Oral Contraceptive Pills

Oral Contraceptive Pill Use



Oral contraceptive pills- contain two types of synthetic (man-made) female hormones, progestin and oestrogen. These hormones are normally produced by the ovaries.

  • The birth control pill works primarily by blocking ovulation (release of an egg). If there is no egg to meet the sperm, pregnancy cannot occur. This is the most important mode of action.
  • The pill also work by making cervical mucous thick and unreceptive to sperm, slowing tubal function which is required to move the egg down the Fallopian tube to meet the sperm, and by making the lining of the endometrium unreceptive to implantation of a fertilized egg should one get as far as the uterus. The latter might only happen if pills are missed.
  • In general, women do not ovulate until least 10 days after stopping birth control pills.



Starting Birth Control Pills for the First Time

Choose a back up method of birth control (such as condoms) to use with your first pack of pills because the pill may not fully protect you from pregnancy during the first week that you start taking them.


Several ways to start taking the pill:

  • Start your first pack of pills on the day your period begins – contraception will start immediately.
  • Start your first pack of pills on the first Sunday after your period begins. This will result in your menses almost always beginning on a Tuesday or Wednesday every 4 weeks – contraception will start after 7 days, i.e. after you have taken 7 tablets – this is called ‘The 7 Day Rule ‘
  • Start your first pack on the fifth day after your period begins - contraception will start after 7 days, i.e. ‘The 7 Day Rule ’applies
  • Start your pill today if there is absolutely no chance that you could be pregnant. Use a backup method of contraception for 7 days, i.e. ‘The 7 Day Rule ’applies.


  1. A patient is given a pack containing 21 pills.
  2. Take one pill everyday (same time each day) for three weeks.
  3. After those three weeks, you do not take tablets for 7 days.
  4. During those seven days, you will have your period.
  5. After a week’s  break, you start on your next packet. So it is three (3) weeks on and one (1) week off’.
  6. If you miss only one pill, take as soon as you remember it and then take the next one on time (even if that means you’re taking the two of them at the same time). If the delay is less than 12 hrs, you should still be safe. If it is longer than 12 hrs, you need to be careful so you could avoid sex for seven days or take extra precautions for 7 days – The 7 Day Rule. See the details below.
  7. Missing more than one pill is quite risky particularly near the beginning or end of a packet. To avoid pregnancy, follow the advice on the pack leaflet strictly.

Procedure on How to Take the Pill:

1.  Choose whatever approach you want to follow in starting the pill (as mentioned above).

2.  Try to associate taking the pill with something you do at about the same time every day, like brushing your teeth in the morning, eating a meal, or going to bed. Keep the pill near the place where you are engage in the selected activity. Establishing a routine will make it easier for you to remember.

3.  The pill works best if you take one at about the same time every day.

4.  Check your pack of pills in the morning to make sure you took your pill the day before.

5.  If you have bleeding between periods, make sure to take your pills at the same time every day. If you have spotting (light bleeding between periods) for several cycles, call a doctor’s office for advice.

6.  If you forget your pills for a day or two, follow the instructions below:

If you miss one pill, take the forgotten one (yesterday’s pill) as soon as you remember it, and take today’s pill at a regular time. As you may ovulate, use your back up method of contraception for the following 7 days of pill taking especially if the delay was more than 12 hours. If you do not have 7 tablets left in the pack, you should start a new pack and either continue until you take 7 tablets; The 7 Day Rule, and then stop for a period and throw the rest of the pack away or continue with 2 packets back to back, i.e. miss a period. You may have some spotting towards the end of the 2nd pack. This is not a problem.

  • If you miss two pills in a row, you may take two pills as soon as you remember and 1 pill the next day or you may leave the missed pills in the packet and continue taking the tablets as normal. You may have some spotting. Use your back up method of birth control for 7 days after the correct pill taking has started – i.e. The 7 Day Rule.

7.  If you have severe diarrhea or vomiting lasting several days, begin using your back up method of birth control on your first day of diarrhea or vomiting and continue using it until your next period or follow The 7 Day Rule, counting from the 1st day AFTER the diarrhea stops. The pills may not be absorbed appropriately from your gastrointestinal tract of regular pill taking when you are sick.

8.  If you are prescribed antibiotics, inform your doctor that you are on the pill as the pill may not work. Therefore as long as you are on the antibiotics and for 7 days of regular pill taking after finishing the antibiotics, use alternate contraception

9.  Periods tends to be short and scanty on the pill, and you may see no fresh blood at all. A drop of blood or a brown smudge on you tampon or underwear is considered a period. This is because combined oestrogen and progestin birth control pills suppress the formation of the uterine lining.

  • If you have not missed any pills and you miss one period without any signs of pregnancy, pregnancy is unlikely. Do a home pregnancy test or call the doctor if you are worried.
  • If you forgot one or more pills and miss a period, run a home pregnancy test or contact your doctor about a pregnancy test.
  • If you miss two periods in a row and feel pregnant, contact the doctor for an examination, even if you took your pills every day and even if a home pregnancy test is negative.

10.  If the doctor put you on continuous pills (21 days of active pills followed by another 21 days of active pills with no 7 day break of non-hormone, inactive pills) in order to suppress your menses because of endometriosis or premenstrual syndrome, you will very likely have break through bleeding. If spotting persists through more than 3 packs of pills, contact your doctor to confirm that you should stay on that brand of pills.

11.  Pills may cause pregnancy symptoms when you first start taking them. Breast soreness, upset stomach, mild headaches, mild oedema of the legs and mood swings and irritability are common. If you can bear these symptoms, try to continue taking the pills as best you can because most of these mild symptoms go away after the 2nd or 3rd month of taking the pills.

12.  Some women with persistent mood or physical symptoms find that these symptoms are on the days when they are NOT taking the active hormone pills. Discuss this with your doctor.

13.  Most antibiotics do not decrease the effectiveness of pills. There are some anti-tuberculosis drugs that do. Check with you doctor or pharmacist if a given medication is known to interfere with birth control pill effectiveness.

14.  Immediately contact the doctor if any of these danger signs appears:

  • Abdominal pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headaches (severe), dizziness, weakness, or numbness
  • Eye problems- blurred vision or vision loss, speech problems
  • Severe leg pain- calf or thigh

Remember: ACHES