Switching from combined pill to mini pill side effects

The birth control pill is an imperfect—though still awesome—invention. Even though it's been one of the most popular birth control methods for decades, many women have a love-hate relationship with their pill. On top of the fact that the basic idea hasn't changed since it first became a contraceptive option in the 1960s (three weeks of daily pills followed by an unnecessary placebo week—really?), side effects of the birth control pill range from annoying to truly problematic.

But not all versions of the pill affect women the same way. There are two main categories of birth control pills—combined hormonal pills, which contain doses of estrogen and progestin, and "mini pills," or progestin-only pills—and the type you're using matters. "Everyone’s body is different and can react differently to the pill depending on many factors—a big one being their own health history," says Janell Sanford, Pharm.D., pharmacist in charge at the Pill Club. In other words, you might simply tolerate one form of the pill better than another.

So how do you know when you need to switch? We asked the experts what's normal, which side effects of the pill you should never put up with, and when it's time to switch.

Side Effects of the Pill: What's Normal

Anytime you tinker with your body's hormonal balance, there are bound to be side effects. But the good news is, most of these are temporary and will go away after your body has a couple of months to adjust, says Sanford. "For example, although weight gain is not a confirmed side effect of birth control, some pills can cause temporary water retention, which feels like weight gain and usually resolves after one, two, or even three cycles," she says. Some of the most common side effects women report: spotting, mood changes, and breast tenderness.

Other side effects are more serious. "The major health consequence of estrogen-containing birth control pills is a slightly increased risk of blood clots," says Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine. If you notice chest or leg pains, swelling or redness in your legs, shortness of breath, eye problems, or blurry vision, call your doctor ASAP. Severe headaches or abdominal pain can also be a sign something more serious is going on, says Sanford. If you have a severe headache that doesn't go away with over-the-counter painkillers or abdominal pain that doesn't feel like your average cramp (and especially if it occurs on the upper right side of your stomach), let your doctor know.

Signs It's Time to Switch

If you notice any of the serious side effects above, talk to your doctor ASAP. For the more common—but still annoying—ills, here's how to talk to your doctor about finding a better fit.

If you're still spotting after a couple of months…Breakthrough bleeding is more likely to happen on lower-dose birth control pills. "Some women will develop spotting when they shouldn't be bleeding," says Dr. Minkin. "Switching it up to a slightly stronger pill [with a higher dose of hormones] might just be helpful."

If you want to switch to a new birth control pill, there are things you need to consider. You may be switching from a mini-pill to a combined pill. Even for the same type of pills, different pill brands may contain slightly different doses of the hormones estrogen and progestin.

Use these tips to ensure the transition is smooth and know when to start the new pack and when to use backup contraception.

Reasons for Switching

Before you switch pills, you need to have a discussion with your healthcare provider about which pill you want to change to, as well as your reasons behind this change and your expectations. Reasons for why you may switch pills are varied and can include one or more of the following:

• You may be looking for a pill with certain non-contraceptive benefits, like reducing acne flares.
• You may want the convenience of an extended cycle pill.
• You may want to minimize certain side effects of your pill like nausea or irregular bleeding.
• You may want to switch from a combination pill to a progestin-only one—possibly you have a new contraindication to estrogen (for example, migraines with auras). 

In the end, figuring out what pill you will be switching to is probably the hardest part of this whole process. Once you have made a decision, you can move forward with your new pill prescription in hand.

Switching Between Combination Pills

When switching from one pill to another, there are a couple of strategies, so be sure to confirm with your healthcare provider which one you should do. One strategy is to finish your entire old pill pack (including the placebo pills in the fourth week). Then, when you come to what would have been week one, day one of your old pill brand, start your new pill pack.

If you do this, you should have automatic pregnancy protection and do not need to use a backup birth control method. Just to be sure though, check the package insert (that comes with your new pill prescription) to double-check if you should be using a backup method for the first seven days.

Alternatively, you can actually start your new combination pill right away. That being said, if it has been more than five days since menstrual bleeding started, you need to abstain from sex or use backup contraception for the next seven days (for example, a condom).

It's important to be aware that your body may need to adjust to the new type, level, and/or dose of hormones in your new pill. Be prepared to possibly experience some side effects.

Most experts recommend giving your new pill brand at least three months for these side effects to go away before deciding if you want to stop it—in other words, patience is key here until your body adjusts. 

From Combination Pills to Mini-Pill

When switching from a combination pill to a mini pill, you can take your mini-pill immediately. But if it has been more than five days since you last had menstrual bleeding, you need to either abstain from sex or use backup contraception for the next two days.

From Mini-Pill to Combination Pill

If you are switching from a progestin-only pill to a combination pill, you can start the combined hormonal contraceptive right away. You do not need to wait for your next menstrual period.

If more than five days have passed since you last had menstrual bleeding, you should use a backup method for the first seven days of your new pill pack to avoid getting pregnant (or abstain from sexual intercourse).

A Word From Verywell

Switching birth control pills is a common process, and reasonable in many instances, as new lifestyle or personal issues arise. While it’s a good idea to be knowledgeable about your birth control options, let your healthcare provider help you decide what to start using—this is what they are trained to do, and they have experience working with people just like you.

Once you have the green light and are making the switch, be sure that you have continuous pregnancy protection and be aware if you need to use backup birth control by talking with your healthcare provider first. This will ensure a seamless switch and allow you to move forward without the worry of unintended pregnancy.

Frequently Asked Questions

• Is it OK to switch from name-brand to generic birth control?

  Yes. Generic versions of birth control pills have the same active ingredients as their name-brand equivalents. If you are taking brand-name birth control, you can ask your doctor or pharmacist if it is available as a generic.

• Do you need to backup birth control when switching pills?

  It depends. If you start the new birth control prescription immediately after finishing your previous pack of pills, you should be covered. However, if it has been more than five days since the start of your last period, you will need to use backup birth control, such as a condom, for the first seven days.

• Can switching brands of birth control cause a missed period?

  Yes, it can take some time for the body to adjust to a change of hormone levels when switching birth control brands. It can be normal to skip a period for a month when changing birth control pills.

  Similarly, changing between different types of hormonal birth control—such as going from the pill to the vaginal ring—can also cause you to skip a period.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Klein DA, Arnold JJ, Reese ES. Provision of contraception: Key recommendations from the CDC. Am Fam Physician. 2015;91(9):625-633.

2. University of North Carolina-Chapel Hill. The pill, patch and ring.

Additional Reading

• Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recommendations and Reports. 2016;65(4):1-66. doi:10.15585/mmwr.rr6504a1.
• Klein DA, Arnold JJ, Reese ES. Provision of Contraception: Key recommendations from the CDC. Am Fam Physician. 2015 May 1;91(9):625-33.

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.

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