When choosing a birth control method, you might be staring at your options thinking: OK. What do I even do here? Which one of these is right for me? There are a million choices. I feel like I’m on a birth control Bachelorette-style reality TV show like Leah on Big Mouth.
Enter the pill. It sounds retro, right? But the birth control pill is alive and well, despite the popularization of the IUD and implant in recent years. There is so much information (and misinformation) about the pill that it might make your head spin. Side effects, effectiveness, types of pills, schedules, hormones, cramping, nausea…so what is the deal?
From the information you need, to some of the myths you should do away with, here is everything you need to know about the birth control pill.
How does the birth control pill actually work?
A birth control pill is a daily pill you ingest to prevent pregnancy. According to Kristina Tocce, resident physician at Vibrant, Planned Parenthood's sex toy e-tailer, the pill uses small amounts of synthetic estrogen and progesterone (and in some cases, progesterone only) to prevent ovulation.
If you’re wondering what ovulation is: It’s when an egg is released from the ovary into the uterus each month.
Mini pills (progesterone only pills) work by thickening the cervical mucus, they “therefore act primarily as a barrier (sperm cannot enter the uterus.” This thickening should be undetectable by the pill taker.
If used perfectly, the pill is 99 percent effective. But according to Tocce, “people aren’t perfect and it’s easy to forget or miss pills—so in real life, the pill is approximately 91 percent effective (that means about 9 out of 100 pill users get pregnant each year).”
(When we say “use perfectly,” we mean every single day, at the same time.)
Will you get a period?
Monthly birth control pills come in 21- to 28-day cycle packs, usually with one week of sugar pills (placebo pills). During the placebo week you will get your “period.”
It’s not so much a real period (shedding of the uterine lining) but a withdrawal from the pill’s hormones. According to Very Well, “Not having any hormones during week four can cause the lining of your uterus to weaken just enough to allow for some bleeding to occur. It is important to point out that withdrawal bleeding is due to the change in hormone levels and is not a true period.”
Not every kind of pill has a placebo week, meaning you’re on the pill every day, without a period. It’s not at all unsafe or unhealthy to take a birth control pill that doesn’t allow for “periods.”
The placebo week exists mostly to relieve anxiety around not getting your period and is often extra reassurance that you are not pregnant.
Do you really need to take the pill at the same time every day?
Yes, the pill should be taken every day, at the same time. (This is not just a rumor.)
Tocce suggests keeping it to a 15-minute window. While consistency is the way to go with every birth control pill, it is “essential when on the mini pill.”
So set an alarm on your phone and be sure to keep your birth control in your purse or wallet so you can grab it on the go.
What happens if you forget a pill?
If you forget to take your birth control pill, you can usually take two the next day to make up for it. While this is generally the case, you should check with your doctor. When it comes to reproductive health, taking any sort of risk is not a great idea.
“There are many types of pills on the market and it never hurts to call your health care provider’s office [to] check what you should be doing with your specific pill,” Tocce says. “Using back-up (condoms) [and making] a plan with your health care provider is always a good idea!”
If you miss more than one pill, condoms are an absolute must until the next cycle.
How healthy is the pill?
The pill will not compromise your health or fertility, no matter how many years you’re on it. So, you can do away with that old myth right now.
“It is perfectly healthy to be on the pill for years,” Tocce tells Brides.
What about that thing where people say you will need months on months to rid yourself of the hormones and in order to get pregnant?
Tocce is putting the kibosh on this one, too, “Fertility should return to baseline shortly after discontinuing use, so be sure to start a new method immediately if you are not trying to get pregnant.”
Are there side effects?
There are some side effects you can expect with the pill, especially when first starting it. These will vary from woman to woman. Tocce says negative side effects may include bleeding between periods, nausea and vomiting, and a changes in your sex drive.
Some women experience no side effects at all. It’s really about your body and how it reacts to the hormones. If you experience ongoing side effects, speak to your doctor—you might be on the wrong pill. There are many different kinds of pills, and it can take some trial and error to find the right one for you.
Of course, Tocce points out that there are also a lot of positive side effects of taking the pill as well: “It is easy to take (just swallow with water), nothing has to be done ‘in the moment,’ you may have lighter periods and fewer cramps, you may be able to control when your periods come, acne may improve, some pills may offer protection against endometrial and ovarian cancer, as well as iron deficiency anemia, ovarian cysts and pelvic inflammatory disease.”
How is it different than the IUD?
The IUD (intrauterine device) is an implant and does not require daily maintenance. It comes in both nonhormonal and hormonal options. The IUD’s effectiveness always remains the same, whereas if you don’t take the pill every single day at the same time, you risk lowering the effectiveness.
The IUD delivers hormones localized to the uterus, whereas the pill is ingested with hormones reaching the bloodstream. In short: “The pill needs to be taken every day and the hormones from the pills are absorbed into your circulation,” Tocce says. To learn more about the IUD, check out our complete guide.
No form of birth control is necessarily better than the other. It’s about what works for you and what fits best with your body. “Most women will do well on any pill,” Tocce tells us. “The lowest dose pill with the fewest side effects is optimal and your health care provider can help you select the pill that you feel is right for you.”
For birth control options, talk to your doctor. Birth control comes in several forms including patches, pills, IUDs, and arm implants.