Yes, Mili is a combination birth control pill. It contains two hormones: a progestin called norgestimate (0.250 mg) and an estrogen called ethinyl estradiol (0.035 mg). Because it includes both an estrogen and a progestin, it falls into the category of combined oral contraceptives, distinguishing it from progestin-only “mini pills” that contain just one hormone.
What’s in Each Pack
A Mili pack contains 28 tablets total. The first 21 are dark blue “active” pills, each delivering the same dose of both hormones every day. The remaining 7 are inactive reminder pills with no hormones, taken during the week you have your period. This consistent daily dose across all 21 active pills makes Mili a monophasic pill, meaning the hormone levels don’t change from week to week.
This is different from a related pill called Tri-Mili (and its lower-dose version, Tri-Lo-Mili), which is triphasic. Triphasic pills adjust the hormone dose across three phases during the cycle. Tri-Lo-Mili, for example, steps up the progestin from 0.180 mg in week one, to 0.215 mg in week two, to 0.250 mg in week three. Mili keeps things simpler with a single, steady dose throughout.
How Mili Prevents Pregnancy
The combination of estrogen and progestin works primarily by stopping ovulation. If no egg is released, pregnancy can’t happen. The hormones also thicken cervical mucus, making it harder for sperm to reach an egg, and thin the uterine lining, which reduces the chance of implantation.
When taken correctly without missing any pills, Mili is about 99% effective, translating to roughly 1 pregnancy per 100 women per year. In real-world use, where missed pills and timing errors are common, the typical failure rate rises to about 5%.
How Mili Relates to Other Brands
Mili uses the same active ingredients (norgestimate and ethinyl estradiol at the same doses) found in several well-known brands. Ortho-Cyclen was the original brand-name version, and other generics with the identical formulation include Sprintec, MonoNessa, Previfem, and Estarylla. If you’ve taken any of these, you were on the same combination of hormones at the same strength. Your pharmacy may substitute one for another depending on availability and insurance coverage.
How to Start Taking It
There are two common ways to begin your first pack. With a Day 1 start, you take your first active pill on the first day of your period, and you’re protected right away. With a Sunday start, you take your first pill on the first Sunday after your period begins. The Sunday start makes it so your period typically falls on weekdays rather than weekends, but you’ll need to use a backup method like condoms for the first seven days since protection isn’t immediate.
After finishing all 21 active pills, you take the 7 inactive pills to complete the pack. Your period usually arrives during this hormone-free week. Start your next pack the day after your last inactive pill, whether or not your period has fully stopped.
What to Do If You Miss a Pill
If you’re less than 48 hours late (meaning you missed one pill), take it as soon as you remember, even if that means taking two pills in one day. No backup contraception is needed.
If you’ve missed two or more pills in a row (48 hours or more since your last active pill), take the most recent missed pill right away and discard any other missed ones. Continue with the rest of the pack on your normal schedule. You’ll need to use condoms or abstain for the next 7 days. If those missed pills fell in the last week of active pills (roughly days 15 through 21), skip the inactive pills entirely and start a new pack immediately to maintain protection. If you had unprotected sex during the first week of the pack and missed pills, emergency contraception is worth considering.
Common Side Effects
In clinical trials involving over 1,600 women, the most frequently reported side effects were headaches or migraines, affecting about 33% of users. Other common effects included vaginal infections (8.4%), stomach pain (7.8%), genital discharge (6.8%), and breast tenderness or pain (6.3%). About 5% of women reported mood changes, including depression. Less common effects included bloating (3.2%), nervousness (2.9%), and rash (2.6%).
Many of these side effects are most noticeable in the first few months and tend to improve as your body adjusts. Headaches in particular are common across all combination pills because of the estrogen component.
Medications That Can Reduce Effectiveness
Certain drugs speed up how your liver processes hormones, which can lower the amount of active hormone in your blood and make the pill less reliable. The most notable culprits include some seizure medications (such as phenytoin, carbamazepine, and topiramate), the antibiotic rifampin (used for tuberculosis), the antifungal griseofulvin, and the herbal supplement St. John’s wort. Some HIV and hepatitis C medications can also alter hormone levels in either direction.
If you’re prescribed any new medication, let your prescriber know you’re on a combination pill so they can assess whether a backup method or alternative contraception is needed.