Birth Control Medications (Contraceptives) (cont.)
Francisco Talavera, PharmD, PhD
Combination contraceptives, that is, contraceptive medications containing both estrogen and progesterone, are the most effective means for contraception with the exception of surgical sterilization. Several types of combination birth control pills exist, including monophasic pills, biphasic pills, triphasic pills, and 91-day-cycle pills.
- Use: Starting at the beginning of the pill pack, take 1 each day at approximately the same time every day to increase protection from pregnancy. Keep the pills in the original container to ensure they are being taken correctly (the container labels each pill with a day of the week to make it easy to follow along with the calendar).
- When to begin: The following regimens may be used when first starting on birth control pills:
- Taking 1 pill each day, starting on the fifth day after the onset of menses (menstruation, menstrual period) and continuing for 21 or 28 days (see following instructions for 21- vs 28-day containers)
- Beginning pills on the first day of the menstrual period
- Beginning on the first Sunday after the menstrual period starts
- Twenty-one-day birth control pill container: Take 1 pill daily for 21 days, stop for 7 days (a period should start during this time), then resume taking the pills with a new container of pills.
- Twenty-eight-day birth control pill container: Start with the first pill in the container, and swallow 1 daily for 28 days. Do not stop taking the pills. The last 7 pills do not contain hormones and are usually a different color than the other 21 pills in the container. These last 7 pills are sugar pills (some contain an iron supplement) intended to help keep women on schedule taking your pills. A period should start while taking the last 7 pills.
- Ninety-one-day birth control pill: One pill is taken daily for 12 weeks (84 days), followed by 1 week (7 days) of inactive pills. A menstrual period occurs during the week of inactive pills, so women on this regimen have a period only once every 3 months.
- If pills are missed: Missed doses should be taken as soon as possible. The next pill is taken at the regular time. If more than 1 pill is missed, begin taking the pills as soon as possible, but also use an additional form of birth control for the remainder of the cycle. Women who miss more than 1 pill per cycle may be at greater risk of becoming pregnant.
- Missed period: Pregnancy should be ruled out as a possible cause of missed periods while on birth control pills. Birth control pills should be discontinued if pregnancy is confirmed.
- When to seek immediate medical attention: Seek emergency medical care if any of the following symptoms occur: abdominal pain, chest pain, headaches (severe), eye changes (blurred vision), or severe thigh or calf pain. These symptoms are easy to remember by learning the mnemonic device ACHES.
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