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you take for the first 3 weeks contain the hormones that prevent pregnancy and regulate your menstrual cycle. The pills you take during the fourth week are inactive (placebo) pills. You take one pill every day at the same time. After you take the last of the hormone-containing pills, the hormone levels in your blood fall quickly, and menstrual bleeding occurs. If you miss a pill, you should take it as soon as you remember. If you miss two or more pills from one package, take two pills a day until you catch up, but use an additional method of birth control until you begin a new package of pills. When you miss a pill, the sudden withdrawal of the hormones can cause menstrual bleeding. Birth-control pills do not have any effect on your ability to become pregnant after you stop taking them.

If your doctor has recommended against taking the combined pill, you may be able to take the minipill. The minipill contains only the hormone progesterone (progestin) and may be safer if you smoke and are over age 35. (Women over 35 who smoke cigarettes should not take estrogen because it can increase their risk of blood clots and stroke.) Because the minipill does not contain estrogen, it can cause breakthrough bleeding (bleeding between periods), especially if you miss a pill or take one late. Some women who take the minipill do not have regular menstrual periods for a long time. Minipills are slightly less effective than combined birth-control pills; on average, about 2 of every 100 women who use the minipill for a year become pregnant.

Your doctor probably will tell you to begin taking the minipill on the first day of your period, and to take one each day for as long as you want contraception to continue. It is especially important that you take the minipill at the same time each day and use a backup method of birth control, such as a condom, if you take a pill more than 4 hours late.

Some women experience bleeding between periods when starting birth-control pills. Breakthrough bleeding is common during the first few months of using the pill and requires no treatment. Breakthrough bleeding is less likely to occur if you take the pill at the same time every day and don’t skip any. If the bleeding continues, your doctor may prescribe a different dosage of the pills to try for several months. Mild breast tenderness also may occur temporarily. One rare but serious potential side effect of taking birth-control pills is the formation of blood clots in the veins, which can travel to the lungs and cause sudden death.

Emergency Contraceptives

Emergency contraceptive pills (sometimes called morning-after pills) are available in two-pill packets to prevent pregnancy after unprotected intercourse. The pills, like birth-control pills, are either a combination of estrogen and progestin, or progestin alone. The first pill must be taken as soon as possible within 72 hours of unprotected intercourse (it is most effective when taken within 24 hours); the second pill must be taken 12 hours after the first pill. The pills work in the same way as regular birth-control pills and have similar side effects. You should not consider emergency contraceptives a regular form of birth control.

Male and Female Condoms

A condom is a thin rubber sheath (usually made of latex and closed at one end) that is rolled onto the erect penis before intercourse. When a man ejaculates, his sperm are trapped in the closed end of the condom. For maximum reliability, you should use condoms along with a spermicide. Some available condoms are already lubricated with spermicide.

Condoms are up to 98 percent effective in preventing pregnancy when used correctly. Not only do condoms prevent pregnancy, they also prevent the transmission of most sexually transmitted diseases (STDs), reducing the risk by 99.9 percent. But condoms reach these levels of effectiveness only when they are used consistently and correctly (see page 478)—every time you have sex, including oral and anal intercourse.

A variation of the condom is the female condom. This thin rubber sheath fits inside the