What is the easiest type of birth control to start a patient on and how is it administered?

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Last updated: December 17, 2025 • View editorial policy

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Easiest Birth Control to Start and How to Take It

The combined oral contraceptive pill (COC) is the easiest birth control to initiate, requiring only a blood pressure measurement before starting, with no pelvic exam needed, and can be started anytime if reasonably certain the patient is not pregnant. 1

Why COCs Are the Easiest Choice

  • Minimal pre-initiation requirements: Only blood pressure measurement is needed before starting COCs—no pelvic examination, bimanual exam, or other testing required 1

  • Most commonly used method: COCs comprise 21.9% of all contraception currently used in the US, making them familiar to both patients and providers 2

  • Can start immediately: COCs can be initiated anytime if the provider is reasonably certain the patient is not pregnant, using a "quick start" or same-day initiation approach 1

  • Completely reversible: COCs have no negative effect on long-term fertility and are safe throughout a woman's reproductive years 1

Recommended Starting Regimen

  • Start with a monophasic low-dose pill: Begin with a COC containing 30-35 μg of ethinyl estradiol combined with levonorgestrel or norgestimate 1

  • Choose based on insurance formulary: Among low-dose pills, select one with the lowest copay on the patient's insurance, as there are no clear data suggesting one formulation is superior for general use 1

How to Take COCs

Starting the Pill

Two initiation options exist 1, 3:

  • If started within 5 days of menses: No backup contraception needed 1

  • If started >5 days after menses: Use backup contraception (condoms) or abstain from intercourse for 7 days 1

Daily Administration

  • Take one pill daily at the same time: Standard 28-pill packs contain 21-24 hormone pills followed by 4-7 placebo pills 1

  • Continue without interruption: After finishing one pack, immediately start the next pack 3

Managing Missed Pills

Critical instructions for missed pills 1:

  • One pill late (<24 hours): Take it as soon as remembered, continue as usual

  • One pill missed (24-48 hours): Take the most recent missed pill immediately, continue taking remaining pills at usual time (even if taking two pills same day)

  • Two or more pills missed (>48 hours):

    • Take the most recent missed pill as soon as possible (discard other missed pills)
    • Use backup contraception or abstain for 7 days
    • If pills were missed in the last week of hormone pills (days 15-21), skip the hormone-free interval and start a new pack immediately 1
    • Consider emergency contraception if pills were missed during the first week and unprotected intercourse occurred in the previous 5 days 1

Alternative Easy Options

If COCs Are Not Suitable

Progestin-only pills (POPs) offer an alternative when estrogen is contraindicated 1:

  • Norethindrone or norgestrel POP: No exam needed before initiation; if started >5 days after menses, use backup contraception for only 2 days 1

  • Drospirenone POP: If started >1 day after menses, use backup contraception for 7 days 1

Contraceptive vaginal ring provides the simplest regimen overall 1:

  • Insert one ring vaginally for 3 weeks, remove for 1 week, then insert new ring 1
  • Same eligibility criteria and initiation requirements as COCs (blood pressure measurement only) 1
  • Most men are not bothered by its presence during intercourse 1
  • Can be used for extended cycles by replacing monthly (rings contain sufficient medication for up to 35 days) 1

Important Safety Considerations

  • Estrogen increases VTE risk: COCs increase venous thromboembolism risk from 2-10 events per 10,000 women-years to 7-10 events per 10,000 women-years 2

  • Avoid in certain conditions: Do not use COCs in patients with cardiovascular risk factors, history of VTE, or conditions associated with cardiovascular events 4

  • Drug interactions: Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) and rifampin/rifabutin reduce COC effectiveness 1

Non-Contraceptive Benefits

  • Cancer protection: COC use for >3-4 years provides significant protection against endometrial and ovarian cancers 1

  • Does not increase breast cancer risk: Observational data indicate COC use does not increase breast cancer risk 1

  • Improves menstrual-related conditions: COCs benefit acne, dysmenorrhea, endometriosis, heavy menstrual bleeding, and premenstrual dysphoric disorder 1, 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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