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Contraceptive Pills for Women – A Comprehensive Guide to Birth Control Options

Birth control is a crucial aspect of women’s healthcare. Many women rely on contraceptive pills to maintain control over their reproductive health. Contraceptive pills, also known as oral contraceptives, are a type of hormone-based contraceptive designed to prevent unwanted pregnancies in females.

With so many options available, it can be overwhelming to choose the best contraceptive pills for your needs. This comprehensive guide aims to provide you with essential information about the different types of contraceptive pills, their effectiveness, and potential side effects, allowing you to make an informed decision.

There are two main types of contraceptive pills: combination pills and progestin-only pills. Combination pills contain both estrogen and progestin, whereas progestin-only pills solely contain progestin. Both types work by suppressing ovulation, thinning the lining of the uterus, and thickening cervical mucus to prevent sperm from reaching the egg.

The effectiveness of contraceptive pills varies depending on proper usage. When taken correctly, combination pills have a failure rate of less than 1%, making them highly reliable in preventing pregnancy. Progestin-only pills have a slightly higher failure rate but are still considered a highly effective contraceptive method.

As with any medication, contraceptive pills may have potential side effects. These can range from mild symptoms like nausea and headache to more severe complications like blood clots. It’s essential to discuss your medical history and any potential risks with your healthcare provider before starting oral contraceptives.

In conclusion, choosing the best contraceptive pills for women is a personal decision based on individual needs and preferences. With the information provided in this comprehensive guide, you can better understand the different options available, their effectiveness, and potential side effects. Remember to consult with your healthcare provider to find the contraceptive pill that suits you best and to ensure your reproductive health remains under your control.

Key factors to consider before choosing a contraceptive pill

When it comes to birth control for females, there is a wide variety of contraceptive options available on the market today. Among these options, contraceptive pills are one of the most popular choices for women’s birth control. However, before deciding on a specific oral contraceptive, it is important to consider a few key factors.

1. Effectiveness

The effectiveness of contraceptive pills is an essential consideration when choosing the right one for you. Different contraceptive pills have varying levels of effectiveness in preventing pregnancy. It is crucial to choose a pill that has high efficacy rates to ensure reliable birth control.

2. Side Effects

Like any medication, contraceptive pills can have side effects. It is essential to be aware of these potential side effects and choose a pill that minimizes the risk of experiencing adverse effects. Common side effects include nausea, weight gain, mood swings, and changes in menstrual bleeding patterns.

Contraceptive Pill Effectiveness Side Effects
Pill A 99% Minimal
Pill B 98% Moderate
Pill C 95% Severe

Note: The table above provides a general comparison of effectiveness and side effects for different contraceptive pills. It is essential to consult with a healthcare professional for personalized guidance.

Effectiveness of birth control pills

Birth control pills are one of the most common forms of contraception used by women today. These oral contraceptives contain hormones that help prevent pregnancy by stopping ovulation, thickening the cervical mucus, and thinning the lining of the uterus. The effectiveness of birth control pills depends on how consistently and correctly they are used.

When taken correctly, birth control pills are highly effective at preventing pregnancy. In fact, the failure rate for oral contraceptives is less than 1% when used perfectly. However, in real-world scenarios, the failure rate is higher due to human error, such as forgetting to take a pill or taking it at different times each day. The typical failure rate for birth control pills is around 9%, which means that approximately 9 out of every 100 women will become pregnant within a year of using birth control pills.

It’s important for women to understand that birth control pills do not protect against sexually transmitted infections (STIs). Therefore, it is recommended to also use barrier methods, such as condoms, in addition to oral contraceptives to reduce the risk of STIs.

Factors that can affect the effectiveness of birth control pills include certain medications, such as antibiotics and anticonvulsants, which can interfere with the effectiveness of the hormones in the pill. It’s important for women to discuss any medications they are taking with their healthcare provider to ensure that their birth control pills will still be effective.

Overall, birth control pills are a safe and effective contraceptive option for women. They offer many benefits, including menstrual cycle regulation, reduced risk of certain cancers, and improved acne. However, it’s important to remember that no contraceptive method is 100% effective, and it’s essential for women to find the method that works best for them in consultation with their healthcare provider.

