Birth Control Pills: Benefits, Risks and Effectiveness


The absolute majority of mature women use hormonal contraceptives to prevent pregnancy. When planning a pregnancy, many women are wondering «How effective is birth control? ».

Information about safety and effectiveness of birth control medicines can be found in:

  • Highlights of Prescribing Information (the US FDA publishes)
  • Summary of Product Characteristics (the UK MHRA publish)
  • Product Information (the Australian TGA publishes)
  • Product Monograph (the Health Canada publishes)

If you want to know, how effective birth control method is but you do not understand medical terms when reading Product Monograph», the key information about effectiveness of popular hormonal contraceptives you can find in this review.

When you take the pill every single day, it’s great at preventing pregnancy. But missing pills, taking certain medications, and other things may make it not work as well.

How effective are birth control pills?

Effectiveness of oral contraceptives depends on their type. At pharmacies, you can find birth control pills containing one or several active ingredients.

One of the largest manufacturers of combined oral contraceptives – Pfizer claims that their effectiveness is equal 99%. This means that while observing the recommended dosing regimen of combined contraceptive, only 1 woman out of 100 may get pregnant.

If the intake of combination birth control pills is periodically skipped or they are not taken at the same time, the chances of becoming pregnant are increased. Reduced efficiency of birth control pills is not only because of missed doses, but also because of menstrual disorders or the use of combined oral contraceptives in conjunction with other medicines.

If the intake of regular dose of combined contraceptive was skipped, use additional non-hormonal methods of birth control to prevent pregnancy.

When used perfectly, the pill is 99% effective. But when it comes to real life, the pill is about 91% effective because it can be hard to be perfect. So in reality, 9 out of 100 pill users get pregnant each year.

The better you are about taking your pill every day and starting your pill packs on time, the better it will work. But there’s a very small chance that you could still get pregnant, even if you always take your pills correctly.

If effectiveness is the most important thing to you when picking what birth control to use, you might want to check out IUDs and the implant. They’re the most effective kinds of birth control.  But if you decide the pill is right for you, make sure you take them on time for the best effectiveness.

If you are looking for an effective combined oral contraceptive, choose birth control pills in which the dose of estrogen hormone is no less than 20 mcg.

How long do birth control pills take to work?

It depends on when you start taking them. You can take your first birth control pill any day of the month, but you may need a backup birth control method (like condoms) for the first 7 days.

Combination Pills (COCs)

  • If you start combination pills within 5 days after your period starts, you’ll be protected from pregnancy right away. For example, if you get your period Monday morning, you can start the pill anytime until Saturday morning and be protected from pregnancy right away.
  • If you start combination pills any other time, you’ll be protected from pregnancy after 7 days of taking the pill. Use another method of birth control — like a condom or female condom — if you have vaginal sex during the first week you’re on the pill.

Progestin-Only Pills (Mini Pills)

You can start progestin-only pills at any time. You’ll be protected from pregnancy after 48 hours (2 days). So use another method of birth control (like condoms) if you have vaginal sex during the first 48 hours.

Your nurse or doctor can help you figure out the best time to start your birth control pills, and when they’ll start working for you..



What lowers the pill’s effectiveness?

The main thing that makes the pill not work is not taking it every day. But other things, like having vomiting or diarrhea for more than 48 hours may reduce how well the pill prevents pregnancy. The pill may be a little less effective for very overweight women. Some medicines or supplements can also make it not work as well:

• The antibiotic Rifampin (other antibiotics do not make the pill less effective)

• The antifungal Griseofulvin (other antifungals do not make the pill less effective)

• Certain HIV medicines

• Certain anti-seizure medicines

• The herb St. John’s Wort

If you’re taking any of these, use condoms as a backup method. Switch to a different method of birth control if you’ll be on them for a long time.

Your nurse or doctor can help you decide if there’s any reason the birth control pill won’t work well for you.

Is the birth control pill safe?

Chances are the pill will be totally safe for you — most people can take it with no problems. It’s been around for more than 50 years, and millions of people have used it safely.

Can I take the birth control pill?

Like with all medications, the pill isn’t for everyone.

If you’re over 35 and a smoker, you shouldn’t use the pill or any other kind of birth control that contains the hormone estrogen. You can use progestin only pills (mini pills) if you’re a smoker.

