Tips on when to start birth control pills

Sometimes the most challenging part about taking medication is getting started. Everything sounded straightforward during your clinic visit, but now your mind’s blank after opening a birth control package at home for the first time. 

Fortunately, there’s no wrong way to start birth control pills. However, there are different options for when to begin—the difference being your personal preferences and needs. Let’s look at three popular options: the quick start method, Sunday start, and first-day start. 

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The quick or immediate start method is the fastest way to begin birth control. As the nickname suggests, you take your first pill on the day you fill your prescription.

Some clinics do same-day starts where women receive their pill pack from the clinic and take the first pill in the office with a provider. This option can motivate people to start the medication, experience less fear about side effects, and avoid confusion after the clinic visit (Westhoff, 2007).

If you’re going with the quick start method, use backup contraception for seven days to prevent pregnancy. Examples of backup birth control include:

• Condoms: These have the added value of protecting against sexually transmitted infections.

• Diaphragm: These small dome-shaped silicone cups are inserted into the vagina before sex, typically along with spermicide, to prevent sperm from entering the uterus. They come in different sizes and may require a prescription from a healthcare professional.

• Spermicide: Available as a gel, foam, or suppository, spermicide can be purchased over-the-counter and used before sex to prevent sperm from entering the uterus.

• Abstinence: The only way to truly guarantee you won’t get pregnant is to not have sex.

This method is similar to the quick start, except you wait until Sunday to take your first pill.

Many birth control pill packs come with 21 active pills that contain hormones and seven placebo pills for the last week of the cycle. These placebo pills or “off weeks” are when you have your period. Bleeding usually starts on your second or third placebo pill and lasts about five days (TEVA, 2020-a). 

With the Sunday start, your period will usually start on a Monday or Tuesday. Some people like this because they won’t have their period during the weekend.

Like other methods, use a backup contraceptive for the first week to prevent pregnancy.

The most traditional way to start birth control is timing it with the onset of your period. 

As the name suggests, you take the first pill in the pack on the first day of your next period. It doesn’t have to be on day one of your period, but it should be within the first five days. Historically, healthcare providers like this option because it lowered the risk of women taking oral contraceptives during an undetected pregnancy. 

However, this isn’t much of an issue anymore. Research shows that taking birth control pills in early pregnancy doesn’t harm or affect an unborn baby (Charlton, 2016). You can take a pregnancy test before starting your medication to be sure (Curtis, 2016). 

If you start birth control within the first five days of your period, you don’t need backup contraception (TEVA, 2020-b). 

You can also combine the Sunday and first-day start, which means beginning birth control on the first Sunday after getting your next period. This option takes longer, but you get the advantages of both methods—no backup contraception needed during the first week and avoiding your period on the weekend. 

Many birth control pills come in packs designed to help you remember to take them every day. 

For rectangular birth control packs, you’ll typically start with the pill in the upper lefthand corner and work your way to the right. Many packs have the word “start” or “week 1” printed below the first pill.

Other packs will have pre-printed days that start on Sunday and also come with day-of-the-week stickers. If you do the quick or first-day start, use the appropriate sticker to cover the pre-printed days. This will help avoid confusion.

Some birth control pills come in a round package with a dispenser. All of the pills come with a detailed package insert that gives you directions on where to start.

Now that you’ve picked out a suitable start date, you might be wondering if there’s an optimal time of day to take your medication. 

Birth control pills work the same no matter what time of day you take them––as long as you make sure to take them consistently at the same time every day. So it really depends on your personal preferences and lifestyle. Missed pills or taking medication late increases the chance of getting pregnant (Molloy, 2012).

Pick a time of day when you know you’re able to take it. It may be earlier in the day for morning people or right before bed for night owls. People with consistent meal times may benefit from taking it with lunch or dinner, so the meal serves as a natural reminder.

If you have concerns about remembering to take your medication, a cell phone alarm or medication reminder app can help. 

As you can see below, the female menstrual cycle is a complex system of hormones. One way oral contraceptives prevent pregnancy is by changing the body’s natural hormone levels, altering cervical mucus, and in some cases, preventing ovulation (Wright 2020).

Birth control affects your cycle as soon as you pop the first pill, but it takes time before it can block ovulation. There’s a higher chance of ovulating during your first cycle if you start the medication after your period (Allen, 2020). That’s why backup contraception is needed for the first week of medication if you don’t start it in the first five days of your menstrual cycle. 

If you've recently had a baby and want to delay having another, it’s important to think about contraception. Most healthcare providers recommend waiting six weeks after delivery to have sex (or longer in some cases). 

At your six-week postpartum visit, you can have an IUD placed, which is effective immediately, or you can ask about birth control pills. If you’re breastfeeding, birth control that contains estrogen isn’t an option as it can deplete your milk supply (WHO, 2016). 

Ask a healthcare provider about progestin-only pills, which can be used even if you’re nursing. Progestin-only pills (minipills) work well to prevent ovulation, but it’s crucial that you take them at the same time every day to ensure their effectiveness  (Philips, 2016). 

Even if you’re not breastfeeding, you should wait at least 21 days before starting birth control pills containing estrogen due to the increased risk of blood clots after delivery, which can be made worse with estrogen. If you’re in a high-risk group for blood clots, your healthcare provider may recommend that you wait six weeks before taking combination pills.

When a pregnancy ends from an abortion or miscarriage, oral contraceptives can be started right away (Glasier, 2019).

Birth control pills can have side effects including (Grossman, 2010):

• Headache

• Nausea or vomiting

• Bloating

• Weight gain

• Breast tenderness and growth

Some people report multiple side effects, while others report none at all. Generally, side effects get better with time and go away after a few months (Grossman, 2010). If side effects don’t improve, follow up with a healthcare provider who can help find a pill that’s a better fit for you. 

Many women also experience changes to their period, such as changes in cycle length, breakthrough bleeding between periods, and spotting. Breakthrough bleeding and spotting should go away after a few months as your body gets used to the medication. 

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Current version

July 07, 2021

Written by

Hope Chang, PharmD

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.