Oral contraceptives or “the pill” are one method of contraception. The pill is associated with only a 0.3% chance of pregnancy if taken correctly.1 The pill contains a combination of a synthetic estrogen and a progestin.2 There are several types of the pill that are available:3
- 21 active birth control pills + 7 placebo pills
- 24 active birth control pills + 4 placebo pills
- Continuous or extended cycle
- 84 active birth control pills + 7 placebo pills
- Formulations with active birth control pills only (no placebo pills)
The active birth control pills prevent ovulation and thicken cervical mucus which makes it harder for an egg to attach to the uterine wall and be fertilized by a sperm.3 So what exactly do the placebo pills do? In the science world, placebo is defined as something without an effect. Placebos serve as the control or “normal” in scientific experiments. The placebo pills in oral contraceptives are considered inactive pills or “sugar pills.” Unlike missed active pills, which require short-term use of backup contraceptive methods to prevent pregnancy, the placebo pills can be missed without worry.1 Placebo pills do not have to be taken.4 Conversely, the active pills must be taken at the same time every day.5
Placebo pills help women remember to take their birth control pill daily and to start their next pill pack.4 Although the risk of pregnancy is only 0.3% with correct use, the risk increases to 9% with typical use of birth control pills. It may be common for typical users to miss at least 3 active pills in each pill pack.1 The longer women take the pill, the easier it may become to forget to take the active pills correctly.
Besides reminding women to regularly take their birth control pills, the placebo pills try to mimic the normal menstrual cycle. Although this menstrual cycle is not a true menstrual cycle, the hormone withdrawal experienced while not taking the active pills does cause bleeding that is similar to a period.6 A woman’s period will occur while taking the inactive pills. Some women use conventional birth control pills, but skip the placebo pills to make a more continuous birth control option. Skipping the placebo pills means you skip your menstrual cycle and can immediately begin the next pill pack without a break.4
It is important to speak with your doctor about your particular type of birth control and whether it is okay to skip the placebo pills. Some doctors may have a strong preference for you to skip or not skip the placebo pills.7 The formulations with active pills only will not have placebo pills and the active pills can not be skipped. Some women may benefit from skipping the placebo pills and continuing on to the next pill pack, particularly women who may experience menstrual symptoms such as cramping during their period.7
Benefits of taking birth control pills to prevent pregnancy include having an easy start and stop for birth control; however, women have to remember to take a pill everyday (at least the active pills in their pill pack).1 It is important to talk to your doctor about the best birth control option for you. There are other options for contraception besides birth control pills.
Methods of birth control