What are Combined Hormonal Birth Control Pills?

Combined birth control pills are oral pills taken daily that contain 2 hormones (estrogen and progestin). They prevent pregnancy by stopping the release of an egg (ovulation), thickening the cervical fluid, and changing the lining of the uterus.

How effective are Combined Hormonal Birth Control Pills?

The pill is a very effective method of birth control. The pill is about 93% effective at preventing pregnancy in typical use, which means that around 7 out of 100 people who use it as their only form of birth control will get pregnant in one year. With consistent and correct use as described in this fact sheet, it can be over 99% effective.

How can I get Combined Birth Hormonal Control Pills?

You can visit a clinic to get birth control pills or a prescription for them and talk with a healthcare provider about whether they are right for you. In BC, for people with MSP, birth control pills are free. For those without MSP the cost is ~$15 per month.

  • Periods may be more predictable/regular and lighter
  • Less period cramping
  • Decreased symptoms of Premenstrual Syndrome (PMS) and Perimenopause
  • Can be used to skip or shorten your periods
  • Less anemia/iron deficiency due to heavy periods
  • Does not affect your ability to get pregnant in the future – once stopped your fertility  quickly returns
  • Easy to stop using and if you have side effects they go away very quickly
  • Less acne
  • Sexual enjoyment may increase, as using the pill can reduce the fear of pregnancy
  • Some protection against non-cancerous breast tumours, ovarian cysts, and fibroids
  • Decreased risk of ovarian and uterine cancer
  • May protect against osteoporosis and endometriosis
  • Must remember to take a pill every day
  • Some users may experience mild side effects such as: spotting, nausea, breast tenderness, headaches or dizziness (usually these improve in the first few months of use)
  • Possibility of high blood pressure
  • No protection against sexually transmitted Infections (STIs)
  • Rare but serious complications of using the birth control pill include: blood clots, heart attack, stroke, liver tumours
  • Risks increase with age when accompanied by certain other risk factors such as smoking, especially more than 15 cigarettes a day
  • Some people cannot use the combined birth control pill such as people who cannot have estrogen. Be sure to let your health care provider know if you have any other medical conditions

When do I start my pills and when are they effective?

It is recommended you start your pill right away. The pill is effective in preventing pregnancy after one week of use, so you need to use a backup method of birth control such as condoms, or not have sex for 7 days. You do not have to wait for your period to start, but if you happen to start on the first day of your period you don’t need to use a backup method as the pill is considered effective immediately.

How do I take the Combined Birth Control Pill?

Most birth control pills are packaged based on a 28-day cycle. Your pill pack contains at least 21 hormonal pills and you must take all of these pills in a row (one a day at around the same time). After you have taken all the hormonal pills in the pack you can:

  1. take the sugar/placebo pills (if your pack has any)  OR
  2. take a short pill-free break of no more than 7 days, OR
  3. go straight into another pack with no break or sugar pills

In order to be protected from pregnancy for the whole month, you must be sure to start your next pill pack on time and never go longer than 7 days without a hormonal pill. Periods that occur while using the combined hormonal pill are a result of taking a break from hormones. Taking no hormone break (or a shorter than 7-day break) to lighten or skip periods is safe and may make your pill more effective.

What if I miss pills or take them late?

Check in with a health care provider or call Sex Sense at 1-800-739-7367 about your individual situation. Please note: late or missed pills can result in spotting, and excessive vomiting or diarrhea may affect your birth control pill.

Took a pill less than 24 hours late
  • Take 1 pill as soon as you remember and your next pill at the usual time. You may be taking 2 pills on the same day: 1 when you remember and the other at your usual time.
  • If you realize you missed yesterday’s pill when you are taking today’s pill, it’s okay to take 2 at the same time. You will still be protected from pregnancy.
Took pill(s) more than 24 hours late
  • If your pill was more than 24 hours late or you missed more than 1 pill, consider using a backup method such as condoms, or do not have intercourse for the next 7 days until you’ve had 7 hormonal pills in a row
  • Skip your pill break or sugar pills this time, which means you likely won’t have a period (this is safe). 
  • Consider using emergency contraception if you had sex without a condom in the last 5-7 days. For information on emergency contraception click here.

Seek medical attention immediately if you have any of the following ACHES symptoms, as they could indicate a serious complication:

Abdominal pain, especially on the right side of your stomach, below your rib cage

Chest or arm pain, shortness of breath, coughing up blood

Headaches, severe and not relieved by over the counter pain medications

Eye problems, blurred vision, flashing lights, double vision, blindness

Swelling, redness, numbness, tingling or pain in the legs

Some medications and over-the counter herbal supplements may interact with or decrease the effectiveness of birth control. Be sure to mention that you are using birth control to your health care provider or pharmacist.

Questions? We’re here for you!

We know it can be confusing to choose and use a method. We are here to help.

You can visit one of our Options for Sexual Health Clinics to speak with a health care provider. Our Sex Sense Team is available Monday-Friday 9 a.m. to 9 p.m. by phone 1-800-739-7367 or by email at to answer your questions about birth control, or any other questions about sex, sexuality, or sexual health.

This fact sheet contains general information and should not be used in place of individual consultation with a qualified healthcare provider.

Have a question about sexual health?