Types of oral contraceptives for females

Oral contraceptives, also known as birth control pills, are a popular form of contraception for women. These pills contain synthetic hormones that mimic the effects of naturally occurring hormones in a woman’s body. They work by preventing the release of an egg from the ovaries, thickening the cervical mucus to block sperm from entering the uterus, and thinning the lining of the uterus to prevent implantation.

There are two main types of oral contraceptives: combination pills and progestin-only pills.

Combination pills: These pills contain two hormones, estrogen and progestin. They come in different formulations, including monophasic, biphasic, and triphasic pills. Monophasic pills contain the same amount of hormones in each pill, while biphasic and triphasic pills contain varying amounts of hormones throughout the pill pack. Combination pills are the most common type of oral contraceptive and are highly effective in preventing pregnancy.

Benefits of combination pills:

  • Regulate menstrual cycles
  • Reduce the risk of ovarian and endometrial cancer
  • Improve acne and reduce the severity of menstrual cramps
  • Provide some protection against iron deficiency anemia

Progestin-only pills: Also known as mini pills, these pills only contain progestin. They are a suitable option for women who cannot take estrogen due to medical conditions or breastfeeding. Progestin-only pills are less effective than combination pills in preventing pregnancy and must be taken at the same time every day to maintain their effectiveness.

Benefits of progestin-only pills:

  • Can be used while breastfeeding
  • May have a lower risk of certain side effects compared to combination pills
  • Can be used by women who have a history of blood clots or cardiovascular disease
  • May improve symptoms of endometriosis

It’s important to note that oral contraceptives do not protect against sexually transmitted infections (STIs). Using condoms in addition to oral contraceptives is recommended for optimal protection.

Combination pills

How do combination pills work?

Combination pills work by suppressing the release of eggs from the ovaries and thickening the cervical mucus, making it difficult for sperm to reach the uterus. They also thin the lining of the uterus, reducing the likelihood of implantation.

It is important to note that combination pills do not protect against sexually transmitted infections (STIs). For protection against STIs, it is recommended to use barrier methods such as condoms in addition to hormonal contraceptives.

Types of combination pills

There are various types of combination pills available, with different hormone levels and regimens. Some common types include:

Brand Name Hormone Levels Regimen
Ortho Tri-Cyclen Estrogen and progestin 21 active pills followed by 7 inactive pills
Yaz Estrogen and progestin 24 active pills followed by 4 inactive pills
Lo Loestrin Fe Estrogen and progestin 24 active pills followed by 2 low-dose estrogen pills, then 2 inactive pills

It is recommended to consult with a healthcare provider to determine which type of combination pill is best suited for an individual’s needs and medical history.

In conclusion, combination pills are a widely-used contraceptive method for females, providing effective birth control when used correctly. They require a prescription and should be taken according to the prescribed schedule to ensure maximum effectiveness.

Progestin-only pills

Progestin-only pills, also known as mini-pills, are a type of oral contraceptive pills that contain only the hormone progestin. These pills are primarily used by women who are sensitive to estrogen or those who are breastfeeding.

Progestin-only pills work by thickening the cervical mucus, making it difficult for sperm to reach the egg. They also thin the lining of the uterus, making it less receptive to a fertilized egg. These actions help prevent pregnancy.

Unlike combined contraceptive pills, progestin-only pills do not contain estrogen, which makes them suitable for women who have a history of blood clots or are at an increased risk of developing them. They are also a good option for women who are breastfeeding, as they do not interfere with milk production.

It’s important for women to take progestin-only pills at the same time every day to maintain their efficacy. These pills have a higher failure rate compared to combined contraceptive pills, so it’s crucial to follow the prescribed schedule closely.

Progestin-only pills are generally safe for most women, but they may not be suitable for certain individuals. Women who are taking certain medications or have certain medical conditions may need to discuss their options with a healthcare provider.

Overall, progestin-only pills are a convenient and effective contraceptive option for women who cannot or do not want to use estrogen-based contraceptives. They provide a reliable form of birth control and are well-tolerated by many females.

Extended cycle pills

Extended cycle pills are a type of contraceptive pills that are specially designed for women’s birth control. These oral contraceptive pills contain a combination of hormones, such as estrogen and progestin, that work together to prevent pregnancy.

Unlike traditional contraceptive pills, which typically contain 21 days of active hormone pills followed by 7 days of inactive pills, extended cycle pills are taken continuously for an extended period of time. This means that women can go for longer spans without having a menstrual period.

