Midwife Matters

Pregnancy preparations, women's health, and care options

What should I know about birth control pills?

Birth control pills are highly effective in preventing pregnancy. The pills contain the hormones estrogen and progestin. Birth control pills prevent pregnancy by causing three changes in the body:

  1. The ovary does not ovulate (produce an egg). This is the main action of birth control pills.
  2. The cervical mucus thickens, blocking the sperm from entering the cervix.
  3. The lining of the uterus thins, making it less likely that a fertilized egg would attached to the lining of the uterus.

Together, these three changes make it very unlikely that someone taking the pill will become pregnant.

Each pack of pills contains 21 hormone pills and seven nonhormone or “spacer” pills. It is very important to take all pills in their exact order.

A menstrual period usually occurs for a few days while you are taking the spacer pills during the last week of each pack.

Take one pill each day at the same time until you have finished the 28-day pack. You will start the next pact the next day.


If pills are taken at different times of the day, bleeding or spotting between periods can occur. Birth control pills work best when taken at the same time each day.

If you miss one pill, take the forgotten one (yesterday’s pill) as soon as you remember, and take today’s pill at the regular time. Along with taking your pills, use a backup method of birth control (e.g. condoms or diaphragm) for the entire cycle.

If you miss two pills in a row, take two pills as soon as you remember and two the next day. Here is an example: You forgot your pills on Saturday and Sunday but remembered on Monday. What do you do? Take two pills on Monday and two pills on Tuesday. You may have some bleeding, but continue taking your pills in order. Be sure to use a backup method of birth control until you finish you package of pills.

If you miss three or more pills in a row, ask yourself if you are a good pill user. The chances are great that your ovaries will produce an egg and that you may get pregnant. So, start to use a second method of birth control immediately. Throw away your old pack of pills. Contact your medical center about the best time to begin birth control pills again.

If you miss one or more pills and skip the following period, call your medical center for a pregnancy test.

If you miss no pills and skip a period, you may be pregnant, but it is very unlikely. It is rather common for a woman taking birth control pills to miss a period occasionally. If you are worried or have missed two periods in a row, contact your medical center for a pregnancy test and pelvic exam.

If you have spotting (light bleeding during the first three weeks of the pack) for three or more cycles, call your clinic. You may need a slightly stronger pill or one with a different balance. Spotting or breakthrough bleeding is common in women using birth control pills for the first time or if pills are not taken at the same time daily. The more consistently you take your pill (same time daily and not missing any), the fewer problems with breakthrough bleeding you will have.

Other information

  • When you are seen by a health care provider for other reasons, be sure to mention you are on birth control pills. This is particularly important if you are admitted to the hospital for any reason.
  • When taking birth control pills, it is normal for your periods to be lighter and shorter.
  • If you take your pill as directed, you will be protected from pregnancy during the seven days when you are taking the “spacer” pills each month.
  • There is a package insert in your pill packet that gives you excellent detailed information about the pill and its benefits and risks. We encourage you to read it. Please ask about any information that is not clear.
  • Know the name of your pill. Keep the prescription number available for refills.
  • Cardiovascular complications (e.g. high blood pressure, strokes, heart attacks) are very rare occurrences. Women who smoke are at greatest risk. You should not smoke if you use birth control pills.
  • Birth control pills may not prevent pregnancy if you are taking medications, such as antibiotics, anticonvulsants or sedatives, or if you have diarrhea. Continue to take your birth control pills, but also use a backup birth control method for the entire cycle in the above situations.
  • It is recommended that you discontinue the pills about three months before you plan to conceive.
  • For refills: Make sure to check your refill number on your prescription. Check ahead of time when refills are due and call your prescription number in to your HealthPartners pharmacy. Do not wait until the last minute!
  • Minor side effects:(Some symptoms disappear after the first three packets.)
    • Nausea
    • Breast tenderness
    • Spotting
    • Weight gain/loss
    • Mood changes
  • If you have any warning signs, call your health care provider:
    • Severe abdominal pain
    • Eye problems (blurring, flashing of lights or blindness)
    • Severe headaches
    • Severe chest pain or shortness of breath
    • Severe leg pain (calf or thigh–usually one leg)

Health benefits from oral contraceptives

In addition to preventing pregnancy, use of oral contraceptives may provide certain benefits.

  • Menstrual cycles may become more regular
  • Blood flow during menstruation may be lighter, and less iron may be lost. Therefore, anemia due to iron deficiency is less likely to occur.
  • Pain or other symptoms during menstruation may be experienced less frequently.
  • Ovarian cysts may occur less frequently.
  • Ectopic (tubal) pregnancy may occur less frequently.
  • Noncancerous cysts or lumps in the breast may occur less frequently.
  • Acute pelvic inflammatory disease may occur less frequently.
  • Oral-contraceptive use may provide some protection again developing two forms of cancer: cancer of the ovaries and cancer of the lining of the uterus.

« Birth Control Options

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