Contraceptive 28 Day Estrogen/Progestin Combination Pill Pack


In this session we will be discussing the consumer medication information for the 28-day estrogen/progestin combination pill pack.

What it’s for & How to take

The 28 day combination pill pack is hormonal contraceptive birth control. This combination pill pack may sometimes be used to regulate menstrual cycle, decrease your chance of ovarian cysts, decrease blood loss, help with painful periods or treat acne. If you are using this medication for a reason not discussed here, please talk about it with your doctor.

This medication is a combination of two different female hormones, estrogen and progestin. All the 28-day combination packs have a varying dose of an estrogen and progestin. Your specific dose combination is based on many factors that you will discuss with your doctor.

By maintaining a moderately constant level of hormones in your body, the surge of hormones around ovulation is avoided and an egg is not released. This therapy also thickens the vaginal secretions making it more difficult for sperm to reach an egg. This medication affects the lining of the uterus, making it more difficult for a fertilized egg to attach to the uterine wall.

Take your tablet at the same time each day and do not miss a dose. Most pill cycles have 21 days of active tablet and 7 days of placebo tablets. Some of the newer combination packs have either 24 or 26 days of active tablet with the remainder being placebo. Regardless of which combination pack you have, you take it the same, 28 days, strait through without missing a dose.

Unless directed otherwise by your doctor, take your first tablet on the first Sunday following the beginning of your menstrual period. Mark your calendar. If your menstrual period begins on Sunday, take the first tablet that day. You should begin your period sometime during the fourth week of your cycle. Begin your next 28-day medication pack without missing a day regardless of whether you have started your period. If you do not start your period, call your doctor.

Find your medication package paperwork and locate the exact instructions that explain what to do when you miss a dose. Cut out this section and put it in your wallet. What to do when you miss 1, 2 or 3 doses varies depending upon which week you are in and which specific medication you are taking. Ask your doctor or pharmacist to explain these instructions if you do not understand them.

Most Important Warnings

  • Do not use this medication if you smoke cigarettes or any other tobacco products and are over 35 years old. Smoking cigarettes while taking this medication increases your risk of stroke, heart attack, blood clots and high blood pressure. This risk significantly increases if you are over the age of 35 years old.
  • Hormonal contraception does not protect you from sexually transmitted diseases.

Other Warnings & Cautions

  • Do not use birth control pills if you are pregnant, might be pregnant, or are breastfeeding. If you are taking this medication and think you might be pregnant, talk with your doctor right away.
  • When starting this therapy, use an additional form of birth control such as a condom or spermicide for the first 7 days while the medication is building up in your system.
  • If you are ever unsure what to do about the pills you have missed, use a back-up contraception method, such as a condom or spermicidal gel, anytime you have sex. Continue taking one pill each day until you contact your health care provider for instructions. Discuss the possibility of emergency contraception for any unprotected sex.
  • While using hormonal birth control it is possible that your skin may develop dark patches. Sun exposure may make this worse. Avoid prolonged sun exposure and tanning booths. Use sunscreen or wear protective clothing when necessary.

Interactions & Side Effects

  • Tell your pharmacist or doctor all your medication allergies so they may determine if your 28-day combination pill pack is safe for you to take.
  • Taking other medications may decrease the effectiveness of your birth control and lead to an unintended pregnancy. Tell your pharmacist or doctor all the other medication you are taking, including over the counter supplements, even if you don’t take them very often.
  • Ask your doctor if this medication is safe to take with your current or past health conditions. Tell your doctor if you have any circulation issues, heart, thyroid, diabetes, liver, blood clots, cancer, incomplete miscarriage, abortion, mental disease, or any other medical condition you have experienced.
  • While taking your 28-day combination pill pack you may feel some nausea, headache, bloating or dizziness. If these or any other unwanted side effects persist, contact your doctor or pharmacist to talk about it with them.
  • If you experience any significant changes in vaginal bleeding, problems wearing contact lenses, unwanted facial hair, dark patches on your skin, significant weight change, or if you miss your period, contact your doctor to talk about it.
  • Call your doctor right away if you feel any severe headache, problems with vision, speech, or balance, an increase in depression, swelling in your body or any breast lumps.
  • Call emergency 911 if you have any symptoms of a heart attack such as chest and left arm pain, shortness of breath and sweating or if you have symptoms of a stroke such as weakness on one side of your body, slurred speech, sudden vision changes and confusion.

If you have any questions about what you have heard, contact your pharmacist or doctor. This session does not include all the potential interactions or side effects that this medication may cause. Ask your pharmacist how your medication should be stored and how you should dispose of it when you are done taking it. Do not share your medication with anyone, ever. Remember, this is not meant to replace your counseling session with your own pharmacist. In case of overdose, call your local poison control center at 1-800-222-1222.

Updated 7/20