How to Take Birth Control
Take birth control pills at the same time every day without interruption, starting either on the first Sunday after your period begins or on the first day of menstruation, and use backup contraception for the first 7 days if starting mid-cycle. 1
Starting Birth Control Pills
Timing Options
You can initiate birth control using two methods 1, 2, 3:
Sunday Start: Take the first pill on the first Sunday after menstruation begins (if bleeding starts on Sunday, take the first pill that day). Use backup contraception (condoms) for the first 7 consecutive days. 1, 2, 3
Day 1 Start: Take the first pill on the first day of menstruation. No backup contraception needed if started within the first 5 days of bleeding. 1, 3
Quick Start: You can begin pills at any time during your visit if reasonably certain you're not pregnant, but use backup contraception for 7 days. 1, 4
Daily Use Requirements
Combined oral contraceptives: Take one pill daily at approximately the same time, not exceeding 24-hour intervals. 2, 3
Progestin-only pills: Must be taken at the same time each day (within 3 hours) because they rely on consistent timing for cervical mucus effects. 1
Managing Missed Pills
Combined Oral Contraceptives
If one pill is late (<24 hours) 1:
- Take the late pill immediately
- Continue remaining pills at usual time
- No backup contraception needed
- Emergency contraception usually not needed
If one pill is missed (24-48 hours) 1:
- Take the most recent missed pill immediately (discard others)
- Continue remaining pills at usual time (may take two pills same day)
- Use backup contraception for 7 consecutive days
- Consider emergency contraception if missed during first week AND unprotected intercourse occurred in previous 5 days
If two or more pills are missed (≥48 hours) 1:
- Take the most recent missed pill immediately
- Use backup contraception until pills taken correctly for 7 consecutive days
- If missed in the last week of hormonal pills: Skip the hormone-free interval and start a new pack immediately
- Consider emergency contraception if missed during first week AND unprotected intercourse in previous 5 days
Progestin-Only Pills
If >3 hours late 1:
- Take one pill immediately
- Continue daily pills at same time (may take two pills same day)
- Use backup contraception until pills taken correctly for 2 consecutive days
- Consider emergency contraception if unprotected intercourse occurred
Special Circumstances
Vomiting or Diarrhea
Combined oral contraceptives 1:
- If occurs within 24 hours after taking pill: No action needed, continue pills
- If continues 24-48 hours: Use backup contraception for 7 days after resolution
- If continues ≥48 hours: Use backup contraception for 7 days after resolution; skip hormone-free week if occurred in last week of pills
Progestin-only pills 1:
- If occurs within 3 hours of taking pill: Take another pill immediately
- Use backup contraception for 2 days after vomiting/diarrhea resolves
- Consider emergency contraception if unprotected intercourse occurred
Postpartum Initiation
- Progestin-only methods: Can start immediately postpartum 1, 5
- Combined hormonal methods: Wait 3 weeks if not breastfeeding; wait 6 weeks to 6 months if breastfeeding 4
- If starting 4+ weeks postpartum without a period, use backup contraception for first 7 days 2, 3
Common Pitfalls to Avoid
Missing pills near the hormone-free interval is highest risk: The 7-day hormone-free week already extends follicular development; missing pills before or after this increases ovulation risk significantly. 1
Lower-dose pills (20 μg ethinyl estradiol) have less margin for error: More follicular activity occurs when these are missed compared to 30-35 μg formulations. 1
Progestin-only pills require stricter timing: Unlike combined pills with a 24-hour window, progestin-only pills must be taken within 3 hours of the scheduled time daily. 1