Also avoid using combination pills if you’ve had any of these health problems:

  • blood clots, an inherited blood-clotting disorder, or vein inflammation
  • breast cancer
  • heart attack, stroke, angina, or other serious heart problems
  • migraine headaches with aura (seeing flashing, zigzag lines)
  • uncontrolled high blood pressure
  • very bad diabetes or liver disease

Talk with your doctor or nurse about your risks and health problems.  It will help you decide if the pill is right for you.

What are the risks of birth control pills?

Even though birth control pills are very safe, using the combination pill can slightly increase your risk of health problems. Complications aren’t common, but can be serious. These include heart attack, stroke, blood clots, and liver tumors. In very rare cases, they can lead to death. For the most part, progestin-only pills (aka mini pills) don’t have these risks.

When talking with your doctor about birth control, tell them about any medications you’re taking and any health problems you’ve had.

There’s a very slight chance that you can get pregnant even if you always take the pill as directed. But accidentally taking the pill during early pregnancy won’t increase the risk of birth defects.

It’s important to remember that for most people, the chance of having any of these problems while taking birth control pills is really, really low. In fact, pregnancy is more likely to cause serious health problems than the pill. Your doctor or nurse can help you figure out which birth control method will be safest for you.

What warning signs should I know about?

Most people on the pill won’t have any problems at all. But just in case, it’s good to know what the signs of a serious issue are.

See a doctor or nurse right away if you have:

  • sudden back/jaw pain along with nausea, sweating, or trouble breathing
  • chest pain or discomfort
  • achy soreness in your leg
  • trouble breathing
  • severe pain in your belly or stomach
  • sudden, very bad headache
  • headaches that are different, worse, or happen more often than usual
  • aura — (seeing flashing, zigzag lines)
  • yellowing of your skin or eyes

You can always call a nurse, doctor, or your local Planned Parenthood health center if you have questions or you’re worried about any health issues.

Is it safe to take the pill while breastfeeding?

Combination pills may reduce the amount and quality of your breast milk in the first 3 weeks of breastfeeding. If you’re nursing, wait at least 3 weeks after giving birth to start using combination pills. Your breast milk will contain traces of the pill’s hormones, but it’s unlikely that these hormones will have any effect on your baby. Talk with your nurse or doctor about any concerns you may have about breastfeeding while using the pill.

Progestin-only pills are safe to use while you’re breastfeeding. They shouldn’t have any effect on how much milk you produce, and won’t hurt your baby.

What are the different types of birth control pills?

There are a few types of birth control pills.

Combination Pills (COCs):

Birth control pills with two hormones — estrogen and progestin — are called combination pills. They’re the most common type of birth control pill. Most combination pills come in 28-day or 21-day packs.

You’re protected from pregnancy as long as you take 1 pill every day. You don’t have to take it at the exact same time every day, but doing so helps keep you in the habit of remembering your pill. You can also use alarms, reminders, or birth control apps to help remind you.

28-day packs

Take 1 pill every day for 28 days (four weeks), and then start a new pack on day 29. The last pills in 28-day packs of combination pills do not have hormones in them. How many days you take hormone-free pills are different for different brands. Most commonly you’ll take hormone-free pills for 7 days, but sometimes less. These pills are called “reminder” or “placebo” pills — they help remind you to take your pill every day and start your next pack on time. Even if you don’t take them, you’ll be protected from getting pregnant if you have sex on those days. They may contain iron or other supplements that help you stay healthy. During the time you take these “reminder” pills is when you get your period.

21-day packs

Take 1 pill every day for 21 days (three weeks) in a row. Then don’t take any pills for seven days (fourth week). You’ll get your period during the fourth week while you aren’t taking any pills. It’s important to take every pill in a 21-day pack because there are no reminder (hormone-free) pills. The hormone pills will prevent pregnancy even if you have sex during the week when you don’t take any pills.  Start your next pack after not taking your pills for seven days — you may want to use an alarm or reminder to help you stay on track.

91-day packs

Some combination pills have 12 weeks’ worth of hormone pills in a row, followed by up to 1 week of reminder pills. This is so you’ll only have your period once every three months. The hormones will prevent pregnancy even if you have sex during the reminder pill week.  Other pill brands can also be used to skip your period by skipping the reminder pills. Read more about how to use pills to skip your period.

