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Birth Control Pills (Oral Contraceptives)

The birth control pill  is a popular and highly effective method of birth control if taken correctly. The pill has a <1% failure rate (meaning less than 1 out of 100 women unintentionally become pregnant) if used correctly. However, for women who miss taking their pills, the failure rate goes up to roughly 8%, or 8 out of 100 women become pregnant unintentionally.

If you are not likely to remember to take a pill each day, you probably should consider a longer-acting form of birth control, such as the injection, patch, implant, vaginal ring or IUD. Roughly 85% of women who do not use birth control and are trying to get pregnant will conceive within one year.

Birth control pills can be affordable, depending upon health insurance coverage and generic availability. Many birth control pills are available generically and have a lower price; discuss generic availability of birth control pills with your physician or pharmacist if cost is a concern. Also, check with your insurance company before getting a prescription to determine which birth control pills are on their formulary. In general, you should be able to get birth control pills from $10 to $50 per month if you pay cash, although there are many more expensive brands. If you have prescription drug insurance and a prescription, your birth control may be free under the Affordable Care Act.

Advantages to birth control pill use:

  • Lighter periods, less frequent periods, or possibly no periods at all depending upon the type of pill taken and dosing schedule
  • If the birth control pill is taken correctly, it has a high level of effectiveness to prevent pregnancy.
  • The birth control pill can lessen heavy bleeding, pain and severity of endometriosis and fibroid tumors
  • Acne or premenstrual dysphoric disorder (PMDD) may improve with some birth control pills
  • The use of the birth control pill can lower the risk of pelvic inflammatory disease, uterine cancer and ovarian cancer
  • The progestin-only forms may be used by women who are breast-feeding or cannot use estrogen for other reasons

Combination Birth Control Pills

All birth control pills require a prescription from a healthcare provider. Combination birth control pills are available in 21-day packs, with 21 active tablets, or 28-day packs with 21 active tablets, and 7 inactive tablets. Extended-cycle pills such as Seasonique contain 84 active tablets and 7 inactive tablets. The inactive pills are included to help the woman remember when she should start a new pack of pills. If the inactive pills are missed, there is no chance this would result in a pregnancy. However, it is important to start the new pack and active pills on the correct day.

Combination pills contain two hormones, progestin and estrogen, while the “mini-pills” contain only progestin. Generally, combination birth control pills are slightly more effective than progestin-only birth control pills. Combination pills may contain different levels of hormones throughout the month.

Examples of brand name combination pills include: Apri, Azurette, Caziant, Kariva,Velivet, Natazia, Gianvi, Ocella, Yaz, Yasmin, Zarah, Beyaz, Safyral, Kelnor, Zovia 1/35, Zovia 1/50, Aviane, Levora, Portia, Trivora, Junel, Microgestin, Necon, Nortrel, Ortho-Novum, MonoNessa, Previfem, TriNessa, Cryselle, Low-Ogestrel, Ogestrel. See the chart in this section for additional brand names.

A monthly period still occurs with the traditional, combination birth control pills. Women may also choose the extended or continuous dosing birth control pill, in which a period only occurs 4 times a years (e.g., Seasonique) or is completely eliminated (e.g., Lybrel). It is also possible to completely eliminate periods by taking only the active pills continuously from a combination birth control pill package, and skipping the inactive pills. Ask your healthcare provider if this would be a good option for you.

Progestin-only Birth Control Pills (“Mini-Pills”)

The progestin-only or “mini-pills” contain only norethindrone and each pill is active. When you finish one pack of progestin-only pills, you start another pack the next day.  With progestin-only pills you will either get your period in the fourth week, get no periods, or have spotting during the month. Your periods may be heavier or lighter. Do not stop taking your progestin-only pills.

Examples of brand name progestin-only pills include: Camila, Errin, Heather, Jolivette, Nora-BE. See the chart in this section for additional brand names.

What should I do if I miss taking one or more birth control pills?

It is easy to forget to take a pill or to miss a pill at one time or another. But the combination (estrogen and progestin) pills works best if taken every day at the about the same time. The progestin-only pills (mini-pills) MUST be taken at the same time each day (no more than 3 hours late). If you miss a pill, you will increase your chances of releasing an egg that could be fertilized.