How do extended cycle pills work?

Extended cycle pills work by suppressing ovulation, thinning the uterine lining, and thickening vaginal mucus. By preventing ovulation, these pills ensure that no egg is released and therefore there is no possibility of fertilization. The thinning of the uterine lining makes it less likely for a fertilized egg to successfully implant in the uterus. Additionally, the thickening of vaginal mucus makes it harder for sperm to enter the uterus and reach the egg.

Benefits of extended cycle pills

Extended cycle pills offer several benefits to women. Firstly, they provide a higher level of control over their menstrual cycle, allowing them to have fewer periods throughout the year. For women who experience discomfort or side effects during their menstrual periods, extended cycle pills can help alleviate these symptoms. Secondly, extended cycle pills provide an effective form of contraception, with a 99% success rate when used correctly. Lastly, extended cycle pills are convenient and easy to use, with just one pill taken daily to provide continuous protection against pregnancy.

Low-dose pills

Low-dose pills, also known as mini-pills, are a type of oral contraceptive that contains a lower amount of hormones compared to regular birth control pills. These pills are a popular choice among women who want to have greater control over their hormone intake while still effectively preventing pregnancy.

How do low-dose pills work?

Low-dose pills primarily work by thickening the cervical mucus, making it difficult for sperm to reach the egg. In some cases, they also thin the lining of the uterus, which can make implantation more challenging.

Unlike regular contraceptive pills, low-dose pills only contain progestin, a synthetic form of the hormone progesterone. This makes them a suitable option for women who cannot or prefer not to take estrogen-based contraceptives due to health reasons or other concerns.

Advantages of low-dose pills

There are several advantages to using low-dose pills:

Advantages Description
Lower hormone dosage Low-dose pills contain a lower amount of hormones, making them potentially safer for some women.
Reduced side effects With lower hormone levels, users of low-dose pills may experience fewer side effects compared to higher-dose options.
No estrogen-related risks As low-dose pills do not contain estrogen, women who are at an increased risk of blood clots or other estrogen-related complications may find them a suitable choice.
Flexibility in taking Unlike combination pills, low-dose pills have a more forgiving schedule, allowing for a 3-hour window for taking the pill.

It is important to note that while low-dose pills are effective at preventing pregnancy, they may not provide the same level of cycle regularity and acne reduction as higher-dose contraceptives. Women interested in using low-dose pills should consult with their healthcare provider to determine if this contraceptive option is suitable for them.

Continuous use pills

Continuous use oral contraceptive pills are a popular option for women who want to prevent pregnancy and avoid the hassle of taking a pill every day. These pills contain a combination of hormones, including estrogen and progestin, that work together to prevent ovulation and thin the lining of the uterus. By taking the pills continuously, women can avoid having a monthly period.

Benefits of continuous use pills

Continuous use pills offer several benefits for women. Firstly, they provide a high level of contraceptive effectiveness, with a failure rate of less than 1% when used correctly. These pills also help regulate menstrual cycles, reducing the severity of symptoms such as cramping and bloating. For women with conditions like endometriosis or polycystic ovary syndrome, continuous use pills can provide relief from painful periods.

How to use continuous use pills

To use continuous use oral contraceptives, women take an active pill every day without taking the placebo pills or having a pill-free week. This means that they do not have a monthly withdrawal bleed, but some irregular spotting or breakthrough bleeding may occur during the first few months of use. It’s important to start these pills as directed by a healthcare provider and to take them at the same time every day to ensure maximum effectiveness.

Non-hormonal contraceptive options

While hormonal birth control methods, such as contraceptive pills, are popular among women for their effectiveness and ease of use, some women may prefer non-hormonal options for various reasons. Non-hormonal contraceptives do not utilize hormones to prevent pregnancy, making them a suitable choice for women who are unable or prefer not to use hormonal methods.

Copper Intrauterine Device (IUD)

The copper intrauterine device, commonly known as the copper IUD, is a highly effective non-hormonal contraceptive option. This small, T-shaped device is inserted into the uterus by a healthcare professional. The copper IUD works by releasing copper ions, which are toxic to sperm, thereby preventing fertilization. It can provide long-term protection against pregnancy, with some brands offering up to 10 years of protection.

