Shocked african american woman reading leaflet before taking contraceptive pills, sitting on couch at home

Birth control pill: everything you need to know

Combined birth control pills contain two hormones, estrogen, and progestin. ‘Mini-pills’, or progestin-only pills, only contain progestin.


The full name for the combined pill is Combined Oral Contraceptive Pill or COCP. The full name for the ‘mini-pill’ is Progestin-Only Pill or POP. But most people just call them both ‘the pill’.

How well does it work?

Failure rate

Typical use: 7 percent
Perfect use: less than 1 percent
The combined pill works very slightly better than the mini-pill for non-breastfeeding women. In breastfeeding women, who are the main users of POPs, POPs are highly effective (less than 1% pregnancy rate even in typical use)

(Read more about what ‘failure rate’ means in how well does it work?)

Pros

  • Very good at preventing pregnancy
  • You can stop taking it to try and get pregnant whenever you like
  • COCs make periods lighter, reduce menstrual cramps
  • No interruption during sex
  • You don’t need the man to cooperate

Cons

  • You’ve got to take it every day – miss a day and you could get pregnant
  • POPs can make periods irregular and unpredictable, with some women developing amenorrhea.
  • It doesn’t protect against sexually transmitted diseases
  • It can be expensive
  • You need to see a health care provider and get a prescription

How do birth control pills work?

Combined birth control pills, with two hormones, stop you from producing an egg. At the same time, they make the mucus around your cervix thicker so the sperm can’t get through.

Mini-pills, with only one hormone, work just because of this thickening of the mucus. But they also stop you from producing an egg some of the time too, depending on the dose.

Who shouldn’t take birth control pills?

You shouldn’t take any kind of birth control pills if:

  • You’ve had breast cancer 
  • You’ve got blood clot problems that aren’t being successfully treated
  • You think you’re pregnant. (But if you’re on the pill and still got pregnant, it won’t have harmed the baby – read more in pregnancy FAQs)
  • Taking certain medications, such as TB drugs or drugs to treat seizures

Who shouldn’t take combined birth control pills, rather than mini-pills?
You shouldn’t take combined birth control pills, if:

  • You’ve had a long period of bed rest
  • You have migraine headaches with auras, which affect what you see
  • You’ve inherited blood-clot disorders, have had blood clots, or inflamed veins
  • You’ve had a heart attack, a stroke, or, angina
  • You’ve got serious heart valve problems
  • You’ve got lupus
  • You’ve had serious liver disease or liver cancer
  • You’ve got very bad diabetes
  • You’ve got high blood pressure
  • You’re a smoker and are 35 or older
  • Had a baby less than 3 weeks ago
  • Breastfeeding a baby less than 6 months old
  • Have gallbladder disease
  • You’re taking certain medications, such as TB drugs or drugs to treat seizures

This is why you need to see a health care provider and get a prescription before you go on the pill.

What should you do if you miss a pill?

Check the instructions for your brand of pill.

You need to take the pill at the same time every day although it’s okay if you take it three hours later or earlier. If you miss a pill, you should take the next one as soon as you can. You carry on taking the pill as normal. But at the same time, you need to use a backup birth control method, because otherwise, you could get pregnant.

  • Combined birth control pill: If 1 or 2 pills are missed (or if a new pack is started 1-2 days late), users should take a hormonal pill as soon as possible, with no backup method needed. If 3 or more pills are missed (or if a new pack is started 3 or more days late), users should take a pill as soon as possible and use a backup method for the next 7 days.
  • Mini-pill: if you take it more than three hours late, you need a backup for two days.

Back-ups might be a condom, female condom, diaphragm, or sponge. If you’ve had sex and think you might not have been properly protected, you can use emergency contraception.

What can stop the pill from working properly?

  • Vomiting or diarrhea can stop the pill from working properly – check the instructions for your brand of pill.

If you vomit within two or three hours of taking the pill your body might not have absorbed it properly. You should take another pill. But if you keep vomiting, you should use a backup birth control method for seven days after you get better.

  • Do the same if you’ve had severe diarrhea for more than 24 hours.
  • Certain medicines might stop the pill from working as well. They include medication for HIV, and epilepsy, and the herbal remedy St John’s wort.
  • You need to check with a healthcare professional if you’re taking medicines along with the pill.

How safe are birth control pills?

After a few months, most women find the pill doesn’t give them any side effects.

