Combination Oral Contraceptive (OC) Pill
What Are They?
Combined oral contraceptive
(OC) pills contain two hormones, estrogen and progestin. They work by stopping
ovulation (release of eggs) and by making the lining of the uterus thinner. Among
typical users who start combined pills for the first time, about 5% will experience
an accidental pregnancy in the first year. Often, this occurs because pills are
not taken correctly. If pills are used consistently and correctly, one in 1,000
women will become pregnant. Use a backup contraceptive for the first seven days
of your first pack of pills.
- OC Pills decrease a woman’s
risk for cancers of the ovaries and the uterine lining (called endometrial
cancer). Taking them also lowers your chances of having benign or non-cancerous
breast masses and ovarian cysts.
- Pills decrease women’s
menstrual cramps and pain.
- They reduce menstrual
blood loss and a woman’s risk for anemia. Periods may become very short
and light. You may see no blood at all. Most women like this when they understand
it is normal.
- Acne often improves.
One pill brand, OrthoTri-cyclen® is FDA approved for the treatment of
- Many women enjoy sex
more when on pills because they know they are less likely to get pregnant.
- Pills are very affordable
at the Campus Health Service Pharmacy, where they are discounted to $16 per
cycle (one month supply).
- OC Pills do not protect
you from HIV or other sexually transmitted infections.
- You have to remember
to take the pill every day.
- You may have nausea
and/or spotting during your first month of pills.
- Taking the pill may
cause headaches, depression or decreased enjoyment of sex in some women.
- A backup method is required
for the first seven days when starting OC pills, and sometimes when you have
- Pills require a prescription,
but one prescription can last for a year.
- Serious complications
such as blood clots may occur, but are very rare.
- Pills may promote the
growth of breast cancer but probably do not cause breast cancer.
Where Can I Get Pills?
In the United States you need a prescription for OCs. You may see a provider
(M.D. or N.P.) by making an appointment for evaluation with Women’s Health
at the Campus Health Service (621-9202). After the evaluation is complete, your
provider may prescribe the pill for you based upon your needs and health. The
type of pill prescribed will be based on your discussion and is influenced by
your health and personal preferences. Women that have never used the pill will
need to schedule a 3-month follow up visit to Women’s Health to assess
their progress and to discuss any concerns they have (no pelvic exam is required
during this visit).
There are a few options to get the pill from Campus Health:
1) Your private physician
can call in your birth control pill prescription to the Campus Health Pharmacy,
2) You can make an appointment
with Women’s Health for an annual exam and evaluation. After the appointment
the provider can write you a prescription.
3) You can make an appointment
with Women’s Health for a consultation and take the following items with
- Copy of last pap smear
result (within the last 9 months)
- Copy of last gynecology
- Documentation of the
date of your last birth control prescription. The provider is then able to
prescribe birth control to last until your next annual exam is due.
- Records can be faxed
to: “Attention: Women’s Health Clinic”, (520) 626-6156
- Records can be mailed
to: The University of Arizona, Campus Health Service, Attention: Women’s
Health PO Box 210063 Tucson, AZ 85721-0063
- Verify that your records
have been received prior to scheduling your appointment at (520) 621-6512.
What If I Have Sex and
Don’t Use Birth Control?
You can take emergency contraceptive pills within 72 hours of unprotected sex
to avoid becoming pregnant (effectiveness in preventing pregnancy is up to 75%).
The pills are available at the Campus Health Service Pharmacy and you must have
a prescription. Call Women’s Health to schedule an urgent evaluation by
Before Starting the Pill:
1) Read these directions
before you start taking your pills or anytime you are not sure what to do.
2) The right way to take
the pill is to take one pill every day at approximately the same time each day.
If you miss pills or start the pack late, you could get pregnant. The more pills
you miss, the more likely you are to get pregnant.
3) Some women experience
spotting/light bleeding and nausea during the first 1-3 pill packs. If you do
have nausea or spotting/light bleeding, do not stop taking the pill. The problem
will usually go away. If it persists or is severe, consult your provider.
4) Missing pills can also
cause some spotting or light bleeding, even when you make up pills you missed.
On days that you take two pills to make up for the pill that you missed the
day before, you may feel a bit nauseated.
5) If you have vomiting
or diarrhea, for any reason, or if you take some medicines (including antibiotics),
your pills may not work as well. Use a backup method (such as condoms, foam,
or abstinence) until you check with your provider.
6) Choose a backup method
of birth control to keep available (such as condoms or foam). Use the method
- Run out of pills
- Forget to take your
pills two or more days in a row
- Have a serious pill
warning signal and stop taking them
- Want to reduce your
risk of contracting HIV/AIDS and other sexually transmitted infections
Starting the Pill:
1) Decide what time of day
you want to take your pill. It is important to take it at about the same time
each day since this will increase its effectiveness.
- Take one pill each day
until you finish the pack, then immediately begin a new pack. Do not skip
days between packs.
- Associate taking your
pill with something else you do at about the same time each day, such as going
to bed, eating a meal, or brushing your teeth.
- Mark your calendar to
remind yourself of the days you will begin a new pack of pills. Some women
mark their calendar each day as they take their pill.
- Check your pill pack
each morning to make sure you took your pill the day before.
2) You may start taking
your pills according to one of several different schedules. You can:
- Start on the first day
of menstrual bleeding
- Start on the first Sunday
after your menstrual bleeding begins (which helps to avoid having your period
- Start today if you are
sure that you are not pregnant and have not had unprotected sex since your
3) Read the pill package
insert that came with your pack of pills.
4) Use a backup method:
- During the first seven
days that you take your pills (unless you started the pack on the first day
of your regular menstrual bleeding).
- If you start the pack
on the 6th day of your cycle or later.
