Oral contraceptives: Things to know before you pop the pill


Birth control pills are plagued by far too many misconceptions. Read on to discover what they are, how they work, and more.

What are birth control pills?

Birth control pills are hormone-containing medicines used to prevent pregnancy. These medicines, also called oral contraceptives, are taken by mouth.

What are the types of birth control pills?

  • Combination pills (Combined Oral Contraceptives (COCs)) contain the hormones oestrogen and progesterone
  • Progesterone-only pills (POP or mini-pills)

How do birth control pills work?

Mechanisms of action include:
  • Preventing ovulation: Eggs have to be released from the ovary for them to be fertilised by sperm. (Progesterone prevents this release of the egg from the ovary)
  • Progesterone thickens cervical mucus, which prevents the entry of sperm into the uterus
  • Thinning of the inner lining of the uterus: the fertilised egg is not able to attach to the inner uterine lining

How effective are birth control pills?

If used correctly, birth control pills prevent pregnancy with 99% efficacy.

When should I start taking birth control pills?

It is always better to consult a doctor before you start taking birth control pills. If you are starting with birth control pills for the first time, there are three methods for beginning the prescription cycle:
  • First day start: Here, you take the first pill on the first day of your period. You won’t need to take any backup contraceptives with this method
  • Sunday start: Here, the first pill is taken on the first Sunday after your menstruation starts. You need to use a backup contraceptive such as a condom for the next 7 days if you are following this method
  • Quick start: Here, you take the first pill in the pack right away. You need to confirm that you are not pregnant through a pregnancy test before you start taking pills through this method. You will require a backup contraceptive for the first 7 days after you start taking your pill
  • Abortion or loss of pregnancy: In case of an abortion or loss of pregnancy within the first two trimesters, start the pills within the first 7 days, if you desire contraception
  • Post-childbirth: Avoid taking pills for at least 21 days after the delivery of your baby. Consult with a doctor to understand your physical status and risk factors before starting your contraceptive pill course
  • Breastfeeding: If you are a breastfeeding mother, avoid contraceptive pills for at least 42 days after the delivery. Consult your doctor before you starting your contraceptive pill course
Take the pill at the same time every day to maximise the benefits of contraceptives.
Birth Control Pills

What are the types of pregnancy pill packs?

  • 21-day pack: This contains 21 pills that have to be taken every day for 21 days. This is followed by a 7- day break during which you will experience menstrual bleeding. Resume taking the pills after these 21 days.
  • 28-day packs: The first 21- 24 pills contain hormones and the last 4-7 pills in the strip are placebos. The last tablets contain sugar or iron to keep up the habit of taking tablets. You will experience menstrual bleeding when you are taking the placebo. Start a new strip once your 28-day strip is finished
  • 91-day packs: Take one pill a day for 84 days. The last 7 pills will be placebo and you will experience menstrual bleeding during this time

What if I get pregnant while taking birth control pills? Will it affect my baby?

If you find out that you are pregnant while you are taking birth control pills, stop the pills immediately. Birth control pills do not usually affect the foetus during the first few weeks of pregnancy. However, consult a gynaecologist at the earliest possible time for further testing.

What are morning-after pills?

The morning-after pill is a type of emergency birth control that is used to prevent pregnancy in a woman who has had unprotected sex or in cases where birth control precautions have failed. These tablets, as the name suggests, are only for emergency usage and not for routine administration.

If I am looking to get pregnant, how soon can the pregnancy occur after discontinuing birth control pills?

Ovulation usually begins a few weeks after you stop taking birth control pills. You will be able to get pregnant once the ovulation starts again. After discontinuing the pill, you can become pregnant within one to three months.

What are the side effects of birth control pills?

Side effects include:
  • Breakthrough bleeding (A small amount of spotting when you are not actually on your period)
  • Nausea
  • Headache
  • Abdominal cramps
  • Painful breasts
  • Increased discharge from the vagina
  • Decreased sexual drive
  • High blood pressure
  • Changes in the menstrual cycle
Additionally, birth control pills may increase the risk of:
  • Ectopic pregnancy
  • Stroke
  • Heart attack
  • Venous thromboembolism (blood clots in the veins)

Do birth control pills cause cancer?

Studies suggest that women who use birth control pills have a higher risk of developing breast and cervical cancer. However, they have a lower risk of developing endometrial, ovarian, and colorectal cancer compared to women who do not use contraceptives.

How soon do the effects of birth control pills become apparent?

It may take up to 7 days for the birth control pills to show their effects. It’s safer to use backup contraceptives such as condoms during this period.

I forgot to take my birth control pill. What should I do?

  • Combined pill: If you forget to take one dose of your pill, take it as soon as you remember and take the next pill at the usual time (even if it means that you take 2 tablets on the same day). If you have missed two tablets in a row in the first or second week, take two pills on the day you remember them and take two tablets on the next day and then continue to take one tablet per day for the rest of the cycle. Use additional contraception such as condoms for the next 7 days. Check the package information leaflet for accurate information on how to handle missed doses.
  • Mini pill: Take the missed dose when you remember it and take the next pill at the usual time. Use additional contraceptives for the next 7 days.

Are there any contraindications to taking birth control pills?

  • Uncontrolled high blood pressure
  • Above 35 years of age and smokers: increased risk of developing heart complications
  • History of heart disease
  • Venous thromboembolism (blood clots in the veins)
  • Confirmed or suspected breast cancer
Dr. Sosa

Dr. Sosa


An oral physician turned medical writer who writes profoundly about medicine and diseases. Read her contributions and writings about various healthcare topics.

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