When you stop taking the pill it can take one or two months before your period cycle returns to how it used to be before taking the pill. If you had irregular periods before taking the pill, they might be even more irregular when you stop. Talk to your healthcare provider if you’re worried about this.
During the first two to three months, you may have:

  • Tender breasts
  • Nausea
  • Vomiting
  • Bleeding between periods (more likely with the progestin-only or ‘mini-pill’)

If you take your pill every evening or at bedtime, you’re less likely to experience nausea and vomiting.

If you’re still experiencing nausea after three months, talk with your healthcare provider about changing your prescription.

Remember if you stop taking the pill because it’s making you feel sick, you will be at risk of getting pregnant. You’ll need to use another birth control method if you have intercourse.

Combined birth control pills very slightly increase the risk of certain serious health problems including heart attacks, strokes, or blood clots. The risk gets higher if you’re over 35 or you smoke.

Progestin-only pills have fewer serious side effects than combination birth control pills. Ask your health care provider about switching if you’re getting side effects on combined pills.

Immediately contact your nearest health care provider, if you:

  • Get a new lump in your breast
  • See a bright flashing zigzag light (an aura) before getting a very bad headache
  • Have a sudden very bad headache
  • Have different or more headaches than usual
  • Get sore, achy legs
  • Notice your skin or eyes are turning yellow
  • Have no period after having a period every month

How do I get birth control pills?

First, go to your nearest health care provider for a prescription. They’ll first ask you about your medical history and check your blood pressure. After ruling out any serious conditions, they’ll give you a prescription.

The cost of the pills depends on where you live.

Do birth control pills have any health benefits?

Both combined and progestin-only birth control pills can:

  • COCs make your periods more regular and lighter
  • Reduce your menstrual cramps
  • Give some protection against pelvic inflammatory disease, which if left untreated can make you infertile

The combined birth control pill can also:

  • Reduce your acne
  • Makes you less likely to have an ectopic pregnancy, if you get pregnant
  • Makes you less likely to get cancer of the womb or cysts on your ovaries
  • Makes you less likely to get iron deficiency anemia

Tell us what you think

Recent Comments (40)

  1. Good i understand,,,, wich…
    Good i understand,,,, wich is the best way wen breastfeeding

    1. Hey Carol, Any method will…
      Hey Carol, Any method will work alright. It is about which method you prefer and for how long you want to prevent pregnancy. Talk to your health provider for more information.

  2. Am a virgine and need to…
    Am a virgine and need to have sex which is the best contraceptive to use

    1. Hi Liz, It depends on a few…
      Hi Liz, It depends on a few things including, how important is it that you don’t get pregnant, how well does the birth control method work, what are the side effects of the birth control method, how soon would you like to have children among others. Check out this article;- https://lovematters.co.ke/birth-control/types-of-birth-control

  3. Do condoms cause cervical…
    Do condoms cause cervical cancer?

  4. I was on injector plan for…
    I was on injector plan for three years but stopped using in December till date I have not conceived and yet my menestral circle is stable

  5. When can my partner take…
    When can my partner take epill after we had sex and where can I buy the medicine?

    1. Hi Okongo, the E-pill can be…

      Hi Okongo, the E-pill can be bought at your local pharmacy, just ask for the Emergency Contraception Pill. The E-pill can be taken any time within the first 72 hours after having unprotected sex. However the sooner one takes the E-pill the more effective it is likely to be in preventing the unplanned pregnancy. For instance, taking the E-pill within the first 24 hours makes it 95 per cent effective, while if it’s taken between 49-72 hours the pill is only 58  per cent effective. The sooner one takes the pill, the more effective it will be. Also, you may want to consider using condoms since when correctly and consistently used, they help prevent both unplanned pregnancies and Sexually Transmitted Infections. The E-pill only prevents pregnancy. Have a look at this article;- https://lovemattersafrica.com/birth-control/types-of-birth-control/emergency-contraception  

  6. Will I add a lot of weight…
    Will I add a lot of weight when I start using the pill?

    1. Hi Loiuse, this is one of…

      Hi Loiuse, this is one of the expected side effects, some women experience weight gain while taking the pill but this side effect does not affect all women. Unfortunately, you can only tell whether the pill will affect you in this way after you start taking the pill. Have a look at this article for more information of other expected side effects;- https://lovemattersafrica.com/birth-control/8-common-side-effects-of-contraceptives

