Page 9: Hormonal Methods (Part 2)

Now let’s talk about some combined methods of hormonal birth control.



  • Prescriptions at McKinley Health Center require a Co-pay. This co-pay may vary depending on the pill brand.
  • Take the pill at the same time every day. This increases the effectiveness and lessens the likelihood that you will forget it.
  • Most monthly pill packages contain 21 active pills and 7 reminder or placebo pills. The active pills contain the needed hormones. The reminder pills contain no medication but taking the reminder pills daily will help you remember to start your new pill pack on time. The 7 reminder pills are always the last 7 pills in the pill package and will be a significantly different color than the other pills in the package.
  • Contraceptive protection is continuous even during the placebo week of pills, as long as all of the active pills were taken as directed.
  • Your period will usually start after taking 2-4 reminder pills and will usually end about the time you finish taking the reminder pills.

How to Start the Pill

There are 3 common methods of starting the pill:

  • Sunday Start: Take the first active pill in your first pill pack on the FIRST SUNDAY after your period begins, unless it begins on a Sunday. If so, start the pills that day. If you use the Sunday start, it is necessary to use condoms until you have taken seven active pills.
  • First Day Start: Take the first active pill in your first pill pack on the day you start your period. It is not necessary to use any additional method of birth control.
  • Quick Start: Take your first pill the day of your appointment with your provider, regardless of where you are in your menstrual cycle. This allows you to start your pills immediately, without waiting until you get your period. If you use the Quick Start method, it is necessary to use condoms or another back-up method of birth control until you have taken seven active pills. Women concerned about a possible pregnancy before starting the pill should wait until they get their period and choose either the first day start or Sunday start method. If using the Quick Start method, your period may be delayed until you take your placebo pills. If you do not get a period during the placebo week, take a urine pregnancy test. You may experience break-through bleeding throughout the first cycle; continue taking your pills if unscheduled bleeding occurs.


Forgotten/Missed Pills: Refer to the birth control pill handout or the pill insert for specific instructions if you forget to take a pill. If you have any doubt about what to do about and making up missed pills, begin using a back up method of birth control until you can talk to your health care provider.


Another combined hormonal contraception is the Nuva Ring: 

NuvaRing® is made of soft, flexible plastic. It is inserted in the vagina for three weeks and removed for one week. A period starts three to four days after removing the ring. Insertion is easy. Simply squeeze the sides of the ring together and place the ring in the vagina as if inserting a tampon.

To remove the ring, insert a finger inside the vagina, locate the ring and gently pull. Contraceptive protection continues throughout the ring-free week. The ring should not cause any discomfort to your or your partner during intercourse.