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Quick Hits: Questions and Answers on The Pill

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Aishte asks:

Once you take your first pill, when do you think you can have sex?

Heather Corinna replies:

It depends on when you start taking your pills for the first time, and on what level of protection you want.

If you start the pill on the first day of your period, it's likely -- so long as you take every pill in that cycle during and after that week perfectly -- that you will be have the full effectiveness of the pill immediately to seven days later. Pill manufacturers vary on what they state and suggest when it comes to a Day 1 start and effectiveness.

If you Sunday Start -- you start taking the pill on the first Sunday after your period begins -- it's likely you will have the full effectiveness of the pill, so long as you take every pill in that cycle during and after that week perfectly, after seven days of use.

If you start at any other time in your cycle, then you should wait one full cycle of active pills before going without a backup. Because starting the pill at other times means that your normal fertility cycle may keep up as it would without the pill -- for instance, you may ovulate or already have ovulated when you start, or your cervical mucus may not be changed enough to impact sperm motility -- relying on the pill as sole birth control until your first pack is through isn't sound.

Understand, though, that opinions and statements on all of this vary. Some manufacturers and healthcare providers will say that the pill should be effective within seven days no matter when you start, while others will list a range from day one to a whole first pill pack.

Here at Scarleteen, and with my clients at the clinic, I always advise waiting at least one full cycle of the pill before going without a backup method. When you don't want to become pregnant, in my book, it's always best to err on the side of caution. It can be tricky to get in the habit straightaway of taking a pill every day -- especially if you aren't already in the habit with another medication or a daily vitamin -- and there's data to show it's even tougher for younger women than older ones. So, giving yourself a month to get used to taking the pill, and using a backup in case, like many folks, you goof up as you're just getting started, is smart if you want to do all you can to reduce your risks of pregnancy.

And in the case that your partner or you haven't yet gotten your STI tests to assure that it's safe to ditch condoms, that first month leaves you both plenty of time to do that and get your results back before you go without barriers. Remember: the pill offers great protection against pregnancy, but doesn't offer any protection against sexually transmitted infections.

After you've had one full cycle of pills, you can rest assured that unless you don't use it properly afterwards, you'll have the full effectiveness of your pill for every day of every pill cycle from there on out.

Emily asks,

I'm currently on Loestrin 24 Fe and have been on the pill for six months now. I recently just switched the time I took the pill from 12:30 pm to 7:00 pm and have been pretty consistent with taking it (if anything only 2-3 hrs off). I made sure to start this time change on a new pack. 10 days into the pack I had unprotected sex and he came inside of me. I finished the pack and started a new one without getting my period. I'm already 5 days into the new pack and still nothing. I'm worried about being pregnant. What should I do?

It sounds to me like you have been taking your pill properly, and have been using the pill for long enough that you do not need a backup method to be highly protected against pregnancy. Switching the times should not impact effectiveness so long as no days got missed.

While sometimes you may skip withdrawal bleeds without explanation even when on the pill, since you have been sexually active and no single method of birth control is 100% effective, I would suggest taking a pregnancy test just in case. If it's positive, you'll find out early enough to have all your options available to you, and if it's negative then you can stop worrying.

Alycat9 asks,

I just got off my period about 1 day ago and which meant i was into my "regular" pills (about 3 days in) after the placebos in the beginning of the month. After 3 "regular" pills my boyfriend and I had sex and he came inside me. I did not take my birth control pill until RIGHT after we had sex. I'm really stressing right now. Should I get the morning after pill? Please help! Could I become pregnant?

You don't need to take the pill in such a way that it's timed with, before or during sex. You also do not need a morning-after pill because of this.

If you are past your first cycle of pills, so long as you are taking your pills properly every day, you are protected by your pill. Taking a daily pill before or after sex does not increase or reduce the pill's effectiveness.

Remember: no single method of birth control offers 100% protection against pregnancy. The pill, taken perfectly, comes mighty close -- it's 99.7% effective with perfect use, and 92% effective in typical use -- but if you don't feel comfortable with that level of protection, you can always bump it up by just adding a second method to the mix.

Mariella asks,

I have been on the pill for 16 months and had sex during the placebo period, but was unprotected. Can I still get pregnant when I have unprotected sex during withdrawal period?

And Noel asks,

I've recently started taking the birth control pill which was the first day of my period, a Sunday. I had sex using a condom and a few times after that as well (The insert on my pill pack said the pill was effective after 7 days, but after reading all the other questions, I see that it's better to wait a full cycle.). I have also always taken my pill within 20 minutes of my scheduled time and as far as I'm concerned, the condoms were always used correctly. Yesterday (June 1) was when I started taking the green placebo pills and my period was supposed to start, however, it didn't and still hasn't. Should I be worried? Because if I never started taking birth control pills then my period still wouldn't be coming for another week so I'm not really sure.

