Combined Oral Contraceptive Pills (cOCP) or combined OCP, bring together 2 hormones (estrogen and progestin) to prevent pregnancy. The combined oral contraceptive pill is the most common type of birth control pills.
How does the Combined oral contraceptive pill work?
The combined oral contraceptive pill works by preventing the release of an egg (ovulation), thickening the cervical mucus thus blocking sperm from getting into the uterus and getting to the egg, and thinning the endometrium (lining of the uterus) so that if the egg/sperm hook up it can’t stick to the lining.

Combined oral contraceptive pill uses

Combined oral contraceptive pills are used for much more than just preventing pregnancy. There are so many uses and benefits of cOCPs, including:

Combined oral contraceptive pills contraindications

Taking a combination of progesterone and estrogen is not for everyone. If you have high blood pressure or take blood pressure medications, this medication is NOT for you. Also, if you smoke and are 35 years old or older, Pandia Health’s experts in women’s health care do NOT recommend using the combined oral contraceptive pill. Because WITH those health conditions/behaviors, OCPs increase your risks of blood clots and death.
Instead, Pandia Health Medical group’s doctors recommend progestin-only pill (POPs), hormonal IUDs (Mirena, Liletta, Kyleena, Skyla), implant (nexplanon), the birth control shot (depo-provera), or condoms and spermicide.
Pandia Health’s doctors are always happy to help you choose the best birth control for you. As the ONLY women-led, the ONLY doctor-led birth control delivery service, Pandia Health is here to help. If you live in AZ, CA, CO, FL, GA, IL, MI, NV, NY, PA, TN, TX, WA, and WY, schedule an online consultation with one of our expert doctors – they can help you find a birth control method that best suits your lifestyle. *Note we only prescribe the pill, patch, and ring. Already have a prescription? We offer delivery of the birth control pill and Twirla patch to patients in all 50 states. Sign up today!

Birth Control Pills

Types of combined oral contraceptive pills

There are over 40 different types of combined oral pills. One differentiator is monophasic versus biphasic.

Monophasic birth control pills

Most birth control pills come in a 21 or 28 tablet format. Monophasic pills deliver the same amount of hormones throughout 21 tablets. For those pills that come with 28 tablets, the last 7 tablets usually do not have any hormones. Those are called “placebo pills” that are there to keep you in the habit of taking the pill every day and you will usually have a withdrawal bleed on those 7 days. Some brand examples of this type of pills are Sprintec, Vienva, Yasmin, Aviane, and Estarylla. If you are taking a combined oral contraceptive pill (OCP) that only has 21 active pills, you will rest for 7 days and have a withdrawal bleed on those days. Luckily, if you don’t want to bleed, you can skip your period. Yes, you can make #PeriodsOptional using birth control! Check out our blog post here on how to do that safely.

Triphasic birth control pills

On the other hand, there are combined oral contraceptive pills that have 3 different levels of hormones in each pack. These have tablets colored in a different color every 7 pills. Each color of pills has different levels of hormones and the last 7 ones are usually placebo pills (no hormones in it). During those 7 days, you should experience a withdrawal bleed. If the last 7 pills are brown, that often indicates they have iron in them to help replace the iron you lose when you bleed.Common triphasic birth control pills are Tri-Sprintec, Tri-Linyah, or Nortrel 7/7/7.
Check out our CEO and Co-Founder, expert in women’s health, Dr. Sophia Yen, talking about the difference between monophasic and triphasic pills here. Generally, our doctors do not recommend triphasic pills because there’s no need to have your hormones going up and down every month, better to stay stable and smooth.

How to use birth control pills or OCPs

Simply take 1 pill every day, at the same time each day. Many women find that taking the combined Oral Contraceptive Pills right before bedtime or just after their largest meal of the day (usually dinner) reduces nausea and other side effects. For most cOCPs, after taking 21 days of active pills, you’ll switch to 7 sugar pills (placebo pills, without hormones). These are inactive pills with no hormones that are meant to keep you in the habit of taking your pill every day. (and you can skip these and just go into your next pack, if you want.)
There are some combined oral contraceptive pills that come as an “extended cycle” option. Those have 84 active pills and 7 inactive pills. If you are taking these pills, you take 1 tablet per day and will have a withdrawal bleed on those last 7 days, meaning you will be able to skip your period every 3 months! However these extended packs are just old birth control pills (often with more side effects) and you can accomplish the same effect by using “normal” packs and just skipping the last week. However, doing this costs more if you are paying cash because you will need 17 packs/year (skipping bleeds) vs. 13 packs (not skipping bleeds).

Combined oral contraceptive pills cOCPs’ side effects

The risks are very low, but some women have experienced unwanted side effects when taking combined oral contraceptive pills. Minor side effects include breast tenderness, headaches, nausea, and slightly elevated blood pressure or blood sugar levels. Positive side effects are also a possibility, too — reduced acne, fewer mood swings, and lighter bleeds are fairly common. The chances of serious side effects are extremely unlikely, but they are possible. Serious side effects include blood clots, chest pain, migraines, vision problems, slurred speech, confusion, and fainting. If you experience any of these, please see a doctor ASAP or go to the ER and tell them you are on the birth control pill. Those who wear contacts or are nearsighted may notice vision problems as well. These may sound scary, but remember — they’re very rare and most a reversible (if you stop the medication, the problem should go away).

Frequently asked questions

What does the combined oral contraceptive pill do?

The combined oral contraceptive pill works by preventing the release of an egg (ovulation), thickening the cervical mucus thus blocking sperm from getting into the uterus and getting to the egg, and thinning the endometrium (lining of the uterus) so that if the egg/sperm hook up it can’t stick to the lining.

How effective is the combined oral contraceptive pill?

Birth control pills are 99.7% effective if PERFECTLY used (in a research study) and 93% effective in “regular use” (when real people use it and mess up every now and then).

Will combined oral contraceptive pills cause weight gain?

Some women worry about weight gain when taking birth control pills. However, research shows that women do not gain weight on the pill. But each woman is different and if you experience weight gain, then talk to your doctor to consider a different option. Know that there are 40 different combined oral contraceptive pills out there. Often, it’s mostly water retention (and not actual fat) that’s to blame.

When to start a combined oral contraceptive pill?

You may start the combination birth control pill at any time. If you start within 5 days after the first day of your period, you are protected against pregnancy within 24 hrs. For example, if your period starts on Monday afternoon, you can start the pill up to Friday afternoon to be protected from pregnancy within 24 hrs. If you start later than 5 days after the FIRST day of your period, you will be protected from pregnancy after 7 days of taking the pill every day. Use a back-up method of birth control like a condom, female condom, diaphragm, or sponge — if you have vaginal intercourse during the first week of starting the pill. Also, the pill does NOT protect against STDs/ STIs, so always use a condom WITH your birth control to avoid getting STDs. To learn more about the pill check out this post.

When does a combined oral contraceptive pill become effective?

If you start taking the pills on your period (within 5 days of the start of your period), you are theoretically protected within 24 hrs. If you start taking the combined oral contraceptive pill when you are NOT on your period, you are protected after 7 days on the pill.

Do combined oral contraceptive pills cause infertility?

TLDR: No. Some women worry that birth control pills can cause long-term infertility issues. This isn’t true. If you want to have a baby soon, just stop the medication and you should return to full fertility within 3 to 7 days. Watch our video by our Co-Founder and CEO Dr. Yen on birth control and infertility.


Disclaimer: The following 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.