How do birth control pills work?
Birth control pills have two hormones – estrogen and progesterone. They work by preventing the change in hormones that triggers the release of an egg from the ovary. So as long as you are taking pills properly, you do not ovulate (no eggs are released).

How do you take the pill?
Take one pill every day at about the same time each day. Choose the time of day that will be easiest for you to remember. For example, you might choose to put them beside your toothbrush and take one every morning when you brush your teeth. Some women program a daily reminder on their cellphones.

How do you choose a type of pill?
There are many different brands of birth control pills. They have slightly different types of progesterone and different doses. Because everybody is different, it is difficult to tell which kind will be best until you try them. Most women do not have side effects with any type of pill. If you try one kind of pill and you are having side effects, you can wait to see if they will go away (usually in about three months) or talk to a doctor about switching brands.

Pills come in packages with different combinations of hormone and reminder pills. Always take the hormone pills in the order they come in. Reminder pills have no hormones in them, are at the end of the pack, and are often a different colour. The reminder pills are there to keep you in the habit of taking the pills even when you are on your break.
• Many packages have 21 hormone pills and seven reminder pills. This means you will get a seven day break from the hormones each month, during which time your period will come. Our clinic recommends shortening this break to 3 days, and not finishing the reminder pills (see below).
• Some packs have only 21 hormone and no reminder pills, so you can just take a break with no pills before starting you next pack and this is when your period will come (see below for more information).
• Some packs have 24 hormone and four reminder pills (a four day break each month, during which your period will come).

Short breaks or continuous use
Research has shown that birth control pills are more effective when women do not take a seven day break from hormones to have their periods. For packages with seven reminder pills, you may shorten the break by only taking three of the reminder pills and then starting your next pack of pills. Packages with four reminder pills are fine to take as they are. With a 21-day pack, just start again after a three or four (rather than seven) day break. Even if you still have your period, it is okay to start the next package of pills early. Also, this might mean that your period gets shorter and/or lighter, and that is also okay. Each month, be sure to set your alarm or mark your calendar for your next start date.

Some women prefer not to have a period every month, and to take their pills without a break. This is okay, because when you are taking birth control pills the lining in your uterus does not grow as much and does not need to shed every month. If you want to skip a period, you may use your pills continuously by not taking a break or any reminder pills.

When to start your pills
We recommend starting your pills on the day following a surgical abortion or after a medical abortion (once you have had a check-up ultrasound and the doctor says the abortion is complete). Many women also start on the first day of their period, although be sure to use another form of protection until that time. You can also start any day, but if it is not the first day of your period make sure to back up with condoms or not have sex for one full week to allow the pills enough time to start working.

What to do if you miss a pill
You need to use “back up” birth control methods to make sure you are protected against pregnancy in any of the following circumstances:
• If you miss a pill or if you take your pill late (more than 12 hours later than your usual time)
• If you start a new pack of pills late
• If you have vomiting or diarrhea
• If you are taking other medications that may interfere with your pill, such as antibiotics.

What kind of back up should you use?
• Condoms: it is best to use condoms for one week after any of the above • Plan B: it is safest to use emergency contraception (the morning after pill) as well if you have had intercourse without condoms within two days before or after any of the above.

Where can you get pills?
You need a prescription from a doctor in order to get the pill. You can get a prescription from your family doctor or from a youth, sexual health, walk-in or women’s clinic. Some clinics will also be able to sell you the pills, often at a reduced cost. Otherwise, you will need to go to a pharmacy to get them. For a referral to a clinic or doctor, call 211 on your phone or the Sex Sense Line at 604-731-7308 or toll free at 1-800-SEX-SENSE.

What kind of side effects can the pill have?
There are both good and bad side effects. Women who take oral contraceptives have a significantly reduced risk of developing ovarian and endometrial cancers. Many women find that their periods get lighter and less painful and their acne improves. The most significant adverse effect is a slightly increased risk of blood clots (deep venous thrombosis, DVT). This is highest in the first 6-12 months of use. Some women also have nausea, breast tenderness, bloating, a small amount of weight gain or loss, headaches, dizziness, mood swings, loss of sex drive and spotting/irregular bleeding. Many or all of these side effects may lessen or go away after about 3 months. Taking the pill also causes a slight increase in your chance of developing gallstones.

If you are having any of the following symptoms, you should seek medical attention immediately as they may be serious danger signs (notice that they spell out ACHES to make them easier to remember):
• A abdominal pain (severe) upper right side
• C chest or arm pain (severe), shortness of breath and/or coughing up blood
• H headaches, severe and not relieved by Aspirin or Tylenol, dizziness or numbness
• E eye problems such as blurred vision, flashing lights, double vision, blindness
• S swelling/redness, severe leg pain, speech problems

Who should not use the pill?
• Women who have a family history of strokes and blood clots before age 50
• Women who have migraine headaches with visual symptoms (seeing an 'aura', seeing spots or lights)
• Women who have breast cancer or impaired liver or kidney function
• Women over the age of 35 who smoke cigarettes or have migraines
• Women with very high blood pressure; heart disease; a history of blood clots or clotting disorders; lupus; or diabetes with nephropathy, retinopathy or neuropathy
• During breastfeeding, progesterone-only pills are best for the first 6 months