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Birth Control Pills:

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How do I take birth control pills?

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 23, 24, 26, or even 28 active pills. The example shown below is for a 28-day pill pack in which you take 21 active hormone pills, and then seven placebo pills that contain no active hormones. These last seven pills are just “reminder” pills in most pill brands. They are taken during the fourth week, including during your period. With packages that have 24 active pills, the last 4 are “reminder” pills or 7 pills with lower amounts of hormones. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as shown below.


28 Day Pill Calendar

  1. To take the Pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the birth control pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
  2. You should take one pill each day, at the same time of day until you finish the pack. Take the Pill when you are doing something regularly so you don't forget. For example, you could keep your pill pack near your toothbrush, or set your cell phone alarm as a reminder. The best time to take the Pill is ½ an hour after a complete meal such as dinner or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some young women who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill at dinnertime may cure this symptom.
  3. After completing a 28-day pack, you should immediately start a new pack of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period will stop once you begin the new pack of pills.

Can I take more than 21 days of birth control pills in a row?

Some girls prefer to take 42 pills (2 packages of pills), 63 pills, or even continuous pills because of cramps, PMS, or convenience. In fact one Pill type comes in a package with 84 pills and 7 reminder pills, and another with 84 pills and then 7 low dose estrogen pills. Talk to your health care provider about whether extended Pill taking makes sense for you.


Extended pill taking works best with monophasic Pills (all one dose, all one color). The downside is that some girls get more irregular periods or, unexpected spotting and some insurance companies may not allow the extra packages without a medical reason.


What if I forget to take one or more combined birth control pills?

Emergency contraception is recommended if you've had unprotected intercourse during the time you missed your pills. People of all ages can buy Plan B One-Step™ without ID or a prescription. Another type of emergency contraception is called Ella™, and everyone requires a prescription to get it.


What if I forget to take one or more progestin only birth control pills?

If you forget even one progestin-only Pill or are even 3 hours late, take it as soon as you remember and use condoms (or another backup method of protection) for at least 2 days. Take the next pill as usual, so you might take two pills in one day. Continue to take the rest of the pack as you normally would. Start the next pack on time.


Does it mean I'm pregnant if I don't get my menstrual period while I'm on the Pill?

Not usually. At times, you may not get your menstrual period while using birth control pills. This can be normal. If you miss one menstrual period and you have not missed any pills, everything is probably fine. Just start a new pack of pills at the usual time. But if you are concerned, or skip 2 periods in a row, you're still probably fine, but check with your health care provider and get a pregnancy test. If you miss any pills and miss your period, keep taking your pills, but see your health care provider for a pregnancy test.


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Written and reviewed by the CYWH Staff at Boston Children's Hospital

Updated: 5/20/2014


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