Birth Control Pills

Picture of hand holding various birth control pill packages
There are many different brands of birth control pills. When used perfectly, the pill is 99% effective in reducing the risk of pregnancy. The pill is often used for other medical reasons.

Birth control pills are also known as:

  • The Pill
  • Oral contraceptive pill (OCP)
  • Oral contraceptives (OC)

Make an appointment to get birth control pills, or for help choosing the best birth control for you.

The Pill in detail

How the birth control pill works

Most birth control pills are a dose of hormones (estrogen and progestin) that a female takes once a day to prevent pregnancy. The birth control pill is about 99% effective at preventing pregnancy when used perfectly. It is one of the most popular and effective methods of birth control.

The combined birth control pill works primarily by preventing the ovaries from releasing an egg each month (ovulation). It also thickens the cervical mucus, which acts as a barrier and helps to immobilize sperm. And lastly, it thins out the lining of the uterus (endometrium), which makes it difficult for a fertilized egg to implant itself into the wall of the uterus.

The progestin only pill (aka minipill/progestin only pill/POP) primarily prevents pregnancy by thickening the cervical mucus and thinning the lining of the uterus. It only prevents ovulation (release of an egg) in about 40% of cycles.

Neither type of birth control pill offers any protection against sexually transmitted infections.

Birth control pill side-effects and dis-advantages

Possible side-effects are usually minor

For most users, the pill is safe, effective and convenient. Some users may experience minor side effects such as midcycle bleeding (spotting), nausea, water retention, breast tenderness or mood changes when starting the pill. These side-effects should disappear within the first 3 months. A user may also notice a change in vaginal discharge (part of how pill reduces the risk of pregnancy).

If you have persistent side-effects, your doctor may recommend trying a different brand of pills to reduce them.

There are some rare but serious risks associated with combined hormonal contraception (blood clots, stroke, etc). The risks of using birth control pills are smaller than the health risks associated with pregnancy. See the danger signs below.

However, there are some women who may not be able to use the pill because of their health history (for example, people who have migraines with aura, have high blood pressure or cholesterol, diabetes may need to explore other methods instead).

Benefits of birth control pills

  • regulates periods and can be used to control timing and frequency of bleeding
  • decreased cramping and blood loss
  • reliable (99% effective when taken correctly)
  • convenient
  • may be used to treat acne
  • reduces risk of ovarian cysts, benign breast disease, endometriosis, ectopic pregnancy, ovarian and endometrial cancers

How to get birth control pills

Make an appointment at any of our clinics to see a doctor about getting a prescription for birth control pills.

Once our doctor has determined you can safely take the pill and written you a prescription, you can buy your pills right here at our clinic! We can also write you an outside prescription if you prefer to purchase them at a pharmacy. We will teach you everything you need to know about the pill and answer any questions you have.

Using birth control pills properly

  • It is important to take your pill at the same time everyday, for it to be most effective.
  • Be sure to start your new pack immediately after finishing your last, without missing a day, even if you still have bleeding. You will always start your new package on the same day of the week.

If you are new to the pill, the doctor will probably start you on a 28 day package which means you will be taking a pill everyday for 4 weeks. The schedule for taking your pills will depend on which pill you are prescribed. It may be 21/7, 24/4, 24/2/2,  or an extended cycle where active pills are taken continuously. Be sure to clarify the correct schedule for your particular pill.

The last week or few days of your package contains placebo pills or sugar pills which are inactive (they contain no hormones). During this placebo time is when you will experience a withdrawal bleed (similar to period bleeding). You are still protected from pregnancy even during this time provided you have taken your pills correctly during the package and begin again on schedule.

Bleeding or spotting outside this placebo time is not uncommon. It does not mean the pill is not effective. Spotting is more likely if you have taken your pills inconsistently. If midcycle bleeding persists, speak to a physician.

Starting the birth control pill

If begin taking your first pill on the first day of your period, you are protected immediately against pregnancy.

You may also do a “quick start” method which means you start your pills as soon as they are prescribed, regardless of where you are in your cycle. With this quick start method, you must use a back-up method of birth control, such as condoms, for at least the first 7 days to limit your risk of pregnancy.

When to use backup birth control

Vomiting & diarrhea

If you vomit within two hours of taking your pill, take another pill as the first pill may not have been absorbed properly by your body. Use a back-up method for 7 days.

If diarrhea persists for more than a two days, continue to take the pill but use a back-up method for the rest of the package.

Conflicting medications

There are some medications and herbal remedies that may make the pill less effective. Some of these include:

  • Rifampin, rifabutin, and Griseofulvin
  • some anti convulsants (Barbituates; Oxcarbazepine;  Primidone; Phenytoin; Carbamazepine; Toprimate;Lamotrigine and Vigabatin)
  • Certain antiretroviral therapies
  • St. John’s Wort

If you are not sure whether the medication you are taking interferes with the pill, call us or a pharmacy, and use a back-up method for the rest of the package.

If you miss a pill

It is important to take your pill everyday at approximately the same time (within 2-3 hours of your regular time) in order for it to be effective.  There is evidence that ovulation and pregnancy risk can occur if birth control pills are missed for as little as 12 hours.

If you have unprotected sex after missing any pills contact the clinic at 592-3479 to discuss using Emergency Contraception such as Emergency Contraceptive Pill (ECP) or a Emergency Copper IUD insert. It is possible to obtain the ECP in advance from our clinic to keep “on hand” for such an occasion and we recommend this.  You may also obtain ECP from pharmacies in BC without a prescription.  The sooner you take the ECP the more effective it is at preventing pregnancy.

Island Sexual Health Society recommends the following guidelines for clients who have missed pill(s).

The Missed Pills Guide [pdf] will help you figure out how best to deal with a missed birth control pill.

Danger signals for birth control pill users

Call your doctor or go to the nearest medical treatment centre if you have any of the following symptoms while taking birth control pills:

  • A – Abdominal pain, severe
  • C – Chest pain (severe), cough, or shortness of breath
  • H – Headache (severe) or increased frequency or intensity of headache, dizziness, weakness, or numbness
  • E – Eye problems: vision loss or blurring, speech problems
  • S – Severe leg pain in calf or thigh

Why won’t ISH prescribe birth control with estrogen (combined pill, patch or ring) to people with migraine with aura?

ISH follows the World Health Organization guidelines that recommends that a person with ovaries on an estrogen based product (combined pill, patch or ring) who develops any neurological symptoms “should not use the method”. Focal neurological symptoms in a user, “represents an unacceptable health risk if the method is used.” Medical literature shows that among users who have migraines, users who also have focal neurological symptoms have a higher risk of stroke than those without focal neurological symptoms when using combined hormonal birth control products.

The WHO also recommends that a user considering using Combined hormonal methods (combined pill, patch or ring) should not use them if they already has migraine headaches with focal neurological symptoms.

The WHO Medical Eligibility Criteria are more positive about the use of progestin only pills (POP/Micronor/Mini pill) by people who have migraine headaches with focal neurologic symptoms. Other progestin only alternatives are Depo-Provera and Mirena or Jaydess IUDs. Other options such as copper IUD or condoms also may be an acceptable alternative for you.

We encourage you to discuss these methods with a physician to determine an acceptable contraceptive option for you.

World Health Organization Medical Eligibility Criteria for Starting Contraceptive Methods 2004