Barrier Methods

Barrier methods are another type of non-hormonal contraceptive option. These methods work by physically blocking sperm from reaching the egg, thereby preventing fertilization. Some common barrier methods for women include:

  • Condoms: Male condoms and female condoms are both effective at preventing pregnancy by acting as a barrier between the sperm and the cervix. They are also the only contraceptive method that provides protection against sexually transmitted infections (STIs).
  • Cervical Cap: This small, silicone cup is inserted into the vagina to cover the cervix, preventing sperm from entering the uterus.
  • Diaphragm: Similar to the cervical cap, the diaphragm is a shallow silicone cup that covers the cervix. It must be used together with a spermicide for maximum effectiveness.

Note: It is essential to remember that barrier methods, while effective, may have a higher failure rate compared to hormonal contraceptives. Proper and consistent use, as well as checking for any damage or expiration, is crucial.

These non-hormonal contraceptive options provide women with alternatives to hormonal birth control methods. It is important to consult with a healthcare provider to determine the most suitable method based on individual needs and preferences.

Common side effects of contraceptive pills

Contraceptive pills are a popular choice for women’s birth control. They contain hormones that prevent pregnancy by inhibiting ovulation and thickening the cervical mucus. While contraceptive pills are generally safe and effective, they can sometimes cause side effects in females. It’s important to be aware of these potential side effects when considering oral contraceptives.

  • Nausea: Some women may experience mild nausea when taking contraceptive pills. Taking the pill with food can help alleviate this side effect.
  • Headaches: Hormonal changes caused by contraceptive pills can trigger headaches in some women. If headaches become severe or persistent, it’s recommended to consult a healthcare provider.
  • Breast tenderness: Some women may experience increased breast tenderness while taking contraceptive pills. This side effect usually subsides after a few months.
  • Changes in menstrual cycle: Contraceptive pills can cause changes in the regularity and flow of a woman’s menstrual cycle. This may include lighter or heavier periods, spotting between periods, or missed periods.
  • Mood changes: Hormonal fluctuations can affect a woman’s mood while taking contraceptive pills. Some women may experience mood swings, irritability, or depression.
  • Weight gain: While not common, some women may experience weight gain while taking contraceptive pills. This can be attributed to fluid retention or changes in appetite.
  • Decreased libido: In some cases, contraceptive pills can decrease a woman’s libido or sexual desire. If this side effect is bothersome, it’s recommended to discuss alternative birth control options with a healthcare provider.

It’s important to note that the occurrence and severity of side effects may vary among individuals. If any side effects persist or worsen, it’s advised to consult a healthcare provider for further evaluation and guidance.

Rare but serious side effects of birth control pills

While birth control pills are generally safe and effective for the majority of women, there are rare but serious side effects that may occur. It is important for women to be aware of these potential risks before starting oral contraceptives.

1. Blood clots: Birth control pills can increase the risk of developing blood clots in the legs (deep vein thrombosis) or in the lungs (pulmonary embolism). This risk is higher for women who smoke, are over the age of 35, have a personal or family history of blood clots, or have certain medical conditions.

2. Stroke: Some studies have shown a slightly increased risk of stroke among women who use birth control pills. This risk is highest for women who have other risk factors for stroke, such as high blood pressure, diabetes, or a history of migraines with aura.

3. Heart attack: Although uncommon, certain types of birth control pills may slightly increase the risk of heart attack. This risk is higher for women who smoke or have high blood pressure.

4. Liver tumors: In rare cases, birth control pills may cause benign liver tumors. These tumors are usually non-cancerous and can disappear once the pills are stopped.

5. Gallbladder disease: Some studies have suggested a slightly increased risk of developing gallbladder disease among women who use birth control pills, especially those who are overweight or have a history of gallbladder problems.

It is important for women to discuss their medical history and any potential risk factors with their healthcare provider before starting any contraceptive method. This will help determine the most suitable and safest choice of birth control pills.

Women should also be aware of the warning signs of serious side effects and seek medical attention if they experience symptoms such as severe chest pain, shortness of breath, sudden severe headache, blurred vision, or leg swelling.

Remember, while the risk of these serious side effects is rare, it is crucial for women to be informed and make the best decision for their own health and well-being.