I was also wondering, if your period started and ended within the 7 days of taking the placebo pills would you still be protected against pregnancy? Like if your period ended on the 4th day and you had sex on the 5th day?

The pill is equally effective every single day of your pill cycle, so long as you are taking your pills properly. It is not ineffective or less effective during the placebo period. It also isn't effected by how long your withdrawal bleed (you don't really have a period on the pill: you have a bleed due to withdrawal from the hormones) lasts or when it begins.

For more information on why, check this out.

It's not atypical for it to take a couple of cycles for some women to start having withdrawal bleeds with the pill or during the placebo period. If you find that you don't have at least a few days of bleeding either on your placebo pills or at some point during your cycle within your first few pill packs, then check in with your healthcare provider or take a home pregnancy test.

Nicole asks,

I know that the birth control pill is supposed to suppress ovulation, but in the case that it fails or the woman misses some pills, when would a woman ovulate? Could it be anytime after she misses the pill, or would it be around a week after she had her period (the first-second week of the pill pack)?

There's really no predicting that that I know of, nor any solid data on that issue. Remember too, that combined oral contraceptives work in three different ways -- suppressing ovulation, thickening cervical mucus, and thinning uterine lining to make implantation unlikely -- because sometimes, ovulation just isn't suppressed with a given pill cycle, for any number of reasons. So, even if a woman is taking her pill perfectly and somehow does ovulate, those other two protections should still protect against pregnancy.

So, should you miss a pill, take that pill as soon as you remember. Should you miss two, same deal. Should you miss three, you'll want to replace them one per each of the next three days with your scheduled pill, but it's generally agreed that we're then looking at a more likely risk scenario, and it'd be smart to use a backup method of birth control for the rest of that pill cycle.

Should you find that you're often missing pills, it's a good idea to have a chat with your healthcare provider. It's hard for a lot of people to stay regular with the pill, and there are other methods you have to remember less often with the same combination of hormones. So, if you like the pill but can't deal with a daily medication, you have options which may work better for you.

Vespa asks,

I usually take my pill every morning around 7.30am. However, I had unprotected sex with my boyfriend, and did not take the pill until around 4pm that day. Is this okay - am I still protected?

If you are on a combined oral contraceptive (one that has two hormones in it, and your information packet with your pill packs will tell you that), then it's not vital to take the pill at the same time every day. You want to try to take it around the same time just to keep your cycle as regulated as possible, and also to most easily remember to take pills daily, but taking combined OCPs at different times of the day should not decrease your pill's effectiveness in any way. If a person takes the pill all willy-nilly, at all kinds of different times, it can be more likely to space out taking a pill each day.

However, if you are on a progesterone-only pill (a minipill), then it is important to take it within a three-hour window of each day to keep it effective. But even then, one late pill in a cycle certainly will not make a minipill ineffective, and may not decrease its effectiveness.

Annie asks,

Recently I have been reading the Birth Control Bingo pages on the site, mainly because I have been taking combination birth control pills for several years now and I was curious to know just how effective, mathematically, I can expect them to be for me. So, really, I guess have three questions:

1) The site says that when used perfectly, combination pills are 99.7% effective. Why aren't they 100% effective when used perfectly? Some reasons I could think of include digestive issues (ie, not keeping the pill down or not being able to absorb it for some reason) and drug interactions, but are there other reasons? If so, is there anything you can do to minimize their effects?

2) Who qualifies as a "perfect" user? In three years, I can think of maybe three occasions when I legitimately forgot a pill and took it around 12 hours late. I probably take pills 2-3 hours late two or three times a month on average. Other than that, I -always- take my pill within the same 1 hour window every day. I'm in generally good health, don't have any problems keeping my pills down, & any time I'm prescribed a new medication by my doctor I always ask about whether it might affect my birth control. Based on this, how "perfect" a user am I? How close to 99.7% can I expect to be?

3) I also saw on the Birth Control Bingo page that, statistically, 8% of sexually active women using combination pills as their only form of birth control will become pregnant each year. Is there any way to translate this statistic into one that tells us how long a given woman using the combo pill can expect to go without becoming pregnant? What does 99.7% mean in those terms? Does that mean that 3 out of every 1,000 I have sex, I can expect to have a significant pregnancy risk? That seems awfully high to me, but I don't know how else to interpret the 99.7%.

Thanks so much for the info!

As far as why they, nor any other method is 100% effective, the best I can tell you is that women's bodies are wily, uppity and sometimes very determined critters, who sometimes just find their way around a given birth control method, even a highly effective one. Some women are just profoundly fertile, to the point that even used perfectly, hormonal methods still don't always work for them. It is rare, but it does happen. There also has to be room left for manufacturing errors, or storage errors on the part of pharmacies.

