Q&A: Am I taking my birth control pills correctly? (Part 2)

In the last post we talked a little bit about the reasons for taking birth control pills, and how estrogen and progesterone work together to support the uterine lining. I am not going to take this opportunity to dive deep into hormones (that’s a topic to discuss all on its own), but I’ll share a few more things that impact how and when birth control pills should be taken as we go along. I’m doing my best to keep things practical here in this post. 🙂

When should I start taking my birth control pill?

POSTPARTUM: (Check out my comprehensive podcast and post on birth control options for breastfeeding women!)

• If you’re NOT breastfeeding and taking a combined oral contraceptive pill –> you can begin taking your pill as soon as 3 weeks after birth. Discuss with your provider at your postpartum checkup. You can usually begin before you go to the mikvah.
• If you ARE breastfeeding and taking a progesterone only pill (the minipill) –> it’s preferable to wait for 4-6 weeks after birth to start, until breastfeeding is established as supply can be impacted before then. But don’t wait too long! The uterine lining is thin after birth, and the progesterone-only pill will continue to keep it thin, hopefully preventing spotting/staining. Some recommend beginning as soon as you get back from the mikvah so any spotting will be on colors (but know that you will need to use spermicide as a back up for a few days).
• Women who are not breastfeeding may choose to take the minipill as well but are likely to struggle more with staining.

NOT POSTPARTUM:

Note: From a Taharas HaMishpacha perspective, the progesterone-only pill is rarely a good option for a non-postpartum woman, reserved mainly for women with a clotting condition. The minipill isn’t enough to achieve good cycle control, especially when the uterine lining has already thickened. It is also slightly less effective as a contraceptive.

Your provider will usually suggest beginning a combined oral contraceptive the Sunday after your period starts (to stay organized) or with the first day of your next period. However, both Tahareinu and Machon Puah recommend beginning on Day 3 of your Period to decrease spotting going forward. This allows the uterine lining that has already built up to shed, but starts the contraceptive pill before the hormones start flowing to build it up again.

What you should not do is start the pill in the middle of your cycle! The process of ovulation* has a point of no return, like a train heading downhill. Once the egg has developed into a follicle of a certain size, it will “roll” on out of the ovary, even if you started birth control pills the day before. At that point, you’ve set yourself up for a lot spotting and staining, potentially for the next couple months, as the artificial hormones try to overcome the naturally occuring ones that are completely off sync. Plus, you might get pregnant, if you don’t use a backup method. Which brings us to the next point!

How long after starting my pill can I count on it for contraception?

You can rely on a combined oral contraceptive pill (progesterone + estrogen) after 1 full week of taking the pills. Most frum women will begin a new birth control before their sheva neki’im, so they need not worry. (A problem only arises if a woman takes a break of longer than 7 days between birth control packs, or missed more than 2 pills. We’ll talk about this more in the next post.)

You can rely on a progesterone only pill (minipill) just 48 hours after starting the pill as long as you take it consistently every day. (See the question “Does it really matter when I take my pill?”) After a full week of taking the minipill, you may “unlock” further contraceptive potential, but that’s not reliably true (more info on why in Part 3). Spermicides are the usual “backup method” for frum women. They come as suppositories (neirot), film (most easily found in Israel), and foam, and can be purchased without a prescription in the pharmacy.

Next post:

*Ovulation = when the egg exits the ovary and heads towards the uterus in the hopes of becoming fertilized along the way