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Birth control pills: the placebos, period timing and condom backup

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Anonymous asks:

Hello, I love your site very much as it offers straight and honest answers to questions that we ask ourselves every day. Thanks a lot for that ^_^

I am 23 years old, and I have 1 1/2 questions. I am currently taking Loestrin24 Fe and have been on it for about a year and a half. My main use for it was to help with painful cramps I would get every month, but now I have become sexually active with my fiance. We were both virgins who believe that sex should only be shared by two people who are truly in love and I know that I can trust him 100%. So STDs are really not an issue and I have been having sex without any other form of contraception other than birth control. My first question is as follows, is it possible/more likely to get pregnant while taking the inactive pills of the birth control cycle pack? Is it absolutely necessary to use a condom as a secondary form of birth control while I am on the inactive pills?

My next and main question is this, currently I start my pill pack on a Monday, and with this specific birth control I start the inactive pills on a Thursday therefore I get my "period" on a Saturday. I don't want to get my period on a weekend anymore, so what is the best way to restart my cycle so that I get it say on a Monday or Tuesday. Would it be okay to just take the inactive pills up to Sunday which is the last day I am currently taking them, go without taking ANY pills for two days and start the new pack on a Wednesday-- or should I just skip some of the inactive pills altogether? Thanks a lot for your time, your site is very helpful :)

Heather Corinna replies:

Hey there, Susie. You're welcome!

Birth control pills are equally effective every single day of your cycle so long as you are taking the pills as directed, and on time every day, and without any other medications which could interfere with them. Some antibiotics, for instance, may decrease effectiveness, and the herbal supplement St. John's Wort is a big offender in this department. In general, though, so long as your pharmacist or doctor knows you are on the pill, they will let you know when giving you any other medications if you need to use a backup method.

Why you have equal effectiveness on the placebo weeks is because the active pills will have kept you from ovulating the cycle before, and since you'll be continuing your pills in the next cycle, you won't ovulate then, either. So, even though you aren't putting the hormones in your system during that week, you don't need to because there's no egg to fertilize so long as pills are taken correctly before and after that week.

So far as condoms go, overall, the only way we truly can know that STI risks have been reduced as much as possible is when a couple:
• Has been monogamous for at least six months and is remaining so,
• Has been using latex barriers for any oral, vaginal and/or anal sex for at least those six months, and
• EACH have had at least TWO full STI screenings with negative results before going without barriers.

By all means, if neither you nor your partner have EVER had ANY kind of sexual contact with anyone else, your risks of many STIs are indeed nonexistent, and are low with most. Things like Oral Herpes (HSV-I) or Pubic Lice -- two infections which are often transmitted from nonsexual contact would be the big risks for couples who have never had any other kind of sexual contact. By all means, trust and love are important, but they really are not parts of safer sex practices, nor do we know them to reduce STI risks. The practices I've outlined for you above are the only ones we know to reduce risks if people are going to be sexually active, and if either of you have ever had any kind of sexual contact with someone else, then your risks are going to be the same as anyone else's.

STI risks aside, it's also about how much risk you're willing to take. BCPs are, indeed, incredibly effective when used correctly, but even in perfect use, they're not 100% effective. However, when you back up with condoms, pregnancy really becomes nigh unto impossible. So, it's up to you to figure out what level of risk you're comfortable with and choose accordingly. (As a bonus, backing up with condoms also lets your male partner play an equal part in birth control responsibility, which is pretty cool.)

In terms of your question about how to time your withdrawal bleeds, what you want to do with your pill is a Sunday Start, where you start the pill on the first Sunday after your last period, or in your case, your last withdrawal bleed. That will generally result in a withdrawal bleed that starts on Monday or Tuesday. If you're going to switch it up like that, just do so taking less of your placebos, rather than by skipping any active pills. However, it sounds like you're already pretty darn close to that, and do understand that there's really no way to take the pill in which you are always guaranteed not to get your bleed on a weekend.

Here's some more information for you on the pill, as well as on safer sex practices and on male birth control participation:

Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.