Back to blog

How to start taking the 21 day Combined Oral Contraceptive pill

How to start taking the 21 day Combined Oral Contraceptive pill Image
Written by Nurx
Share this article

Combined, or “combination,” birth control pills contain both estrogen and progestin. The majority of birth control pills fall into this category. There is more than one way to start the pill — right away or when your next period begins. Here’s what you need to know:

Quick start: If you are certain you’re not pregnant, take your first COC the day you get your pills. 

  • If you start the pill within 5 days of the start of your period, you are protected against pregnancy right away. For example, if you started your period Thursday morning, you have until Tuesday morning to start taking your pill and still be protected from pregnancy right away.
  • If you start the pill more than 5 days after your last period started (Tuesday afternoon or later, in our example), then use a backup method (condom!) every time you have sex for the next 7 days to protect against pregnancy. After 7 days, you will be protected from pregnancy on the pill alone.
  • Tip: If you start your pill pack on any day other than Sunday, use the weekday stickers provided in your pack to place the appropriate days of the week above the first row of pills.

First day of period: Take your first COC on the first day of your period. No backup method is needed. You are protected against pregnancy right away.

How to take the pill

Take one pill each day, at the same time of day until the pack is empty.

  • Tip: Set up a daily alarm on your phone to remind you to take your pill at the same time each day. 
  • Tip: Keep your pills in your makeup bag or tote so you’ll always have them with you when it’s time to take one.

Start the next pack the day after you finish the last pack. There is no break between packs.

Do not skip pills even if you are experiencing spotting or bleeding or feel sick to your stomach.

Do not skip pills even if you don’t have sex very often.

What to do for a late or missed pill

If you miss 1 active pill

  • Take the missed pill as soon as you remember.
  • Take the next pill at your regular time, even if that means you take 2 pills in one day.

If you miss 2 active pills in a row in Week 1 or Week 2 of your pack

  • Take 2 pills on the day you remember and 2 pills the next day.
  • Then take 1 pill a day until you finish the pack.

If you miss 2 active pills in a row in Week 3 of your pack

  • Throw out the rest of the pill pack and start a new pack that same day.
  • You may not have your period this month but that is expected.

If you miss 3 or more active pills in a row (during the first 3 weeks)

  • Throw out the rest of the pill pack and start a new pack that same day.

You could become pregnant if you have sex in the 7 days after you restart your pills. You must use a backup birth control method (such as condoms) for those 7 days.

If you had unprotected sex before you were back on the pill for 7 consecutive days, and that’s within the last five days, you might want to take emergency contraception just in case.

If you forget any of the reminder pills in Week 4

  • Just throw away the pills you missed.
  • Keep taking 1 pill each day until the pack is empty.
  • You do not need a backup method if you start your next pack on time.

Finally, if you are still not sure what to do about the pills you have missed, keep taking one active pill each day and use a backup method anytime you have sex until you can message with a Nurx medical provider or another healthcare provider.


More articles that might be helpful:

How to Order Birth Control Online

Which Emergency Contraception is Right for You?

Who Should Do a Home HPV Test (You, Maybe)


This blog pro­vides infor­ma­tion about telemed­i­cine, health and related sub­jects. The blog content and any linked materials herein are not intended to be, and should not be con­strued as a substitute for, med­ical or healthcare advice, diagnosis or treatment. Any reader or per­son with a med­ical con­cern should con­sult with an appropriately-licensed physi­cian or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.

Back to top