  7. Am a virgin which is the…
    Am a virgin which is the best contraceptive method to use

    1. Hey Cess, there are various…

      Hey Cess, there are various methods you can use when you do decide to have sex. Some of the of the methods will prevent pregnancy for a short period of time while others will prevent for a longer period of time. Some of the methods are more effective that others, while some methods are permanent. It is also important to note that some of the methods will present some side effects. Take time and think about how important it is for you to prevent pregnancy and also get as much information as possible on each of the methods. Have a look at the following article that provide more information on the various methods;- 

      https://lovemattersafrica.com/birth-control/choosing-the-right-birth-control/how-to-choose

      https://lovemattersafrica.com/birth-control/types-of-birth-control

  8. Will I add weight when I…
    Will I add weight when I start using the pill?

    1. Hi Phillis, weight gain is…

      Hi Phillis, weight gain is one of the possible side effects one can experience. Unfortunately, there is no way to tell if you will experience this side effects. 

  9. my worry has always been the…
    my worry has always been the weight gain, i want to keep or reduce my current weight I cannot afford to add.

  10. Will i gain weight if i…
    Will i gain weight if i start having sex

  11. Are you supposed to take one…
    Are you supposed to take one P2 or both at the same time to peeve pregnancy?

  12. Wil the pill make the user…
    Wil the pill make the user fat?

    1. Most people people who use…
      Most people people who use the pill end up gaining alot of weight. If you don’t want the weigh you should choose another method. I speak from experience as well.

      1. Hello Abbie, thank you for…

        Hello Abbie, thank you for sharing. This is one of the expected side effects however, there is no way to tell for sure if one will experience it. 

  13. I fear the pill it will make…
    I fear the pill it will make me fat?

    1. Hi, there is no way to know…

      Hi, there is no way to know for sure that you will experience this side effect but yes, this is one of the side effects of using the pill. You can consider speaking to your health care provider to explore other options based on your needs. Have a look at the following article for more information on the different methods;- 

      https://lovemattersafrica.com/birth-control/choosing-the-right-birth-control/how-to-choose

      https://lovemattersafrica.com/birth-control/types-of-birth-control

    2. Most people I know put on…
      Most people I know put on alot of weight when they start use the fp pill.

      1. Hey Catherine, this is one…

        Hey Catherine, this is one of the side effects that’s expected as a result of using the pill.

  14. Where can you get the copper…
    Where can you get the copper IUD and is it expensive?

  15. Hi is the mini pill…
    Hi is the mini pill(progesterone only pill) safe to use 7months post delivery. Is it still effective.

    1. Hi Macky, it is one of the…

      Hi Macky, it is one of the safer birth control pills. However, it has been linked with low milk production (if you are breastfeeding). However, if you feel you are having problems please speak to a medical practitioner for advice on the way forward.

  16. You are most welcome…

    You are most welcome Anonymous and we are always pleased to help.

  17. Hi how can i know my safer…
    Hi how can i know my safer days

  18. Knowing your safe days needs…

    Knowing your safe days needs you to track your cycle. Your cycle begins on the first day of your period to the first day of your next period.

    To know how long your cycle is, you will need to track it closely for a few months. Most women’s cycle’s last between 28 and 30 days. However, yours may be longer or shorter. Day one through seven are considered to be infertile (safe days). Day eight through to day 19 are considered to be your most fertile. From day 20 to day 26 to 30 are considered to be your infertile days (safe days).

    This article should provide more information. Please remember, that using this method can prevent pregnancy but you will still be exposed to STI’s. This method is not full proof and pregnancy could still occur.

    https://lovemattersafrica.com/birth-control/types-of-birth-control/safe-days-pros-and-cons?fbclid=IwAR16Aj90XjCzFNMEo3HV_4sgn8S1ve4qI-ih7v-NlwmqpPohTBYYw_7fmEs

  19. Hi, i had a miscarriage at…
    Hi, i had a miscarriage at 18 weeks 6days due to cervical incompetance and I’ve been on pills for two months now. Eversince i started using the pills i havent seen my periods and am worried. Is this normal or should i seek assistance

    1. Hi Alice, thank you so much…

      Hi Alice, thank you so much for reching out to us. We are so so sorry to hear you have been through such a hard time. This is a medical issue and we strongly suggest you go to the medical practitioner who prescribed the pills to you for proper advice on the way forward.

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