Who's a perfect user? Someone who is sure to use a backup method when they first start using the pill, ideally for a full cycle, but at least for the first even days. Someone who takes a pill every day without fail, ideally as close to the same time as possible. Who never starts a given pill pack late. Who takes every single pill in a pack (excluding placebo pills: it doesn't matter if you take those or not) each cycle, and in the proper order for triphasic pills where that matters. Who does not vomit or get diarrhea when taking pills. Who isn't using any medications which may interfere with the pill. You sound to me like a perfect user.

As far as translating the effectiveness statistics to anything beyond what they actually mean -- that, for instance, in typical use, 8 women out of one hundred will become pregnant using the pill as a sole method each year -- we really can't do that accurately. So, no, I would not apply those numbers as you have to the number of times you have sex, because a given frequency of sex is not part of these statistics. And yes: even with perfect use, we are looking at a not-too-insubstantial number of women who become pregnant every year. Those numbers may seem high, but as someone whose other job is counseling in an abortion clinic and talking to women about their birth control, I can assure you that I do see women -- far less regularly than those not using methods perfectly or at all, mind you -- who report perfect use, and a good number of women who are typical or imperfect users of the pill who have become pregnant.

If you're not comfortable with your risks even with perfect use, you always have the option of backing up with a second method, which often will basically double your protection, which is also not at all insubstantial. But unfortunately, if we're going to be sexually active and include activities which pose risks of pregnancy, most of us do have to accept that an unplanned pregnancy is always a possibility, even when it is a very remote one. However, it really is not likely when using one or two methods of reliable birth control: the vast majority of unplanned pregnancies occur when no birth control method was used at all, or secondarily, when a method was not used properly or consistently.

Katty asks,

I just took out my IUD on Friday. I had it for a year and a half. I have been taking the pills(YASMIN28) since Saturday but I have been havin sex with my husband with no protection since Sunday. Can I get pregnant from that?

As I mentioned above, you should use a backup method of birth control when starting the pill -- and most other hormonal methods -- for the first time. Ideally, we suggest one full cycle, but you can refer to the first question and answer to see levels of effectiveness predicted for other start dates. I would say it's quite possible you have had pregnancy risks, and would suggest using a backup method for the rest of this first cycle if you want to prevent a pregnancy. Your healthcare provider should have talked to you about how long they suggested you wait before going without a backup method.

The IUD, when removed, usually returns a woman to her regular fertility cycle without any delay. So, since the addition of the pill may not mean a timely withdrawal bleed right away, I'd suggest taking a pregnancy test just in case when you get to your placebo period.

18yroldmom asks,

I'm 18 with an 11 month old son. I have a boyfriend who is 26. I started taking BC Trinessa a month ago. We started having unprotected sex within the second week of me taking it. Then I started forgetting to take it every day, and we would still have unprotected sex and he would cum in me. While on my first 3 days of placebo I had no period. We still had sex unprotected during this time of placebos and no period. Then i got a period for a few days and than started my second month of trinessa. Could this get me pregnant? I would really like to know. Thank you.

If you are not taking your pills properly, then it is not sound to expect them to be effective. In order for pills to be effective, they need to be used as directed, which includes taking pills daily. Again, we also advise using a backup method for the first cycle, primarily to protect against situations like this, where in your first cycle, it's easy to have a hard time getting in the habit of taking your pills correctly.

Did the bleeding you have seem pretty much like what you're used to with your normal periods? Maybe a day or so shorter, or a little lighter, but not like very short spotting for only a day or two? if it was a lot like, or exactly like, your normal periods, it's not likely you became pregnant. If, however, it seemed more like short, light spotting, I would suggest taking a pregnancy test.

KC asks,

I was wondering how the chances of spotting on 28 day cycle pills compare to those of the extended cycle pills (where you only bleed every 3 months or so)?

We'll usually see more spotting or unexpected/unpredictable bleeding with women who are suppressing menstruation with contraceptives, because some lining will still usually build up and shed itself. Without a placebo period every cycle, there's no chemical withdrawal to effectively force it to shed in a more timely way.

So, if you want to best avoid unexpected bleeding or spotting, while it can still happen with 21-day-active-pill brands or schedules, it's less likely to do so.

Denielle asks,

I didn't get my prescription filled on the right day, so I started a new package 1 day late. The night I was supposed to start the package, and then next morning we had unprotected sex. Am I able to get pregnant on the first missed pill day?

If you've been on the pill for a while, taking that one pill late is not likely to reduce your effectiveness, especially if you made it up with an extra pill on the next day (by taking two). It's possible, but it's not likely.

For the future, be sure that you always have your prescription for new packs filled well before it's time to start them. You can also ask your healthcare provider or pharmacist to make sure your prescription schedule is such that you always have an extra pack on hand.

written 11 Jun 2008 . updated 11 Jun 2008

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.