Any time you miss a pill it is best to use a back-up method of birth control, such as a condom or diaphragm with a spermicide, or a contraceptive sponge. Your chances for getting pregnant increase depending upon when you missed your pill during your cycle. Check with your healthcare provider for more information about missed birth control pills.

If you miss one or two combination (estrogen and progestin) pills, take them as soon as you remember. Take your next pill at the regular time. This means if you miss two pills, you would take both missed pills at the same time, and then take your next pill whenever it is due. Taking two pills at once may make you feel a little nauseous, but that will not last long. Use a back up method of birth control, such as a condom, sponge or spermicide until you finish the pack, unless your healthcare provider advises otherwise.

If you miss three combination pills in a row, call your healthcare provider. They may want you to stop using your current birth control pack and start a new pack while using a back up method of birth control.

You could become pregnant if you miss taking your progestin-only pill (mini-pill) by more than 3 hours. If you miss taking one mini-pill, take it as soon as you remember, and take the next pill at the regular time. Continue to take the remainder of the mini-pills on the regular schedule. Use a back-up method of birth control, such as a condom, sponge or spermicide for the next 48-hours.

If you are still confused about what to do if you have missed any birth control pills, use a back-up method of birth control each time you have vaginal intercourse, and take a birth control pill each day until you can talk to your health care provider.

Warnings for Birth Control Pill Use:

Birth control pills should NOT be used by women who have a history of breast cancer, endometrial cancer, undiagnosed vaginal bleeding, liver tumors or disease, increased clotting or stroke risk, or if pregnant.

Smoking increases the risk of serious heart side effects when using a combined estrogen and progestin birth control, including the ring or the patch. Combination estrogen and progestin birth control should NOT be used in women over 35 years of age who smoke due to an increased risk of rare but serious side effects, such as heart attack, blood clots, and stroke.

Women of any age should avoid combination hormonal birth control if they have a history of uncontrolled high blood pressure, chest pain, diabetes, severe headaches, heart or liver disease, blood clots or stroke. Cardiovascular risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day (>15 per day). Women should talk to their healthcare professional about their individual risk profile before deciding which birth control method to use.

Let your physician know if you have migraine headaches when discussing birth control options.

The birth control pill does not protect against any form of sexually transmitted disease (STD), including HIV and AIDS. A male latex or female condom should be used in combination with any other form of birth control if protection against STDs is needed.

Breastfeeding mothers should avoid the estrogen in combined hormonal birth control as it may reduce milk supply. Birth control options for breastfeeding women include IUDs, progestin only pills (“mini-pills”), the implant or the birth control shot.

Common Side Effects with Birth Control Pills:

  • Spotting between periods
  • Possible weight gain
  • Breast swelling or tenderness
  • Nausea or upset stomach
  • Mood changes

Serious Side Effects with Birth Control Pills:

  • Blurred vision
  • Severe stomach pain
  • Severe headache
  • Swelling or pain in the legs
  • Chest pain, heart attack, blood clots, stroke

Other warnings and side effects exist for birth control pills. It is important to review the specific consumer information for the birth control of choice and discuss any questions or concerns with your healthcare provider.

Tell your healthcare provider about all other medications you take, including prescription, over-the-counter, vitamin and herbal supplements. Certain medications may make your birth control less effective. Be sure to have complete drug interaction review each time you start a new medication.

