Birth Control Options for Women - Oral Contraception

Taking the Pills. Typically, the user takes the first pill either on the Sunday after her period starts or during the first 24 hours of her period. (The first pill can be started at any time during the menstrual without affecting the bleeding patterns. Ovulation can occur that month, however.) The remaining pills are taken once a day, ideally at the same time of day, until the pack is used up. The user, if she has a 21-day pack, waits seven days before starting a new pack. If she is on the 28-day pack, she takes the seven inactive pills.

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If a woman misses one or more pills, she should take the following precautions:

Missing the first pill in a new cycle. Take a tablet as soon as she remembers and the next one at the usual time. Two tablets can be taken in one day. Use barrier contraception for seven days after the missed dose. [See Spermicidal and Barrier Contraception.]
Missing a pill two days in a row. Take two pills as soon as she remembers and then two more the following day. Also use back-up barrier contraception until the next pill cycle.
Missing more than two, she should discard the pack, use a back-up birth control method and begin a new cycle on the following Sunday, even if she has started bleeding. One study found that women who miss three pills will probably still not ovulate, but nevertheless, they should take all necessary the precautions to prevent pregnancy.

Progestin-Only Oral Contraceptives

Progestin-only pill brands including the following:

Levonorgestrel (Plan B).
Norethindrone (Micronor, Avgestin, Norlutin, Nor-QD). (This progestin is made from male hormones, so may cause more male side effects than others.)
Norgestrel (Ovrette).

Progestin-only pills, which only contain progestins, are always sold in 28-day packs and all the pills are active. Progestin-only pills must be taken at precisely the same time each day to maintain top effectiveness. If a woman deviates from her pill schedule by even three hours, she should call her doctor about using back-up contraception for the next two days. Progestin-only pill users will experience even lighter periods than those taking combination pills; some may not have periods at all. These agents should not be used by premenopausal women in their 40s, since they pose a higher risk for adverse effects in this group.

Candidacy for Combined Oral Contraceptives
Should Definitely Avoid OCs	May Use OCs with Caution	May Use OCs
Smokers over age 35, including light smokers (less than half a pack a day).		Any nonsmoking woman (including over age 35) with no risk factors that preclude OCs.
Breast cancer patients or women who had breast cancer within five years.	Women with breast cancer more than 5 years ago, or those with a family history of breast cancer. This risk may exist only in women with a family history of breast cancer who took OCs before 1975. New low-dose OCs do not appear to pose this risk, but more research is needed.
Women with any liver disease or abnormalities.	Women using drugs that affect liver enzymes, women with gallbladder disease or gallstones.
Women diagnosed with migraines or other headaches that are accompanied with auras, visual disturbances, or other neurologic symptoms.		Women with mild headaches or migraines without neurologic symptoms, such as auras or visual disturbances.
Pregnant women.	Women who are at least 21 days postpartum. Nursing women with gestational diabetes should avoid progestin-only OCs. Low-dose combined may be best option for all nursing women, unless estrogen interferes with milk production.
Women with a history of or risk factors for stroke or heart disease, including hypertension of 140/90 or greater or hypertension with blood vessel injury.	Women who are very overweight (only at recommendation of physician).
Women with diabetes and kidney, eye, or other complications related to blood vessel damage or women who have had diabetes for more than 20 years.		Women who have diabetes without any other risk factors for heart disease and stroke and who have no signs of organ damage.
Women with risk factors for blood clotting (e.g., history of thrombophlebitis, pulmonary embolism, prolonged immobilization after surgery).	Women with uterine or vaginal bleeding of unknown causes.	Women with a history of abnormal, precancerous Pap smears (called dysplasia).