- If you start the pack
when you are 2 or more days late in getting your period. Call Women’s
Health, 621-7617 to discuss emergency contraception.
- No backup method is
needed if you start the pack on days 1-5 of your regular menstrual bleeding
or if you are switching directly from contraceptive injections, the ring or
5) Call Women's Health if
you have any questions or concerns, 621-7617.
Frequent Concerns / Minor Side Effects:
Spotting / light bleeding:
Light or skipped periods:
- Spotting or “breakthrough
bleeding” which occurs while a woman is taking birth control pills happens
most frequently during the first three pill cycles. This is because the uterine
lining is adjusting to a lower estrogen and progestin level than is usually
- Breakthrough bleeding
can sometimes be caused by missed birth control pills, drug interactions,
- If you are having a
problem with spotting or bleeding that is persisting past the first three
cycles and it is not associated with missed pills, call Women’s Health
(621-7617). These issues are best evaluated individually and an appointment
may be schedule to see a Women’s Health provider.
- Women taking pills note
that their periods tend to be short and light, and they may see no fresh blood
at all. A drop of blood or a brown smudge on your tampon, pad or on your underwear
during the week you are taking the placebo (no hormone) pills, is counted
as your period while you are on the pills.
- If you have not missed
any pills and you miss one period without any other signs of pregnancy, pregnancy
is very unlikely. Many women miss one period every now and then. Call Women’s
Health if you are worried.
- If you have missed two
or more pills and miss a period, you may need to stop taking your pills and
use another method of contraception. Contact Women’s Health for an evaluation
and pregnancy test. Basic pregnancy tests are available at the Campus Health
Pharmacy and most drug stores, which are very sensitive and will diagnose
pregnancy 12-14 days after ovulation.
- If you miss two periods
in a row, call Women’s Health right away for an evaluation and pregnancy
test, even if you did not miss any pills.
Nausea is much less common with the combination (low dose) pills. However, some
women have nausea the first month or two they take the pills. This tends to go
away in the next cycle. To relieve nausea, try taking the pills in the evening
or with food. If nausea continues for more than two cycles or is severe, see your
Some women will notice an increase (or decrease) in breast tenderness. Often
this will disappear or improve over the first few months. If it is severe, discuss
this with your provider at the three-month follow up visit.
Most women do not notice mood changes when taking oral contraceptives. Premenstrual
Syndrome (PMS) symptoms tend to improve on pills. However, some women will notice
mood changes such as depression, irritability, or increased PMS when starting
oral contraceptives. If the symptoms are severe or persistent, contact your
Most women do not notice weight changes on combination pills. As many women
lose weight as gain weight on the pill. If you have concerns regarding weight
gain with the pill, talk with your provider. Sometimes changing to another pill
will be helpful.
The following are steps you should take if you miss a pill or pills:
Being “reasonably certain”
that you are not pregnant means that you have no pregnancy signs or symptoms (i.e.,
breast swelling/tenderness, your period stops or becomes very light, nausea or
- One pill missed:
Take the missed pill as soon as you can and continue taking your pills daily,
no emergency contraception is needed.
- Missed 2-4 pills:
Take one of the missed pills and today’s pill. If this occurs:
- In Week 1 you need
emergency contraception, a backup method for the next 7 days, and to finish
the pill pack on the regular schedule.
- In Week 2 you do
not need emergency contraception or a backup method; finish the pill pack
on the regular schedule.
- In Week 3 you do
not need emergency contraception or a backup method. You should skip the
rest of the pills in your current pack and start fresh with a new one.
- Missed 5+ pills:
Take one of the missed pills and today’s pill and skip the rest in your
current pack, starting fresh with a new pill pack.
- If one or more of
the 5 missed pills was a placebo pill, ignore the missed pills and continue
with your current pill pack on schedule.
- You have not had intercourse
since your last period
- You’re using a
reliable method of contraception correctly and consistently
- It’s been seven
days or less since a regular period
- It’s been four
weeks or less since you’ve delivered a baby
- It’s been six
months or less since you’ve delivered a baby and you are regularly breastfeeding
and have not yet had a period
Serious complications such as blood clots may occur, but are very rare. Call Women’s
Health (621-7617) or 911 if you have any of the following:
Recent studies show that women
who smoke fifteen or more cigarettes per day and take birth control pills run
a higher risk of heart/circulatory disease.
- Numbness or severe headaches
(not tension headaches) that are not relieved with aspirin
- Severe leg pain in the
calf or thigh (usually only one leg)
- You have severe chest
pain, shortness of breath, or a cough
- You have eye problems:
blurred vision, flashing lights or blindness
- Severe abdominal pain
Fertility and the pill:
- Pills are a good option
for women who want to become pregnant in the future.
- By preventing causes
of infertility such as uterine fibroids, ectopic pregnancies, ovarian cysts,
endometrial cancer and possible endometriosis, oral contraceptives may improve
your future ability to become pregnant.
- If your periods are
irregular prior to taking pills, they may again become irregular after you
stop taking pills.
- Return of fertility
is not improved by periodically taking a break from the pills (taking a break
is not medically helpful).
- You may experience some
delay (typically 2-3 months) in becoming pregnant compared to the amount of
time it would have taken if you had not taken pills.
- Between 1% and 2% of
women will not menstruate for six months or more after taking pills. However,
it is not certain that taking oral contraceptive pills causes this lack of
- Because most women conceive
soon after stopping pills, you should use another method of contraception
right away if you don’t want to become pregnant. Having used oral contraceptives
does not affect pregnancy rates in a negative way.
a downloadable brochure containing information on Birth Control Methods click
The information provided above is for educational purposes only. Please
do not use this information to diagnose yourself. If you have further questions
or concerns about this topic or any others, please contact a Campus
Health Service provider at (520) 621-9202.