Birth Control Pill Options

Generic Name Brand Name(s) Description
Desogestrel/ethinyl estradiol Apri, Azurette, Caziant, Cesia, Cyclessa, Desogen, Emoquette, Kariva, Mircette, Ortho-Cept, Reclipsen, Solia, Velivet, Viorele Combination progestin and estrogen pill; Caziant, Cyclessa and Velivet are triphasic
Dienogest/estradiol valerate Natazia Quadraphasic progestin and estrogen pill
Drospirenone/ethinyl estradiol Gianvi, Loryna, Ocella, Syeda, Vestura, Yasmin, Yaz, Zarah Drospirenone-containing birth control pills may be associated with a higher risk for rare but blood clots (DVT, PE) than other progestin-containing pills. Women should consult with their MD prior to using drospirenone. Drospirenone-ethinyl estradiol is available generically for added cost savings.
Drospirenone/ethinyl estradiol/levomefolate Beyaz, Safyral Drospirenone-containing birth control pills may be associated with a higher risk for rare but serious blood clots (DVT, PE) than other progestin-containing pills. Women should consult with their MD prior to using drospirenone; contains a daily dose of folate supplementation to lower the risk of having rare neural tube defects in a pregnancy occurring during Beyaz or Safyral use, or shortly after stopping
Ethynodiol/ethinyl estradiol Kelnor, Zovia 1/35, Zovia 1/50 Monophasic combination progestin and estrogen pill; both are branded-generic versions of Demulen (no longer marketed)
Levonorgestrel/ethinyl estradiol Altavera, Amethia, Amethia Lo, Amethyst, Aviane, Camrese, Camrese Lo, Daysee, Enpresse, Introvale, Jolessa, Kurvelo, Lessina, Levlite, Levora, LoSeasonique, Lutera, Lybrel, Marlissa, Myzilra, Nordette, Orsythia, Portia, Quartette, Quasense, Seasonale, Seasonique, Sronyx, Triphasil, Trivora Combination progestin and estrogen pill; Enpresse, Myzilra, Triphasil, and Trivora are triphasic; Amethia, Amethia Lo, Introvale, Jolessa, Quartette, Quasense and Seasonale are extended-cycle pills (period occurs only once every 3 months); LoSeasonique, Daysee, Camrese, Camrese Lo, and Seasonique are also extended-cycle pills; Lybrel, and it's generic version Amethyst are continuous-cycle pill (no periods at all, but spotting may occur)
Mestranol/norethindrone Necon 1/50, Norinyl 1/50, Ortho-Novum 1/50 (brand discontinued) Combination progestin and estrogen monophasic pill
Norethindrone Camila, Errin, Heather, Jencycla, Jolivette, Nor-QD, Nora-BE, Ortho Micronor Progestin-only birth control pills (“mini-pills”); for use in breast-feeding or high risk for blood clots. Must take at the same time each day to prevent ovulation and be most effective; slightly less effective than combination hormones. Generic, lower cost versions of norethindrone are available.
Norethindrone/ethinyl estradiol Alyacen 1/35, Alyacen 7/7/7, Aranelle, Balziva, Brevicon, Briellyn,  Cyclafem 1/35, Cyclafem 7/7/7, Dasetta 1/35, Dasetta 7/7/7, Estrostep Fe, Femcon Fe, Generess Fe, Gildagia, Gildess Fe, Junel 21 1.5/30, Junel 21 1/20, Junel Fe 1.5/30, Junel Fe 1/20, Leena, Loestrin 21 1.5/30, Loestrin 21 1/20, Loestrin 24 Fe, Lo Loestrin Fe, Loestrin Fe 1.5/30, Loestrin Fe 1/20, Microgestin 1/20, Microgestin 1.5/30, Microgestin Fe 1/20, Microgestin Fe 1.5/30, Modicon, Necon 0.5/35, Necon 1/35, Necon 10/11, Necon 7/7/7, Norinyl 1/35, Nortrel 0.5/35, Nortrel 1/35, Nortrel 7/7/7, Ortho-Novum 1/35, Ortho-Novum 7/7/7, Ovcon 35, Ovcon 50, Philith, Tilia Fe, Tri-Legest Fe, Tri-Norinyl, Wera, Zenchant, Zenchant Fe, Zeosa Combination progestin and estrogen pill; Necon 10/11 is biphasic; Aranelle, Alyacen 7/7/7, Cyclafen 7/7/7, Dasetta 7/7/7, Estrostep Fe, Leena, Necon 7/7/7, Nortrel 7/7/7, Ortho-Novum 7/7/7, Tilia Fe, TriLegest Fe, Tri-Norinyl are triphasic. Generic, lower-cost options are available.

Norgestimate/ethinyl estradiol Estarylla, Mono-Linyah, MonoNessa, Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Ortho-Cyclen, Previfem, Sprintec, Tri-Estarylla, Tri-Linyah, Tri-Previfem, Tri-Sprintec, TriNessa Combination progestin and estrogen pill; Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Tri-Estarylla, Tri-Linyah, Tri-Previfem, Tri-Sprintec, and TriNessa are triphasic; generic, lower cost options are available.
Norgestrel/ethinyl estradiol Cryselle, Elinest, Lo/Ovral-28, Low-Ogestrel, Ogestrel Combination progestin and estrogen pill

See also: Oral Contraceptives

See Also:

Last updated: 2013-11-26 by Leigh Anderson, PharmD.

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