 9% typical-use failure rate with pills. 1
Important Safety Information
Do not use combined oral contraceptives if you:
- Are over 35 years old and smoke (especially more than 15 cigarettes/day) 5
- Have uncontrolled high blood pressure (≥160/100 mmHg) 3
- Have migraines with aura or focal neurologic symptoms 3
- Have a history of blood clots, stroke, or heart attack 5, 3
- Have active liver disease 3
- Have diabetes with complications (kidney, eye, nerve, or blood vessel damage) 5, 3
Pills do not protect against sexually transmitted infections (STIs). Use condoms consistently for STI protection. 1
Follow-Up Care
You don't need a routine follow-up visit specifically for the pills, but you can return anytime to discuss side effects or concerns. 1 A visit 1-3 months after starting can be helpful to address any issues. 3
You can get up to 1 year of pill packs prescribed at once, which improves continuation and reduces pregnancy risk. 1, 3
When to Contact Your Healthcare Provider Immediately
- Severe leg pain or swelling (possible blood clot)
- Severe chest pain or shortness of breath
- Severe headache, especially if new or different from usual
- Vision changes or loss
- Severe abdominal pain
- Yellowing of skin or eyes