The Standard Practice for Birth Control Pills
Taking birth control pills consistently, regardless of bleeding, maintains their effectiveness. For individuals using combined oral contraceptive pills, which contain both estrogen and progestin, a typical pack includes 21 active hormone pills followed by 7 placebo pills. During the week of taking the placebo pills, individuals will experience bleeding. It is important to start the next pack of active pills on schedule, even if bleeding is still occurring or has not yet started.
This continuous daily regimen ensures a steady level of hormones in the body, which prevents ovulation and thickens cervical mucus, thereby preventing pregnancy. Missing active pills, especially at the beginning or end of a cycle, can reduce contraceptive protection. Progestin-only pills are taken every day without any break or placebo pills. There is no scheduled bleeding week with progestin-only pills; continuous daily intake at the same time each day is important for their efficacy.
Understanding Bleeding on Birth Control
The bleeding experienced while taking combined oral contraceptive pills is distinct from a natural menstrual period. This bleeding, often called withdrawal bleeding, occurs due to a temporary drop in hormone levels during the placebo week. Unlike a true menstrual period, which sheds the uterine lining after ovulation and no fertilization, withdrawal bleeding responds to the absence of active pill hormones. The active hormones in birth control pills suppress ovulation, meaning an egg is not released from the ovary.
Some individuals using continuous or extended-cycle birth control regimens might experience infrequent bleeding or no bleeding at all. These regimens involve taking active hormone pills for longer periods without a placebo week, or sometimes indefinitely. The absence of bleeding on these regimens indicates that the uterine lining is kept consistently thin by the hormones, reducing the amount of tissue to shed. This can also occur with progestin-only pills, where irregular spotting or no bleeding can occur due to the continuous presence of progestin.
What to Do If You Miss a Birth Control Pill
For combined oral contraceptive pills, if one active pill is missed, it should be taken as soon as it is remembered, even if that means taking two pills on the same day. The next pill should then be taken at the usual time. If two or more active pills are missed, the specific instructions can vary depending on the week in the pill pack the pills were missed, but a healthcare provider should be consulted. In such cases, using a backup method of contraception, such as condoms, is recommended for at least seven days after restarting the pills to ensure continued protection against pregnancy.
Progestin-only pills require a stricter adherence to timing. If a progestin-only pill is missed by more than three hours from its usual time, its effectiveness may be reduced. If this occurs, the missed pill should be taken as soon as remembered, and the next pill should be taken at the regular time, even if it means taking two pills in one day. Backup contraception should be used for at least 48 hours following a missed progestin-only pill. It is advisable to contact a healthcare professional for guidance if multiple pills are missed or concerns arise.