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Clinical Reference Systems: Pediatric Advisor 10.0

Birth Control Pills


Combination oral contraceptives (birth control pills) contain two female hormones: estrogen and progesterone. Taking one of these pills every day prevents the normal release of an egg from the ovary each month. If an egg is not released, a woman cannot become pregnant.


There are many types of birth control pills. Your physician will prescribe the type that seems best for you. You must follow the directions your physician gives you for taking the pills. (There are different directions for different types of pills.) The following types of pills are the two most commonly used.

  1. 28-day pills, Sunday start
    • Begin your first pack of pills by taking the first pill on the first Sunday after your menstrual period begins (even if you are still menstruating).
    • Continue taking one pill every day. When you have taken the last pill in the pack (on a Saturday), start a new pack the next day (Sunday). Do NOT skip any days between packs.
    • Your period should start during the last week of each pack of pills.

  2. 28-day pills, day 1 start
    • Begin your first pack on the first day of your period.
    • Continue taking one pill every day. When you have taken the last pill in the pack, start a new pack the next day. Do NOT skip any days between packs.
    • Your period should start during the last row of pills in each pack that you take.

Take the birth control pill prescribed by your physician.


  1. Try to take your pill at the same time every day. This will help you remember to take the pills. It will also help keep hormone levels steady.

  2. Use a backup method of birth control (such as condoms and spermicide) until you have been taking the pills for 2 weeks.

  3. Your risk of pregnancy increases when you miss any pills.

    If you forget one pill, take it as soon as you remember, even if it is the next day. Take the next pill on time.

    If you miss two pills, take two pills daily for two days. Then take one pill a day. Use an additional method of contraception (condoms, spermicide) until your next period starts.

    If you miss three or more pills in a row, stop taking your pills and use other birth control methods until your next menstrual cycle starts. If your menstrual cycle doesn't start as scheduled, check with your health care provider.

  4. Use condoms, even though you are taking birth control pills, for protection against sexually transmitted disease until you have a long-term, single-partner relationship.

  5. If you have bleeding between periods for several cycles you may need a different pill. Call your physician for an appointment.

  6. Periods tend to be shorter and lighter while you are taking birth control pills.

  7. If you miss your period completely and have not missed any pills, continue taking your pills. If you have missed any pills or have missed two periods in a row, you may be pregnant. Do not start a new pack until you have a pregnancy test.

  8. Any time you are seen for medical reasons, be sure to mention that you are taking birth control pills. This is particularly important if you are admitted to the hospital or having surgery.


  1. Advantages
    • Birth control pills are 99 percent effective in preventing pregnancy.
    • The hormones in the pills may offer protection against fibrocystic breast disease, fibroadenomas of the breast, ovarian cysts, cancer of the uterus, and pelvic inflammatory disease (an infection of the female reproductive system).
    • The pills usually have no side effects.
    • Periods become regular and usually shorter, and menstrual cramps may be less severe.
    • This method of birth control does not require planning at the time of sexual activity.

  2. Disadvantages
    • The hormones in the pills have some rare but potentially serious side effects. These side effects include high blood pressure, stroke, heart attack, blood clot, liver problems, and worsening of headaches. These side effects are most common among women over 35 years old.
    • Women who smoke have an increased risk of side effects, particularly after age 30.
    • Birth control pills cannot be taken by all women, for example, if they have cardiovascular disease, breast cancer, or liver disease.
    • A woman has to remember to take a pill every day and must carry pills with her when she is away from home.
    • This method of birth control provides no protection against sexually transmitted disease.
    • The pills are one of the more expensive methods of birth control.


  • pain, swelling, and redness in the calf of one of your legs
  • shortness of breath, sharp chest pain, or coughing up blood
  • blurred vision or slurred speech
  • severe headaches
  • severe abdominal pain.


  • jaundice (yellow eyes and skin)
  • numbness or tingling
  • increasing headaches
  • severe mood changes.

Written by David W. Kaplan, M.D., and the staff of the Adolescent Medicine Center, The Children's Hospital, Denver, Colorado.
Copyright 1999 Clinical Reference Systems