Progestin-Only Pills (aka Mini Pills):

Progestin-only pills have 1 kind of hormone (progestin) — these pills don’t have any estrogen. You must take progestin-only pills within the same three hours every dayto be protected from pregnancy. For example, if you take your progestin-only pill at 12:00 p.m., taking it after 3:00 p.m. the next day puts you at risk for getting pregnant. Alarms, reminders, or birth control apps can help you take your pill on time.

Progestin-only pills come only in 28-day (four-week) packs. All 28 pills have hormones. You must take every pill in a progestin-only pack to be protected from pregnancy — there is no hormone-free week. You may get your period during the fourth week. You could also have bleeding on and off throughout the month (spotting), or get no period at all.

How do I use the pill to stop my period?

Skipping your period with the pill is super easy. Basically you make sure you take an active pill with hormones every day. You can do this two ways:

  • You can use a brand of pills that has 3 months of active pills in a row so you only get your period 4 times a year.
  • You can skip the placebo pills in your pack and jump right to the next pack, either all of the time or just when you have something special coming up and don’t want your period then.

You may have some bleeding or spotting when you use the pill to skip your period. It’s totally normal and if you skip your hormone-free week every month, it should go away after about six months.

There’s nothing dangerous or harmful about using the pill to skip your period. And it comes in really handy if you want a special occasion (like a vacation or a hot date) to be period-free.

I missed a pill. What do I do?

The pill works best if you take it at the same time every day, but almost everyone on the pill forgets to take it sometimes. Knowing what to do when you miss a birth control pill is important.

Here’s a handy tool to help you figure out what to do if you miss a pill. You’ll need to know the name of the pill you’re on in order to use this tool. You can find the name on your pill pack or by calling your doctor or the drugstore where you got it.

If you can’t find out the name of your pill, use a condom anytime you have vaginal sex until you’re able to talk with your nurse or doctor. If you’ve already had sex in the last 5 days since making a mistake, you may want to use emergency contraception.

When can I start taking birth control pills?

You can begin taking the birth control pill any day of the month. However, when you start taking your pill could affect whether or not you need to use a backup birth control method (like condoms) for the first 7 days.

Talk with your nurse or doctor about the best time for you to start taking the pill.

Combination Pills (COCs)

You can start the combination pill at any time.

  • If you start combination pills within 5 days of when your period starts, you’ll be protected from pregnancy right away. For example, if you get your period Monday morning, you can start the pill anytime until Saturday morning and be protected from pregnancy right away.
  • If you start combination pills any other time, you’ll be protected from pregnancy after seven days of taking the pill. Use another method of birth control — like a condom or female condom — if you have vaginal sex during the first week on the pill.

Progestin-Only Pills (Mini Pills)

You can start progestin-only pills at any time. Pregnancy protection will begin after 48 hours (two days). Use another method of birth control like condoms if you have vaginal sex during the first 48 hours.

You must take progestin-only pills at the same time every day. If you take it more than three hours past your usual time, use a backup method of birth control for the next 48 hours (two days).

Starting the Pill After Pregnancy

You can get pregnant again shortly after being pregnant, so talk with your nurse or doctor about starting your birth control as soon as you can.

You can start taking the progestin-only pill right after an abortion, miscarriage, or childbirth.

You can start taking the combination pill right after an abortion or miscarriage. In general, you can start taking the combination pill three weeks after giving birth, but you should wait at least six weeks if you’re breastfeeding. Read more about breastfeeding and birth control pills.

What do I do if I want to get pregnant?

If you decide you want to get pregnant, stop taking the pill. No matter what kind of birth control pill you’re on, it’s possible to get pregnant right after stopping. It can take a few months for your period to go back to the cycle you had before you started taking the pill, but that doesn’t mean you can’t become pregnant.

What side effects should I expect while taking the pill?

Taking the pill may cause some side effects. One of the most important things to keep in mind when starting the birth control pill is that most side effects usually go away in 2-3 months.

Some people have headaches, nausea, sore breasts, or spotting (light bleeding) between periods after starting the pill. These birth control side effects usually clear up after a couple of months. If you still don’t like the way the pill makes you feel after a few months, talk with your nurse or doctor. They may suggest another brand or birth control method. Some people try a few different types of pills or methods before finding the right one for them.

