Birth control pill: Frequency Asked Questions

Yes, it’s absolutely safe to take two pills in one day, including taking two pills at once. That said, the most effective and best way to take your birth control pill is to take one every day (and if you’re taking the mini-pill, it’s extra important to take it at the same time every day). Regularly taking more than one pill a day won’t make your birth control more effective.

However, if you miss a pill, take it as soon as you remember, even if that means it’s at the same time as your next regularly scheduled dose. You might feel nauseated if you have to do this, especially if you need to take two pills at once, so take your pills with food.

Having "loose" poop every now and then probably won't affect how well your pill works, but severe diarrhea (eg. if you have it several times in one day) might. If you rely on the pill for birth control and you have severe diarrhea, it's a good idea to use a backup method like condoms if you have sex while you're sick or in the 7 days after you recover.

Unless you’re in a totally exclusive relationship and you and your partner have both been tested recently for every single STI, you should definitely use condoms with whatever other birth control method you choose. Using a condom with another form of birth control is called dual protection. It means you’re being super-safe and protecting yourself against both pregnancy and STIs.

Basically you need to figure out what time it is in your home time zone and take it at that time. For example, if you live in Washington, DC, and you travel to Spain, which is 6 hours ahead, you should take your pill 6 hours later in the day than you normally would. So if you take your pill at 9AM in DC, you should take it at 3PM in Spain.

If you remember your pill by setting an alarm on your phone, however, make sure to adjust it as needed when you’re on the road. If it’s easier (for example, if your usual pill time falls in the middle of the night wherever you’re visiting), you can change your schedule, as long as you don’t go more than 24 hours without a pill. So, if you live in DC and you go to Spain and want to stay on a 9AM schedule, it’s totally fine to take your next pill at 9AM Spanish time (18 hours after your last East Coast pill). But if you're taking a progestin-only pill (also called the mini pill), the rules are different. You need to take it within 3 hours of your normal time or you've missed that dose. So even if that means taking it late at night, you have to stick to your regular schedule.

Also, if you're traveling long enough that you'll be starting a new pack of pills while you're gone, don't forget to stick them in your suitcase!

For most people, the risk of blood clots when using the ring, the patch, or the combined birth control pill (which is the most common type of pill) is low. But smoking increases this risk. If you are over 35 and smoke 15 or more cigarettes a day, the combination pill, patch, and ring are not safe options for you. If you’re over 35 and you smoke less than 15 cigarettes a day, talk to your provider about whether these birth control methods are safe options for you. People who smoke can always use the IUD, the implant, the shot, the mini-pill (progestin-only pill), and any method that is hormone free (like condoms, for example).

One of the main ways hormonal birth control prevents pregnancy is by stopping ovulation—so the egg never leaves the carton, so to speak. The pill, the patch, the ring, and the shot are most reliable at blocking ovulation, so people using these methods may have fewer ovarian cysts. If you tend to get ovarian cysts, your provider may recommend one of these methods to prevent future cysts. /The progestin-only or mini-pill has an unpredictable effect on ovulation and may lead to more cysts. These almost always disappear on their own, but if you’ve had problems with cysts in the past, the mini-pill may not be the best contraception for you.

For women with high blood pressure, methods with estrogen–the pill (except for the mini-pill), the ring, and the patch–may make their blood pressure even higher, increasing the risk of a heart attack or stroke. Fortunately there are lots of highly effective birth control options that are safe and estrogen-free like the IUD, the implant, or the shot. Talk to your doctor about your condition and what birth control is best for you.

That’s fine—the easiest thing is probably to finish out your current pack on schedule and start the next pack at the time you prefer. In that case you shouldn’t need any backup.

If you can’t wait for your next pack, just make sure you don’t allow more than 24 hours to pass between pills. So, for example, if you want to switch from morning to afternoon, you have to take 2 pills in one day—one at the old time and one at the new time. That’s probably better than waiting 36 hours and worrying about backup for a week! Only catch is you may also have to relabel your pill pack, because if you take the “Wednesday” pill on Tuesday night and forget to change the rest of the pack, confusion may abound.

Using a method of birth control with estrogen, like the pill, patch, or ring, increases the risk of forming a blood clot, but the risk is so low that if you don't have any factors that increase your chances of having a blood clot, you can safely use all types of birth control. If you do have an increased risk of blood clots because you've had one before you've had a stroke or heart attack, or you have a medical condition that increases your risk of a blood clot, like high blood pressure, then adding birth control with estrogen to the mix increases your risk too much and it's not recommended that you use birth control with estrogen in it. But that doesn't mean there isn't a birth control method for you!

If you can't take estrogen, you have quite a few options available to you. First you have the non-hormonal methods, like the copper IUD. You can also use any of the hormonal methods that only contain progestin, not estrogen, like the implant, mini-pill, shot, and hormonal IUDs, like Mirena, Skyla, Liletta, and Kyleena. These don't increase your risk of blood clots and are all really good at preventing pregnancy.

If you're worried about blood clots or don’t know if you have risk factors, talk to a health care provider about which birth control methods are options for you.

If you feel like your birth control is changing your behavior, it's time to talk to your health care provider. Everybody responds to birth control differently, and your provider can help you decide whether it's time to try something else. It might be a matter of switching hormonal methods or deciding whether to avoid hormonal birth control altogether, or you may choose to wait it out since some negative side effects go away with time. The bottom line: If your current method is making you feel blah, don't settle. There are a lot of methods to choose from and sometimes it can take a few tries to get it right.