Interactions with other medications

When considering the use of contraceptive pills for females, it is important to be aware of any potential interactions with other medications. Some medications can interfere with the effectiveness of birth control pills or increase the risk of side effects. It’s crucial to consult with a healthcare provider or pharmacist before starting any new medication while using hormonal contraceptives.

Types of medications that can interact with contraceptive pills:

  • Antibiotics: Certain antibiotics, such as Rifampin, can reduce the effectiveness of oral contraceptives by increasing the metabolism of hormones in the body. It is recommended to use an additional method of contraception, like condoms, during antibiotic therapy.
  • Anticonvulsants: Some anticonvulsants, including Phenobarbital and Phenytoin, can decrease the effectiveness of contraceptive pills. Healthcare providers may suggest alternative birth control methods for women taking anticonvulsants.
  • Antifungal medications: Certain antifungal medications, such as Griseofulvin, can reduce the effectiveness of hormonal contraceptives. Using additional contraception methods may be necessary while taking antifungal medications.
  • St. John’s Wort: This herbal supplement can decrease the effectiveness of oral contraceptives by increasing the metabolism of hormones. It is recommended to use alternative contraception methods when taking St. John’s Wort.
  • Protease inhibitors: Some HIV medications, such as certain protease inhibitors, can interfere with the effectiveness of birth control pills. Women with HIV should consult their healthcare providers for alternative contraception options.
  • Antidepressants: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may impact the effectiveness of hormonal contraceptives. It is important to discuss the use of antidepressants with a healthcare provider to determine the best contraceptive options.

It is crucial to inform healthcare providers of all medications, including any over-the-counter drugs or herbal supplements, that are being taken while using contraceptive pills. They can provide guidance on potential interactions and advise on suitable alternatives to ensure effective birth control for women.

Choosing the right contraceptive pill based on lifestyle

Contraceptives are an essential part of birth control for women. The contraceptive pill is one of the most popular options. With a variety of options available on the market, it can be overwhelming to choose the right one based on lifestyle. Here are some factors to consider when selecting the best contraceptive pill:

  • Lifestyle: Consider your daily routine and lifestyle when choosing a contraceptive pill. If you have a busy schedule or often forget to take medication at the same time every day, a low-dose pill may be the best option. Alternatively, if you prefer a more hands-off approach, long-acting contraceptives like an intrauterine device (IUD) or implant may be more suitable.
  • Hormone preferences: Different contraceptive pills contain different types and levels of hormones. If you are sensitive to hormones or have experienced side effects in the past, you might want to consider a contraceptive pill with lower hormone doses or a hormonal-free option like a copper IUD.
  • Side effects: Some women experience side effects when taking contraceptive pills. These can include mood swings, weight gain, or changes in libido. It is essential to be aware of potential side effects and choose a pill that minimizes these effects, or consider alternative birth control methods if the side effects are severe.
  • Convenience: Consider the convenience factor when selecting a contraceptive pill. Some pills require daily intake, while others allow for less frequent dosing. Additionally, some pills come in blister packs with different colors for different days of the week, making it easier to track whether the pill has been taken or not.
  • Health considerations: It’s important to consider any underlying health conditions when choosing a contraceptive pill. Certain pills may be contraindicated for women with certain medical conditions, such as a history of blood clots or migraines with aura. Consult with a healthcare professional to determine which pill would be the safest and most appropriate for your situation.

Remember, there is no one-size-fits-all when it comes to contraceptives for women. It’s essential to assess your lifestyle, preferences, and health considerations to choose the contraceptive pill that best suits you.

How long does it take for birth control pills to be effective?

Birth control pills, also known as oral contraceptives, are a common form of birth control for women. These pills contain hormone-like substances that work to prevent pregnancy by suppressing ovulation and thinning the lining of the uterus, making it difficult for a fertilized egg to implant.

When starting birth control pills, it is important to remember that they are not instantly effective. It takes time for the hormones in the pills to build up in a woman’s system and start working. Generally, it is recommended to use an additional form of contraception, such as condoms, for the first seven days of starting birth control pills.

However, it is important to consult with a healthcare provider for specific instructions on when birth control pills become effective, as different brands and formulations may have slightly different guidelines. It is also crucial to follow the prescribed dosage and schedule, as missing pills or taking them at irregular times can decrease their effectiveness.