Taking the pill may change your period. It may be lighter and sometimes you might not get one at all, especially if you’ve been taking the pill continuously to skip your periods. Even though the chance of pregnancy is very low if you’ve been taking your pill every day, you can always take a pregnancy test if you miss your period just to be sure.

Remember, you can always call your doctor or a Planned Parenthood health center if you have any concerns while using the pill. They’re there to help and answer your questions.

How much do birth control pills cost?

Prices vary depending on whether you have health insurance, or if you qualify for Medicaid or other government programs that cover birth control pills. For most brands, 1 pill pack lasts for 1 month, and can cost from $0-$50. They’re totally free with most health insurance plans or if you qualify for some government programs.

You may also need to pay for a visit with a doctor or nurse to get a prescription for the pill. This visit can cost anywhere from $35–$250. But under the Affordable Care Act (aka Obamacare), most insurance plans must cover doctor’s visits related to birth control. Learn more about health insurance and birth control.

If you’re worried about cost, check with your local Planned Parenthood health center to find out if they can hook you up with birth control that fits your budget.

How can I get birth control pills for free?

There’s a good chance you can get free or low-cost birth control pills if you have health insurance. Because of the Affordable Care Act (aka Obamacare), most insurance plans must cover birth control pills with little or no cost to you. However, some plans only cover certain brands of pills or generic versions. Your health insurance provider can tell you which types of birth control they pay for, and your doctor may also be able to help you get your birth control covered by health insurance. Learn more about health insurance and affordable birth control.

If you don’t have health insurance, you’ve still got options. Depending on your income and legal status in the U.S., you could qualify for Medicaid or other state programs that can help you pay for birth control and other health care.

Planned Parenthood works to provide services you need, whether or not you have insurance. Most Planned Parenthood health centers accept Medicaid and health insurance. And many will work with you to help you pay based on your income. Contact your local Planned Parenthood health center for more information.

Where can I get birth control pills?

You can get birth control pills at drugstores, health clinics, or Planned Parenthood health centers.

You need a prescription for birth control pills. You can get a prescription from a private doctor or nurse, a health clinic, or your nearest Planned Parenthood health center. In a few states, you may even be able to get a prescription online.

During your visit, a nurse or doctor will talk with you about your medical history, check your blood pressure, and give you whatever medical exam you may need. Most people don’t need pelvic exams in order to get birth control pills. Your nurse or doctor will help you decide what you need based on your medical history.

The pill is an effective way to prevent pregnancy.

If you follow the instructions and use the birth control pill the right way, it gives you great protection against pregnancy.

Take a pill every day, and start your new packs on time. That’s it. But missing or forgetting pills makes it not work as well.

You can also use condoms with birth control pills to get maximum pregnancy protection. Bonus: condoms also protect you against STDs.

The pill has health benefits.

Side effects aren’t always a bad thing, and birth control pills aren’t just for birth control. The pill has many perks besides pregnancy prevention.

Both combination and progestin-only pills reduce menstrual cramps, lighten periods, and lower your risk of ectopic pregnancy.

The combination pill can also reduce or help prevent:

  • acne
  • bone thinning
  • cysts in the breasts and ovaries
  • endometrial and ovarian cancers
  • serious infections in the ovaries, fallopian tubes, and uterus
  • iron deficiency (anemia)
  • PMS (premenstrual syndrome)

The pill makes your period a breeze.

Lots of people like the pill because it makes their periods regular and easy to predict. The hormones in the pill can also reduce menstrual cramps and make your period lighter.

You can also use the pill to stop your period altogether, which is totally convenient for people who just don’t want to deal with Aunt Flo every month.

You can get pregnant right away when you stop taking the pill.

Many people on the pill want to have kids when the time is right. One of the great things about the birth control pill is you can get pregnant right after you stop taking it.

After you stop taking the pill, it can take a few months for your periods to return to the cycle you had before you started using it. Once in a while, people have irregular periods or no periods at all for a few months. This is more likely if your periods were irregular before you started taking the pill.

Whether or not you get your period, if you stop taking the pill, it’s possible to get pregnant. So if you’re going off the pill but still want to prevent pregnancy, start using another birth control method right away.

The pill is convenient.

