Combination Birth Control Pills

What are combination birth control pills?

A combination birth control pill is a type of birth control pill that contains estrogen and progestin. You take combination birth control to prevent pregnancy. As the name suggests, this type of birth control comes in a small pill that you swallow at the same time each day. Your healthcare provider must prescribe combination birth control pills. There are several different types of combined birth control pills available, so your healthcare provider will help you determine which may be best for you.

Combination or combined birth control pills also go by the name combination or combined oral contraceptives.

How do combination pills work?

Combination birth control pills release synthetic (human-made) estrogen and progestin into your bloodstream. Together, these hormones work to prevent pregnancy by:

• Stopping ovulation (when your ovary releases an egg).
• Thickening cervical mucus, which makes it harder for sperm to get into your uterus.
• Thinning your uterine lining, which makes it harder for a fertilized egg to implant.

Combined birth control can come in forms other than a pill, like a ring or patch.

How effective are combination birth control pills?

Combination birth control pills are about 93% effective in preventing pregnancy. This is less than other forms of birth control like an IUD (intrauterine device) or shot. The main reason it’s not as effective as other birth control methods is that it’s easy to accidentally miss doses. This decreases its effectiveness. With perfect use (not missing a dose), it can be up to 99% effective.

What are different types of combined birth control pills?

The main difference between types of combined birth control pills is the amount of estrogen or progestin in each pill or how the dosage varies in one pill pack.

Combination birth control pill types are usually:

• One-phase (monophasic) pills: Each pill in the pack contains the same amount of estrogen and progestin.
• Two-phase (biphasic) pills: The level of hormones in these pills changes once during each menstrual cycle or pill pack. This may mean the estrogen or progestin levels increase one time.
• Three-phase (triphasic) pills: The levels of hormones can change up to three times in one menstrual cycle or pill pack.

Combination birth control pack sizes

Combination pills can vary in pack size. Most commonly, combination birth control pills come in a 28- or 21-day pack. These are sometimes called conventional packs because it’s traditionally how birth control pills come.

Both types have 21 hormone-containing or active pills. The main difference is the 28-pack contains seven placebo pills. You continue to take the pills, but since they don’t contain hormones, you get your period during that time. Once the pack is complete, you begin a new pack.

A 21-day pack doesn’t contain placebo pills. Once you take 21 pills, you take nothing for seven days. Then, on the eighth day, you begin a new pack. The benefit of the 28-day pack is that you’re in the routine of taking the pills, so it’s easy to transition from one pack to the next pack. This is one reason a 28-day combination birth control pill is the most common.

Other common pill pack sizes are:

• Extended packs: These are pills that drastically reduce how often you get your period. Some pills come in 90-day packs. This means you take 84 active pills before getting your period.
• Continuous packs: There’s one pill available in the U.S. that you can take all year (365 days). It can completely stop your period.

There are also low-dose combination pills that contain the smallest amount of estrogen, and high-dose combination pills that contain the highest amount of estrogen.

Your healthcare provider can help determine which type may work best for you based on your lifestyle, health history and other factors. You provider typically requires a physical examination or pelvic exam before prescribing a pill, in addition to getting your complete medical history.

What brands of birth control are combination pills?

Combination birth control pills come in many different brands. They can contain different types of hormones and in different dosages. Some of the more common brands of combined oral contraception are:

• Sprintec®.
• Junel®.
• Apri®.
• Mircette®.
• Loestrin®.
• Ortho-Tri-Cyclen®.
• Yaz®.
• Seasonique®.

It’s important to note that just because a certain brand works for one person doesn’t mean it’ll work for you. Your healthcare provider can work with you to find the pill that works best.

Is combination birth control better than the minipill?

Most studies show that combination birth control is slightly better at preventing ovulation than the minipill. But the minipill has benefits combination pills don’t have, such as being safe for breastfeeding (chest feeding) and safe for people who can’t take estrogen.

What are the side effects of combination birth control pills?

Some of the more common side effects of combination pills are:

• Headaches.
• Nausea.
• Sore breasts.
• Bloating.
• Spotting or bleeding between periods. (This usually subsides after a few months.)

Contact your provider if you experience side effects for longer than a few menstrual cycles. They can recommend a different combined pill to try.

Which pill has the least amount of side effects?

The types of side effects you experience from a birth control pill are unique to you. It’s hard to say which pill produces the fewest side effects because everyone is different. Most often, your provider will begin with the lowest doses of hormones to prevent pregnancy first. This typically causes the least amount of side effects. But because there are several different types of progestin and varying hormone dosages in pills, it may take time to figure out which pill produces the least amount of side effects. It’s not uncommon to try a few pills before settling on the one that works best for you.

What are the pros and cons of the combination pill?

While most combination birth control pills share similar pros and cons, they can also vary widely depending on the person. For example, your friend may be on the same pill as you and have a completely different experience.

Combination pills typically have the following benefits:

• Safe: Birth control pills are safe for most people.
• Less painful periods: Combination birth control pills can improve heavy bleeding or painful periods, even those due to endometriosis or fibroids.
• Regular, predictable periods: Combination pills can treat irregular periods by making your cycle regular or making them shorter.
• Reduce cancer risk: Studies show oral contraception can reduce your risk of developing uterine and ovarian cancer.
• Clearer skin: Most combination birth control improves acne and helps with excess hair growth because it balances hormones.
• Reversible: Your fertility returns almost immediately after stopping the pill.
• Helps with menopause symptoms: Combination pills can help reduce uncomfortable symptoms like hot flashes.

Remember, there are several types of combined birth control pills on the market. Your healthcare provider can help find the one that gives you the most benefits.

Some of the disadvantages of combination pills are:

• Inconvenience: You have to remember to take a birth control pill at the same time each day. This can be hard to do, even for people with great memory or reminders on their phones.
• Increased risk for deep vein thrombosis (DVT): You may be at risk of DVT, heart attack and stroke, especially if you’re older than 35, smoke cigarettes or have a history of cardiovascular disease. You shouldn’t take hormonal birth control until six weeks after childbirth to reduce your risk of DVT.
• Decreased milk supply: People who are nursing may experience a decrease in milk supply from combination birth control pills.

There are other medical conditions or health reasons that may make birth control pills unsafe. Make sure you share your full medical history with your healthcare provider. They may suggest a different type of birth control based on this information.

The other downside to a combination pill is that it offers no protection against sexually transmitted infections (STIs). You’ll need to use a condom with a pill to reduce your risk of STIs.

What happens if you miss a pill?

Combination birth control pills only work if you take a pill at the same time each day. If you take a pill a few hours late, this isn’t usually a problem. But, if you skip a pill entirely, you should use a backup method of birth control for at least seven days (or the rest of your menstrual cycle as a precaution).

When should I call my healthcare provider?

Contact your healthcare provider if you miss your period or believe you may be pregnant. You should also call your provider if you experience any of the following symptoms:

• New or worsening headaches, vision changes or blurred vision.
• Abdominal cramping or vomiting.
• Chest pain or breathing difficulties.
• Jaundice.
• Leg pain or swelling in your leg.

A note from Cleveland Clinic

Combination birth control pills are the most common type of birth control pill. There are over 30 different brands and types of combination pills on the market today. It’s called a combination pill because it contains two different hormones that work together to prevent pregnancy. Birth control pills can have other benefits, as well, like lighter periods and better skin. They can also come with drawbacks like breast tenderness or bloating. Talk to your healthcare provider about which combination birth control is right for you. They can help you find a pill that works best.