Birth Control

The combination pill

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What is the combination birth control pill? It might be for you if… How do you use it? How much does it cost? What are the side effects and benefits? Where can you get it?

What is the combination birth control pill?

The combination birth control pill is a type of oral contraception that contains the hormones estrogen and progestin, which work together to prevent pregnancy. The combination birth control pill is the most commonly used kind of birth control pill.

The combination pill contains two different kinds of hormones, estrogen and progestin. The main way they work to prevent pregnancy is by stopping ovulation from happening, which means that the ovaries don’t release an egg.

You take one pill a day to prevent pregnancy. Most combination birth control pills come in packs of 28 pills, with 21 consecutive pills containing hormones, followed by seven placebo pills, which don’t contain hormones. Some brands of combination birth control pills contain different numbers of pills with and without hormones. Taking the placebo pills isn’t necessary to prevent pregnancy, but it can help you make sure you start your next pack on time. And with some brands, the placebos contain vitamins like iron or folic acid. While you’re taking the placebo pills, you’re still protected from pregnancy as long as you took the pills with hormones in them correctly and start your next pack on time.

Quick Facts

Very effective if you use it correctly. Easy to use, but you have to remember to take it every day.

Effectiveness

The combination pill is pretty effective the way most people use it.

Perfect use: Over 99% effective

Typical use: 93% effective

What are perfect use and typical use?
Side effects

Nausea, irregular bleeding, headaches, and sore breasts are the most common side effects, but they’re usually temporary.
Effort

You have to take your pill every single day, which can be hard.
Easy to get

You have to see a provider to get a prescription.
Cost

As low as $0 (with insurance) or as high as $50 a month.

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It might be for you if…

Effectiveness at preventing pregnancy is a top priority for you.

The combination birth control pill is more than 99.7% effective at preventing pregnancy when used perfectly (exactly as directed). That means fewer than one out of every hundred people using the combination birth control pill perfectly for a year will get pregnant.

However, the effectiveness of the pill with perfect use is based on the experiences of people involved in clinical trials who are taking the pill perfectly every single time for an entire year. The effectiveness of the pill with typical use, which means how effective it is when real people use it in real life, is going to be more relevant for most people. In the case of the birth control pill, when it’s used as people typically use it, it is 93% effective at preventing pregnancy. That means 7 out of every 100 people using the pill for a year will get pregnant.

You can remember to take a pill every day.

In order for the pill to be as effective at preventing pregnancy as possible, you have to take it every single day.

You want predictable periods.*

If you feel comforted by getting your period every month—and not having random spotting in between periods—the combination birth control pill could be a good choice for you.

*When you’re on the birth control pill, the bleeding that can happen while you’re taking the placebo pills is not actually a period, it’s called withdrawal bleeding. The amount of bleeding and when it comes depends on the type of pill you are taking, how long you’ve been taking it, and your body’s hormones. It’s common for people who have been taking the combination pill for a while to have very light bleeding or no bleeding at all. There’s no need for concern if you stop having bleeding all of a sudden.

You want the option to skip periods.

Some combination birth control pill brands are designed to give you fewer periods or no periods at all by extending the length of time you’re taking pills that contain hormones. These are called extended-cycle birth control pills. If you’re not using an extended-cycle brand of combination birth control pill, but you want to skip a period or multiple periods, you can do that by skipping the placebo pills and starting the next pill pack instead. This is called continuous use, and it’s totally safe. If you’re not sure which pills are placebos, check the instructions that come with the pill pack.

You aren’t looking for STI protection, or you’re okay with combining the pill with another method.

Neither the mini-pill nor the combination birth control pill offers any STI protection. So if that’s something you’re looking for, you can use condoms or internal condoms along with the pill. Dental dams and/or gloves also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You want a method that won’t affect your future fertility.

The only birth control method that permanently affects your future fertility is sterilization. You will return to whatever level of fertility is normal for you (which just means that you may be able to get pregnant) just a few days after stopping the combination birth control pill. That could be a good thing if pregnancy is in the near future for you. But if you don’t want to get pregnant right away, you’ll need to use an alternate method as soon as you stop taking the pill.

You want a method that you can stop without help from a provider.

You can stop taking the pill anytime without seeing a provider. Just keep in mind that you will quickly return to whatever level of fertility was normal for you before being on the pill, which means you may be able to get pregnant quickly. If you don’t want to get pregnant, you’ll need to use another form of birth control as soon as you stop taking the pill.

You want to keep your birth control private.

The pill is hard to completely hide. That’s because you’ll have a pill pack that you have to keep on hand, you may need to set a daily reminder to take your pill, and you’ll need to get refills.

You don’t have any of these risk factors.

