Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team. Updated on December 18, 2020
If you’re looking for a quick answer: for most combination birth control pills (those with estrogen and progesterone), while it is recommended that you take the pill as close to the same time each day as possible, you can be off by five hours every now and then and be just fine — but be sure not to do this regularly. By every now and then, we mean once a month, not every day.
If you want more detail on why this is and how this changes for progestin-only pills, read on!
Nearly everyone who starts the birth control pill wonders, “Do I really need to take it at the exact same time every day?” People with uteri are busy, and the idea of a strict schedule can feel suffocating.
However, there are many variations of the pill, each with different hormone compositions and mechanisms; given that everyone’s body, lifestyle, and schedule are different, what is best for you may not be best for your friend.
The combination oral contraceptive pill
On the regular combination pill (called combination because it contains the hormones estrogen and progesterone), your medication can be taken at any time within five hours of the time you took it the day before. For example, if you take your pill before leaving for work at 7:00 AM on Friday but then sleep in on Saturday and do not take it until 10:00 AM, you’ll still be protected. You do not need to take the pill at precisely the same time every day, as long as you’re well within the five-hour difference.
That said, we recommend you take the pill as close as possible to the same time each day. Not only will that consistency increase the effectiveness of the pill, but sticking to a schedule will make it easier to remember to take it every day. If you take the pill every day at the same time, there is a 1% chance you will get pregnant.
This is called perfect use; with imperfect use, either taking your pill outside of that five-hour difference or missing a pill together, your chance of getting pregnant increases. That’s why you may see the effectiveness of the combination pill listed as 91%. In practice, most people aren’t perfect at taking the pill consistently, leading to an increased risk of pregnancy.
Many people with uteri like to start taking their birth control pills as soon as they get them. Once you have them in your hands, you can take your first pill any day of the week and at any time of the month, including if you’re on your period.
However, Dr. Sophia Yen, Pandia Health’s CEO and co-founder suggests that to see the best results, start on the last day of your period; this is approximately on day 3 to 5 of your bleeding. This way, you’re giving your uterus a fresh start and can potentially lead to less breakthrough bleeding as your body adjusts to your new medication.
Birth control can also be more than just a method of contraceptive. With birth control, you can also make your #PeriodsOptional. By skipping the last week of your birth control pack (a.k.a the sugar, or placebo, pills), you can eliminate your period for good. Leaks be gone!
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How soon does the pill start working?
Protection against pregnancy depends on when you start taking your pill and the type of pill you’re using. It’s smart to use a backup method of contraception like condoms or abstaining from sex for the first seven days you’re on birth control while you wait for it to start working and begin to provide you with protection.
If you want to be extra careful, you might consider using a backup method for the whole first month. Certainly, it’s better to be safe if you want to avoid an unplanned pregnancy! Dr. Yen suggests always using a condom to avoid sexually transmitted diseases such as herpes, HPV (warts), chlamydia, or gonorrhea. Remember, birth control pills can help prevent pregnancy but not protect you against STIs.
Plus, using a condom means you don’t have to deal with additional clean up following sexual intercourse!
Traveling While On Birth Control
If you’re traveling between time zones, you’ll have to be extra careful to make sure you’re taking the pill correctly at the right time. If you’re flying within the USA, chances are you will be ok to take the pill at the same time as usual. For example, if you’re flying from California to New York and you usually take your birth control at 9:00 PM PST, you can still take it at 9:00 PM EST — you’ll actually be taking it three hours early!
But, if you’re journeying farther afield, such as from California to the UK, you will need to do a little more time difference-related math. To take the pill at exactly the same time as usual, you’d be looking at taking it at 5:00 AM GMT.
While it’s ok to take your pill any time within the five hours before or after your usual time occasionally, taking it later can alter its effectiveness, so it is advisable to take it early or on time — 24 hours after your last pill. If the time difference means you’d be taking your pill at an inconvenient time for the duration of your trip, such as at 5:00 AM, you can temporarily shift the time either backwards or forwards by three hours.
Progestin-Only Pills (POPs)
If you are on the progestin-only pill, which only contains progestin with norethindrone, you need to take your pill every day at the same time. If you are as little three hours late to take your pill, you need to use a backup method, such as condoms, if you plan to be sexually active at any point during the next five days. If you had sex in the past 3 to 5 days before you were late to take your pill, you should consider using emergency contraception to be safe.
Sticking to this strict schedule consistently every day can be difficult. That’s why Pandia Health’s expert birth control doctors don’t usually recommend this contraceptive pill. If you can’t use an estrogen-containing medication or have experienced difficulties with the regular combination pill, Pandia Health’s doctors recommend the IUD with hormone, the implant, the shot, or the copper IUD. The upside of these methods of contraception is that you don’t need to remember to take anything each day!
If you have a history of breast cancer, stroke, heart disease, or migraines with aura, among other medical conditions, you may need to use the progestin-only pill (POP) rather than the combination pill.
There is a new POP under the brand name SLYND with a different progesterone known as drospirenone that is more flexible. However, it is much more expensive than regular POPs or regular oral contraceptive pills and will not be the right option for everyone.
How can Pandia Health help?
If you’re not sure when the best time to take your birth control pill is or want to find out what is the best birth control for your needs and schedule, Pandia Health is here to help! Our expert birth control doctors are available to prescribe the best birth control for you from the comfort of your home. If you are in AZ, CA, CO, FL, GA, IL, MI, MN, NV, NY, OH, PA, TX, TN, or WY sign up today to get an online birth control prescription and enjoy our FREE delivery service for all your refills!
At Pandia Health, we pride ourselves on providing expert birth control care. Our doctors prescribe birth control based on the “Pandia Health algorithm”, which takes into account several factors, including age, race/ethnicity, BMI, and your personal medical history, all of which can influence which method of birth control is best for you!
The Main Takeaway
While it is best to take one pill every 24 hours, it is also ok to take the pill slightly less or slightly more than 24 hours after you took your last one if you are using the combined pill. However, taking the pill more than five hours late, or missing it entirely, can increase your risk of getting pregnant. If you are on the progestin-only pill, you need to take it at the same time every day.
If you’re curious about which pill you should be on, watch Pandia’s YouTube video explaining the advantages and disadvantages of the combination and progestin-only pills. Check us out on Facebook and Instagram while you’re here!
Disclaimer: The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.