Taking the birth control pill is easy, but remembering to take it every day can be hard. Luckily, pill packs are small — about the size of a compact mirror — so you can carry your pills with you wherever you go.

The pill is birth control you don’t have to use during sex, so it won’t interfere with the action. If you take the pill correctly, you’re protected from pregnancy all day, every day. Many people say the pill makes their sex lives better because they don’t have to interrupt sex or worry about pregnancy.

You need a prescription from a nurse or doctor to get birth control pills. But you may be able to pick up many packs at once or have them mailed to you. Depending on where you live, you can even get birth control pills online.

You have to take the pill every day.

It’s really important to take your birth control pill every day, or you might not be protected from pregnancy. Using reminder apps, setting an alarm, or keeping your pill pack next to things you use every day (like your toothbrush or phone charger) can help you remember to take your pill.

If you have a really busy life and think you might not remember to take a pill every day, check out other birth control methods like IUDs or implants that are almost impossible to mess up. Take our quiz for help finding the birth control method that’s best for you.

There can be negative side effects.

Like most medications, birth control pills can have side effects. But most usually go away after two or three months. Many people use the pill with no problems at all.

The hormones in the pill can change your level of sexual desire. You may also notice bleeding between periods (most often with progestin-only pills), sore breasts, or nausea.

You may have spotting or bleeding between periods, sore breasts, nausea or headaches. These usually go away after 2 or 3 months.

Birth control shouldn’t make you feel sick or uncomfortable. Luckily, you have many birth control options. If you keep having side effects that bother you after using the pill for 3 months, talk with your nurse or doctor about finding another brand of pill or another birth control method. Just don’t stop taking the pill before you start a new method or you’ll be at risk of pregnancy.

Some side effects of the pill are serious.

Serious problems from taking the birth control pill are very uncommon. People using birth control that has estrogen, like combination pills, have a slightly higher chance of having a few rare but dangerous problems than people who don’t use birth control with hormones. Read more about birth control pill safety.

Check out the package insert that came with your pills or talk to your nurse or doctor for more information about side effects.

What are the health benefits of oral contraceptives?

  • Periods are usually lighter with less cramping
  • If used for several years, the chance of developing cancer of the ovaries and uterus are decreased
  • Decreases cysts on the ovaries, endometriosis, anemia, and fibrocystic breast disease

Are oral contraceptives reversible?

Yes. Most women ovulate and have their menstrual cycle within four to six weeks once they stop taking the pills. If you have not had a menstrual cycle for two to three months after stopping the pill, a pregnancy testshould be performed and a health care provider contacted.

How much do oral contraceptives cost?

The initial physical exam in your healthcare provider’s office could range from $20 to $200. The monthly fee for each supply of pills ranges from $5 to $30 or more, depending on your medical coverage.

What about oral contraceptives and sexually transmitted diseases (STD’s)?

Oral contraceptives do NOT provide any protection against any sexually transmitted diseases, including HIV.

What are the pros & cons of oral contraceptives?

The Pros of Oral Contraceptives include:

  • Low failure rate if used daily as directed
  • Does not interrupt foreplay or sexual intercourse
  • Research for over 40 years has proven long term safety
  • Moderately priced
  • Easy to use

The Cons of Oral Contraceptives include:

  • Requires a prescription
  • Potential side effects like nausea and breast tenderness
  • Chance of blood clots in legs and lungs
  • Must be taken every day at the same time
  • No protection against STD’s

How effective is birth control implant?

Subcutaneous implants containing progestin hormone analogs are one of the most effective medicines used for a long-term contraception.

One of the largest US suppliers of contraceptive implants – Merck published data that they are more effective than oral, transdermal and vaginal contraceptive methods.

Merck asserts that birth control implants are as effective as injectable, intrauterine and surgical methods of preventing pregnancy.

Absolute advantage of birth control implant is that it helps to prevent pregnancy within 2-3 years after the subcutaneous administration.

A significant disadvantage of birth control implant is that a woman cannot place it under the skin by herself. Therefore, besides purchasing birth control implant, a woman needs to pay for doctor’s services.

If you want more information on how effective hormonal and non-hormonal birth control methods are, please, ask your questions by email or phone. After getting a pharmacist’s qualified consultation on online pharmacy, you can buy effective birth control medicines that are required in your case.

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