How to take your contraceptive pill
Step-by-step guide on how to take your pill. To be sure your pill works effectively, you must take it exactly as recommended.
Monophasic pills provide the same dose of hormone every day. There are 21 hormone-containing pills in a pack, with a 7-day hormone-free break (either by taking no pills or by taking inactive pills). Each pack lasts for 28 days, the same length as a typical menstrual cycle.
Monophasic pill brands
Below is a list of 21-day monophasic pills, with links to the Patient Information Leaflet for each (the leaflet included in the medicine packaging which includes directions on how to take).
The following rules for pill taking apply to any of the 21-day, monophasic, combined pills.
Traditional combined pill-taking regime
Start the pill on any day of the month, if you know you are not pregnant.
You can reasonably assume you are not pregnant so long as there are no signs/symptoms of pregnancy and, if applicable:
- You are within 7 days of the first day of your last menstrual period.
- You have not had unprotected sex since your last period.
- You have been using another method of contraception consistently and reliably to the current date.
- You are within 7 days of an abortion or a miscarriage.
- You are fully breastfeeding, not having periods, and are within 6 months of giving birth (although if you are breastfeeding the progesterone only pill is usually preferable).
- You are within 4 weeks of delivery and not breastfeeding and have not had unprotected sex since the delivery.
What to do first: open a new pack of pills. Take one pill every day for 21 days, following the arrow round the pack.
How to continue: choose a time of day you are likely to remember – for many women this is first thing in the morning when they wake up – so keep your pills on your bedside table where you can see them if possible.
Don't forget/miss out pills: it's very important not to forget pills or be late with them. Try and take them at the same time each day. It's good idea to get into a routine, then you are less likely to forget.
What to do if you forget/miss out a pill: if you forget a pill, take it as soon as you remember – don't leave it out – even if you take 2 pills together. For forgotten pills, you must follow the missed pill rules. Perhaps set a reminder on your phone to remind you to take your pill every day at the same time.
When does the pill become effective? If you start the pill within the first 7 days of a period you can assume it will work straightaway. If you start any later than this in the cycle, the pill will take 7 days to be effective. During these 7 days you should not have sex, or use a condom carefully if you do. Once 7 pills have been taken correctly, you have contraceptive cover and you can rely on the pill for contraception.
Don't forget sexually transmitted disease (STI) protection: the pill does not protect you from STIs, so it is recommended to use condoms carefully and consistently with a new partner, at least until you have both had an STI screen. Having regular screening is extremely important, especially for your future fertility. Many women with STIs have no symptoms at all, so go and get tested. You can either visit a local STI clinic or order a home STI test kit.
Common side effects when first starting the pill: you may feel a bit sick, have sore breasts, headaches, or spot bleeding when you first start the pill but these are usually not serious side effects and are likely to settle down within the first 3 months.
The 7-day break: when you get to the end of the pack, you then have 7 days with no pills, or pills that do not contain hormone. During these 7 days the pill is still protecting you from pregnancy. This means you can still rely on the pill and do not need extra contraceptive cover during the 7-day break. You are likely to have a withdrawal bleed, similar to a period, but a lot lighter. 7 days later, on the same day of the week that you started the first pack, you start the second pack and follow the pills back round this pack as before.
Restarting the next pack of pills: it's very important not to be late starting the new pack of pills. You must not have more than 7 days between packs of pills. If you do, you have lengthened the time off the pill and you could produce an egg (ovulate). So do make sure you set a reminder to restart your next pack of pills on the right day of the week.
Extended pill regimes - other ways to take the pill
Having a 7-day break on your pill is now considered outdated.
There are several alternative ways to take the pill. It may seem confusing, especially for someone new to the pill, that these methods exist, but in fact they have much to commend them. These continuous dosing/extended regimes are endorsed by the Faculty of Sexual & Reproductive Healthcare.
When the pill was first developed in the 1960s, it was formulated to have 21 active pills and a 7-day break, to mimic a menstrual cycle, with a period at the end of the month. Women liked to have a bleed as they felt they were not pregnant.
However, with clinical experience, it has become apparent that the monthly bleed is not necessary. Stopping the pill for 7 days a month causes confusion and lends itself to error. Women bleed, because in the 7 days when they do not take their pill, their hormone levels drop. Clinical experience has shown that by getting rid of the 7 day break, there is less room for contraceptive error, and less need to cope with menstruation.
Not having a bleed is not harmful. It doesn't affect the health of the womb or your future fertility. From time to time you do need to bleed however, as the endometrium (womb lining) can build up and this may cause irregular bleeding in the long term if it is not shed from time to time.
By extending the length of time you take your pill, and having less pill breaks, the pill becomes safer and easier to manage. The extended options for taking the pill are called extended pill regimes.
Extended pill regimes are safe and effective. The use of extended pill regimes has much to commend it. Research suggests this is not being encouraged enough.
Below are two extended pill regime options. These are a recommended alternative option if you are taking any 21-day, monophasic pill.
- Take the pill for 21 days.
- When you get to the end of the pack, start a new pack the next day and keep going. Do not have the 7 day break.
- If you run 3 packs in a row like this, this is called tricycling.
- When you get to the end of the third pack, allow yourself a break. This can be for 4–7 days.
- You should bleed in the break - although sometimes women do not bleed.
- After this, start a new pack and repeat, taking another 3 months back-to-back.
- Take the pill for 21 days.
- At the end of the pack, keep going.
- Keep taking your pill every day for as many packs as it takes, until you start to bleed. This could be 6 months or more.
- When you are bleeding - for around 2 days, take a 4-day break, then restart.
- You do not need to use extra contraception in the 4-day break - the pill is still protecting you.
Research demonstrated the Sulak Regime is well tolerated and effective.Buy Contraceptive Pill
Authored 06 November 2018 Dr Tony Steeleby
Last updated 11 February 2019
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