TLDR: For most combination birth control pills (with estrogen and progesterone), you can be off by +/- 5 hours and be fine. Just don’t do it regularly – once a month is okay but NOT every day.

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 be intimidating. There are many variations of the pill, each with different hormone compositions and different mechanisms. You and your doctor have the freedom to choose which one is right for you and your schedule.

Sign up for a telemedicine consultation with Pandia Health’s expert doctors. We can help you select the birth control method that is right for you! Experience that #PandiaPeaceOfMind by getting birth control delivered to your mailbox for FREE 😌

Combination Oral Contraceptive Pill

On the regular combination pill (called combination because it contains the hormones estrogen and a progesterone), your medication can be taken 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 don’t take it until 10:00 AM, you’ll still be protected. It doesn’t need to happen at exactly the same time every day.

That said, try to get as close as possible to the same time. 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 at all. If you take the pill every day at the same time, there is a 1% chance you will get pregnant.

This chance increases if you miss your pill. That’s why you may see the effectiveness of the combination pill listed as 91% – in practice, those with uteri aren’t perfect at taking the pill consistently, leading to a risk of pregnancy.

Many women like to start taking birth control pills as soon as they get them. Once you have your birth control pills in your hands, you can take your first pill any day of the week and at any time of the month, including on your period. 

However, Dr. Sophia Yen, Pandia Health’s CEO/Co-Founder and experienced birth control prescriber and user, suggests for best results (potentially less breakthrough bleeding), start on the last day of your period; this is approximately on day 3-5 of your bleeding. This way, your uterus is a clean palette!

How Soon does the Pill Start Working?

Protection against pregnancy depends on when you start and the kind of pill you’re using. It’s smart to use a backup method like condoms (or abstinence) for the first seven days you’re on birth control while you wait for it to start working. To be extra safe, you might consider using a backup method for the whole month – better safe than pregnant! Dr. Yen suggests always using a condom to avoid sexually transmitted diseases like herpes, HPV (warts), chlamydia, gonorrhea, etc.

As a person with a uterus, why drip semen for the next 24 hrs? Use a condom, avoid that grossness.

Dr. Yen

Traveling While On Birth Control

If you’re travelling between time zones, you’ll have to be extra careful to make sure you’re taking the pill correctly. For instance, if you’re flying from California to New York and you normally take your birth control at 9:00 PM PST, you can still take it at 9:00 PM EST because that will amount to a three-hours EARLY.

But, if you’re journeying farther, like the UK, you would take it at 5:00 AM GMT. Mainly you want to take a pill every 24 hours. It’s always okay to take it early e.g. 21 hours but NOT as good to take it late e.g. 27 hours.

Here are some tips on birth control pills and more info about using birth control while traveling. Let Pandia Health worry so you don’t have to – just “set it and forget it!” 

Progestin-Only Pills (POPs)

If you are on the pill that only contains progestin with norethindrone, you should take it every day at the same time. If you are just three hours late, you have to use a backup method, such as condoms, if you plan to be sexually active for the next five days. If you had sex in the past 3-5 days, you should consider using some emergency contraception to be safe

It can be hard to adhere to this strict schedule everyday so Pandia Health’s expert birth control doctors don’t usually recommend this contraceptive pill. Instead, they recommend the IUD with hormone, the implant, the shot, or the copper IUD if you cannot use an estrogen-containing medication or have other contraindications to the “regular combination pill.”

You may need to use the progestin-only pill rather than the combination pill if you have a history of breast cancer, stroke, heart disease, or migraines with aura, among other medical conditions.

There is a new POP that is more flexible with a different progesterone known as drosperinone, or the name brand SLYND. However, it is much more  expensive than regular POP or regular OCPs. Here is more info about the differences between low-dose birth control and other hormonal contraceptives.

The Main Takeaway

The most important bit of information to remember is to take one pill every 24 hours. It’s also fine to take the pill slightly less than 24 hours after you took your last one – after all, you can always take more birth control pills but you should never take less (if you take fewer than you’re supposed to, you risk getting pregnant. If you take too many pills, too late, you risk getting pregnant)! 

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. Check us out on Facebook and Instagram as well while you’re at it!

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.