For most people, the risk of blood clots while using the pill is very low. However, there are some things that greatly increase your risk, like:

previously having had a blood clot or having certain inherited conditions that increase your risk for a blood clot
smoking cigarettes if you’re 35 years old or older
having uncontrolled high blood pressure
having heart disease or having had a heart attack or a stroke
having recently had major surgery if you won’t be able to get out of bed for a while
having migraine with aura
having had a baby less than three weeks (21 days) ago
testing positive for antiphospholipid antibodies

It’s also not recommended that you use the combination birth control pill if you have or have had:

breast cancer
serious liver disease
complications of diabetes
an organ transplant

If you have any of these risk factors, it’s not recommended that you use either type of ring, the patch, or any of the combined hormonal birth control pills. Check with your medical provider about other options.

How do you use it?

Taking the birth control pill is pretty simple–take one pill every day. But the key thing is that you have to remember to take it every day, no matter what.

Most combination pills come in 28-day packs. Some give you regular bleeding every month that’s like a period. If you want, you can use the pill to skip your period. Some pills are even specially designed to let you have your period once every three months or skip it for an entire year.

There are so many different brands of pills available, it can be a bit confusing. Your health care provider can help you figure out which pill is right for you.

Tips and tricks

Try taking your pill at the same time you always do something else in your daily routine—like waking up or taking other medication.
Set a reminder on your phone.
Have condoms or another backup method of birth control on hand in case you miss a pill.
Have emergency contraception(/birth-control/emergency_contraception) pills on hand, just in case you forget your pill sometime during the month and then have sex without a condom or other barrier method. (Keep in mind that if you take the prescription emergency contraception pill, ella, you’ll need to stop taking the pill for 5 days afterward and use a backup method of birth control until your next period).

How much does it cost?

With insurance

If you have health insurance—whether it’s from work, school, your parents, the ACA marketplace, or Medicaid—chances are good that you’ll be able to get the combination birth control pill with no out-of-pocket cost. The exception may be if you want to use a name brand of a medication that has a generic version.

Without insurance

If you don’t have insurance or if your plan doesn’t cover birth control, the pill averages anywhere from $7- $50 per month, depending on whether you use a generic or name brand version. Many telehealth providers sell birth control pills for $7-$20 per month to people without insurance. Depending on your income, you may be able to go to a low-cost clinic to get it for less.

If you need help covering the cost of the pill, there may be options. For brand-name pills, contact the manufacturer’s website for information about coupons and discounts or contact the Partnership for Prescription Assistance at 1-888-4-PPA-NOW (1-888-477-2669) or www.pparx.org. Also, check with your local family planning clinics and find out if they offer free or low-cost birth control pills—most do.

What are the side effects and benefits?

Every method of birth control has positives and negatives. And everyone’s different, so what you experience may not be the same as what someone else experiences.

The Positive

There are lots of things about birth control that are good for your body as well as your sex life. Here are some of the benefits of the combination birth control pill:

Easy to use—just take one every day
Doesn’t interrupt the heat of the moment
May give you lighter periods
Gives you control over whether and when you have your period
May help clear up acne
Can reduce menstrual cramps and PMS
Some pills offer protection against health problems like endometrial and ovarian cancer, iron deficiency anemia, ovarian cysts, and pelvic inflammatory disease.
You don’t have to see a provider to stop using the pill, you can just stop. Just make sure you start a new form of birth control immediately if you don’t want to be pregnant because you can get pregnant right away after stopping the pill.

The Negative

Everyone worries about side effects, but for many people, they’re not a problem. Most people who do experience side effects of the combination pill find that they go away with time. It can take a few months to adjust.

Side effects that will probably go away after two or three months:

Bleeding in between periods
Sore breasts
Nausea and vomiting

Side effects that may last longer:

A change in your sex drive
Not getting a period anymore
Skin changes, including dark patches on your skin

If you’re having trouble with side effects, your provider may suggest you give it a few months to see if they decrease or go away. But you can stop using the combination pill at any time. Just remember that you can get pregnant right away once you stop using it, so you’ll need to start on another method if you don’t want to become pregnant.

For a very small number of users there are risks of more serious side effects like blood clots, stroke, and heart attack. If you have abdominal pain, chest pain, a severe headache, sudden changes in your vision, or severe pain in your calf or thigh, contact your health care provider or get emergency care right away.

Where can you get it?

You need a prescription from a health care provider to get the pill. There are two main ways to do that: visiting a health care provider in person or seeing a provider through a telehealth platform.

In person

You can get a prescription for the combination pill from any health care provider who can prescribe medications, like an OB-GYN, midwife, or primary care provider. If you don’t have a provider, you can search for a health center to get birth control. In a handful of states, a pharmacist can also write you a prescription for birth control pills right at the drugstore.

Online

It’s easier than ever to get birth control online. To find out what’s available where you live, check out our telehealth search tool.