Additionally, women should keep in mind that birth control pills do not protect against sexually transmitted infections (STIs). Therefore, it is important to use condoms or other barrier methods to reduce the risk of contracting STIs in addition to preventing pregnancy.

In conclusion, while birth control pills are an effective form of contraception for women, it is crucial to allow enough time for the hormones to become effective. Following the prescribed dosage and using additional contraceptive methods during the initial period can help ensure maximum effectiveness and protection.

How to start taking birth control pills

Birth control pills are a popular contraceptive method for women. They are an oral form of contraceptive that contains hormones to prevent pregnancy. If you are considering starting birth control pills, here are some steps to help you get started:

1. Consult with your healthcare provider:

Before starting birth control pills, it is important to consult with your healthcare provider. They will be able to provide you with the necessary information and guidance based on your specific needs and medical history.

2. Choose the right type of birth control pill:

There are different types of birth control pills available for women. Some contain a combination of hormones, while others only contain one type of hormone. Your healthcare provider will help you choose the right contraceptive pill based on factors such as your health, lifestyle, and preferences.

3. Start taking the pills:

Once you have chosen the right birth control pill, follow the instructions provided by your healthcare provider. Generally, you will start taking the pills on the first day of your menstrual period. Take one pill at the same time every day, preferably with a glass of water.

4. Be consistent:

To ensure the effectiveness of birth control pills, it is important to take them consistently. Missing a pill or taking them at different times can reduce their effectiveness in preventing pregnancy. Set a reminder or use an alarm to help you remember to take your daily pill.

5. Monitor for side effects:

While birth control pills are generally safe, they can sometimes cause side effects in some women. Common side effects include nausea, headache, breast tenderness, and changes in menstrual bleeding. If you experience any severe or persistent side effects, contact your healthcare provider.

Benefits of birth control pills Considerations when starting birth control pills
– Highly effective in preventing pregnancy – Requires consistency in taking the pills
– Can help regulate menstrual cycles – May cause temporary side effects
– Can reduce the risk of certain cancers – Does not protect against sexually transmitted infections
– Easy to use and convenient – May not be suitable for women with certain health conditions

Overall, birth control pills are a reliable and convenient contraceptive option for women. By following these steps and consulting with your healthcare provider, you can start using birth control pills effectively and confidently.

Frequently asked questions about contraceptive pills for women

1. Can contraceptive pills be used by all women?

Contraceptive pills are generally safe and effective for most women. However, it is important to consult with a healthcare provider to determine if they are the right choice for you. Certain medical conditions and medications may affect the suitability of contraceptive pills.

2. How do contraceptive pills work?

Contraceptive pills contain hormones that prevent ovulation, thicken the cervical mucus to prevent sperm from reaching the egg, and thin the lining of the uterus to prevent implantation. This combination of actions helps to effectively prevent pregnancy.

3. Are all contraceptive pills the same?

No, there are different types of contraceptive pills available. Some contain a combination of estrogen and progestin hormones, while others only contain progestin. It is important to discuss options with a healthcare provider to determine which type is most suitable for you.

4. How effective are contraceptive pills?

When used correctly, contraceptive pills are highly effective in preventing pregnancy, with a success rate of approximately 99%. However, it is important to take the pills as directed and at the same time each day for maximum effectiveness.

5. What are the potential side effects of contraceptive pills?

Common side effects of contraceptive pills may include nausea, breast tenderness, headaches, and irregular bleeding. These often subside after a few months of use. Serious side effects are rare but can include blood clots and high blood pressure. It is important to discuss any concerns with a healthcare provider.

6. Can contraceptive pills protect against sexually transmitted infections (STIs)?

No, contraceptive pills do not offer protection against STIs. They are solely designed to prevent pregnancy. It is important to use condoms or other barrier methods in addition to contraceptive pills to reduce the risk of STI transmission.

7. Are there any women who should not use contraceptive pills?

Women who are pregnant, breastfeeding, or have certain medical conditions such as a history of blood clots, liver disease, or certain types of cancer may need to avoid using contraceptive pills. It is important to discuss medical history with a healthcare provider to determine the most appropriate contraceptive method.

8. How can I start using contraceptive pills?

To start using contraceptive pills, you will need to consult with a healthcare provider. They will evaluate your medical history and recommend the most suitable type of contraceptive pill for you. They will also provide instructions on how to take the pills and when to start.