Good news for women who use birth control pills: The standard instructions for taking the pill have been re-evaluated and challenged in ways that give a woman more options in how she chooses to both start and use this popular contraceptive.

Here are two examples of how these options can impact female Penn State students.

Case No. 1: At Susan's first exam at the women's health clinic, she requested and received a prescription for the birth control pill.

She filled the prescription right away, but stashed the trim packet in her book bag, ready to start it at the first sign of her period -- which never came.

She had gotten pregnant while she waited.

Waiting to start oral contraceptives with the menstrual period has been the conventional instruction for starting the pill since it was developed more than 40 years ago.

But a new "quick-start" method allows a woman to take the first pill on the day of her office visit, as long as she is not pregnant.

The pill becomes effective in preventing pregnancy after the first seven days of use.

Could this approach have prevented Susan's unplanned pregnancy by eliminating that fallible gap between intent and action?

Recent studies support that it might have, and without an increase in potential side effects.

The reason a woman would traditionally have been instructed to wait for menstruation to start taking the pill was to make sure she wasn't already pregnant and arresting the process of ovulation from the "get-go" of the cycle.

But medical advances in pregnancy testing, ultrasound observation of the ovary and studies showing that pills will not adversely affect an early undetected pregnancy have allowed reconsideration of the benefit of the quick-start method against the risk of waiting.

Now, with healthcare providers becoming comfortable offering women this new method (although off-label) of starting the pill, women can also feel comfortable with it.

In the common goal of preventing pregnancy, it makes sense.

Case No. 2: Tameeka hasn't had her period for three months, but she's not worried about pregnancy.

She has been taking the birth control pill daily but skipping the last week in each pack (the placebo pills) and just restarting the next cycle.

Her plan is to continue this for nine weeks, and then take the placebos from her third cycle of pills to finally have a period.

Why would she be doing this?

The question more recently has been: Why not?

The pill was originally set up to be 21 active (hormonal) pill days followed by seven inactive (placebo) days, mimicking the average 28-day menstrual cycle. Now healthcare providers are suggesting women can continue their active pills for up to 84 days (as in the newly marketed pill brand Seasonale) before signaling the body to release the lining of the uterus by taking the week of placebos.

This means that instead of 12 to 13 periods a year, a woman might have only four.

Healthcare providers for years have advised women with certain medical conditions like painful periods, endometriosis and menstrual migraines to adjust their pill cycles in order to experience fewer periods and their associated discomforts.

And women in the know have quietly applied this idea to avoid their periods during honeymoons, vacations, etc.

What's new in recent years is the medical world's willingness to formally evaluate the idea of using these "extended pill regimens" as an option. Studies of this practice have not resulted in any major medical concerns.

What about period build-up? A build-up is prevented by the presence of both estrogen and progesterone. Estrogen stimulates the uterine lining to grow, while progesterone tones and controls that growth.

Other considerations include the common side effect of irregular bleeding, but this generally becomes less frequent over time.

Costs could be increased as more pill packs are required in a year.

It is recommended that women extending their active pills use a monophasic pill, in which the hormone levels remain constant.

The quick-start method and extended pill regimen are new ways of using an established contraceptive and therapeutic medication.

By understanding when and why these approaches could be considered, women are given greater opportunity to meet their personal needs.