Periods on birth control are not “true” periods, but called withdrawal bleeding. That is because the birth control pill or ring is “withdrawn” for a period to occur. Many women are now using birth control continuous to relieve menstrual problems and for convenience. It is safe not to have a period as long as you are on birth control.

How to start your birth control pills

Try to take your pill at the same time every day (morning or night). If you miss 1 or more pills, take it as soon as you remember and “double up” to catch up in your pill pack. Be aware that you will probably have some bleeding for a few days and it is ok to continue taking the pill.

The 21 and 24 day pill packs have placebo pills (sugar pills) and your period will usually start after the first or second sugar pill. It is ok to restart a new pill pack even if you are still on your period.

• 21 day pill pack with 7 placebo pills: Start your pill the first day of your period and no later than the 5th day of your period. You do not need to use condoms as a back up method to prevent pregnancy.
• 24 day pill pack with 4 placebo pills: Start this pill on the first day of your period (no back up method is needed) or no later than the 5th day of your cycle. This method may make your periods shorter & lighter, improve acne and PMS.
• Using pills continuously: Start pills on the first day of your period or the first Sunday after your period begins. Continue for 3 months or longer as directed by your health care provider. Your pill pack may contain 3 months of pills and a week of placebo pills or may not have any placebo pills at all. Monthly pills can also be used continuously as long as you skip the sugar pills. Spotting may occur in the first few weeks, but should improve with time. Do not stop your pills if you are spotting. Contact the office if you experience “period” like bleeding on continuous pills.
• Quick start: start the first pill in the pack on the day of your office visit as long as you are not pregnant. Use condoms for the first week. Your next period may be delayed until you finish the pill pack.

Using Nuva Ring

Insert Nuva Ring by the 5th day of your period and use condoms as a back up method for the first 7 days in the first month. Many women insert the Nuva Ring on the first day of the month and remove it on the 25th day of the month for 5 days to have a period. Nuva Ring can be used continuously by removing the old ring after 24 days and inserting a new one immediately.

Use a back up method (condoms) for a week if:

• You are starting your first pack of pills on Sunday.
• You are late starting your next pack (after the 7th day).
• You miss more than one pill in your pack.
• If you take the Nuva Ring out for more than 3 hours anytime or restart it later than the 5th day.

Side effects and complications:

You may experience breast tenderness, occasional headaches, nausea, and breakthrough bleeding (spotting or bleeding in between periods) for the first three months. These side effects are not unusual and should improve with time. If you continue to have breakthrough bleeding or have no periods at all after the first three months, please call the office so we can change your prescription. Your periods may be much lighter and should not be misunderstood as not having a period. If you have any withdrawal bleeding or spotting on the placebo pills, you do not need to call.

Danger Signs

Contact the office immediately if you experience:

• Severe or sudden headache
• Pains in chest, groin or legs esp. calf of legs)
• Loss of coordination
• Shortness of breath for no apparent reason
• Slurred speech or visual changes
• Severe mental depression

Smoking and birth control pills don’t mix! The majority of the serious complications related to birth control use occur in women over 30 who are heavy smokers (15 or more cigarettes a day.)

Side Effects

The following side effects are indications for seeking additional advice only if they are continuous or are bothersome to you after the first 3 months of use:

• Abdominal cramping
• Loss of appetite or excessive weight gain
• Nausea, vomiting or diarrhea
• Depression and irritability
• Swelling of ankles and feet
• Change in sexual desire
• Swelling & increased breast tenderness
• Change in pigmentation of exposed skin
• Unusual tiredness and weakness

Some medications may interfere with contraceptive effectiveness and condoms will need to be used while using these medications. The following is a list of commonly used medications, which are known to decrease the effectiveness of BCPs: antibiotics, antianxiety agents, barbiturates, and some analgesics. This is by no means an exhaustive list and if you should have further questions about prescription medications, please call our office for more information. Most over the counter medications are perfectly safe to use with BCPs unless specifically stated otherwise on the package.

Birth control pills do not provide protection against sexually transmitted diseases and therefore condoms should be used if you have sex with more than one partner.

Although condoms do not guarantee against the spread of sexually transmitted diseases, they do offer more protection than birth control pills alone.

A few people may develop high blood pressure when beginning BCPs. It is advisable to check your blood pressure after taking BCPs for 3 months. If your blood pressure reading is above 140/90, please notify our office. You have been given a prescription for 1 YEAR OF BC PILLS. In order for you to receive a refill on your BCPs you must have an annual exam. Please call 3 months in advance to make your annual appointment so that you don’t run out of pills.