Are there contraceptive pill rules I should know?
Yes, there are important rules to familiarise yourself with before using the birth control pill.
“I break this down into a timeline to make the steps easier to navigate.
I also give practical examples of following: the 7-day rule and skipping your period.”
The rules timeline for perfecting the pill
- Understand and feel comfortable with the pill pack
- Decide what day to start
- Know where to start on the pack
- Decide what time of day to take it
- Know the contraceptive pill rules for staying safe
- Know when you are safe from pregnancy
- The option to skip your period
Also read: ‘The Birth Control Pill FAQ’ for information on side-effects and other FAQ
1. Understand and feel comfortable with the pill pack
Why are there different color pills in the pack?
“This is an easy way to see which pills contain hormones, and which don’t.”
Most Combined Oral Contraceptives (COC) packs contain 28 pills made up of two types:
- active or hormone tablets, and
- placebos or sugar tablets.
Active Tablets
The active tablets contain hormones. Depending on the dose of estrogen in the pill:
- 21 active tablets are in a pack – higher estrogen dose
- 24 active tablets are in a pack – lower estrogen dose
Placebo tablets
Placebo tablets are ‘sugar pills’. They contain no hormones, and it is usually during the placebo tablets that you will have your period.
Depending on the number of active tablets, 4 or 7 placebo pills are in a monophasic pack.
Monophasic COC
I will only discuss Monophasic COC in this post.
These are the most commonly prescribed Combined Oral Contraceptives.
“Mono = One
This means all the active pills will:
- be one color
- contain the same dose combination of hormones”
Two examples of low-dose monophasic pill packs:
2. Decide what day to start
If you have regular cycles – pack start
1st-day-of-your-period start
This method is preferred, as you are definitely not pregnant. It offers rapid cycle control and sooner protection.
‘Sunday’ start
This may help to give you period-free on weekends. Start on the first Sunday after your period starts. You are unlikely to be pregnant.
‘Today’ or quick start
Start on the day that you receive your prescription. Do a pregnancy test on the starting day and again two weeks later.
You have now chosen a week day to start the pack on. Jump to step 6 to find out when you will be protected against pregnancy.
If you have irregular cycles -additional rules
- Your doctor will need to make sure that you are not pregnant.
- Do not have unprotected sex for 3 to 4 weeks before this test to minimize this risk.
- I recommend double-checking with a pregnancy test two weeks after commencing the pill.
You can choose a quick or Sunday start, as described above.
You have now chosen a week day to start the pack on. Jump to step 6 to find out when you will be protected against pregnancy.
3. Know where to start on the pack
Now you know which day of the week you want to start on.
Brands have different packaging, pill colors, and layouts. Arrows and days flow in varied directions.
The basics are the same.
Start in the correct place, and follow the arrows.
Highlighted Week Packs
Some packs have a highlighted week, giving you a starting point.
If you decide to start on a Monday, take the highlighted Monday pill; for a Sunday start, take the highlighted Sunday pill, etc.
Day Label Packs
Some packs have a ‘start pill’ at the top left of the pack.
These packs come with 7 stickers. Each starts with a different day of the week.
If you start the pack on a Monday, peel off the sticker that begins with ‘Monday’ and stick it to the top of your pack. If it starts on a Thursday, peel off the sticker that begins with ‘Thursday’ and attach it to the top of your pack, etc.
4. Decide what time of day to take it
Before or after food?
You can take the COC with or without food.
Nausea is reduced by taking it after a meal.
What time of the day?
You need to take the COC at the same time every day.
Choose a time of the day that will fit your schedule and be easy to remember.
This could be at 6 a.m. or 9 p.m. I even have some patients who keep contraceptives in their handbags and set an alarm for 11 a.m. daily.
5. Know the contraceptive pill rules for efficacy
Breaking these rules could have the following effects:
- falling pregnant,
- spotting or breakthrough bleeding, or
- having an acne flair.
Also read: 8 Reliable Birth Control Methods For Females if you find these rules impossible.
Same time daily rule
“I cannot stress this enough, I’m repeating it.”
Choose a time of the day that will fit your schedule and be easy to remember.
The 12-hour rule
“If you forget to take your pill and take it within 12 hours of your usual time, you are safe.”
12-hour rule observed:
Let’s take the example of 6 a.m. daily.
If you get home at 4 p.m. and realize you have forgotten to take your pill, take it immediately. You are within 12 hours of your usual dose time and are safe.
12-hour rule broken:
Let’s take the example of 6 a.m. daily.
If you have a work function and get home at 9 p.m. and realize you have forgotten to take your pill, take it immediately. However, you are now over 12 hours of your usual dosing time. You are no longer safe from pregnancy and need to follow up with the 7-day rule.
The 7-day rule
“The definition of the seven-day rule is to take seven consecutive active tablets before you are safe again.”
When does the 7-day rule come into play?
- If you break the 12-hour rule.
- If you vomit and, or have diarrhea.
- If you take antibiotics.
Once the gastro episode has resolved or your antibiotic course is completed, start the 7-day rule.
The 7-day rule put into practice
Straightforward ∣ 7-day rule
The image below shows an uncomplicated application of the 7-day rule. The closer to the placebos you get, the less straightforward it becomes.
Closer to placebos ∣ 7-day rule
6. Know when you are safe from pregnancy
“I recommend that patients use condoms for the first month while getting into the routine of taking medication daily.”
This ensures no accidents. However, taking the pill like clockwork, daily, from day 1, protects you from pregnancy earlier.
Refer below:
1st-day-of-your-period start
There is no need for additional methods. You are safe immediately.
‘Today’ or quick start
Extra precautions, like condoms, are needed for 7 days before you are safe.
‘Sunday’ start
Extra precautions, like condoms, are needed for 7 days before you are safe.
7. The option to skip your period
“I suggest only trying this after having 3 months of well-controlled COC cycles. The reason for this is to minimize spotting.”
Skip your period – 7 placebo tablets
Very easy if there are 7 sugar tablets. Skip the 7 pills, and you are still on track with your weekday schedule.
Skip your period – 4 placebo tablets
Highlighted week pack
If your pack has 4 sugar tablets, refer to the images below. You will still skip a week of pills, 4 placebos, and 3 active pills to stay on track with your days and current period cycle.
Label pack
Method 1 ∣ Keep label routine
Method 2 ∣ New label start day
Another option with the label pack saves the 3 active tablets. I find it confuses my patients.
Be aware that it may change your future cycles. This means your periods might fall on weekends after the break instead of during the week, or vice versa.
Method 2 using the picture above.
- After taking your last active tablet on this pack, the Wednesday pill, you immediately start your new pack on a Thursday. Don’t take the placebos.
- You would then peel off the sticker, starting with THUR, and stick it to the top of the new pack.
Hopefully, you feel confident about starting your COC journey and can refer back anytime if you are unsure.
I leave you with this YouTube video by Diana in the Pink, a fantastic visual summary of the above.
