How do I know my pill is working?
Sarah replies:Hi. I've actually never had intercourse before, but my gynecologist suggested that I begin taking birth control pills about 2 months before my wedding date to make sure that everything is on the up and up with them (& that I wouldn't have any adverse reactions to them). So far I've been taking them around the same time (anywhere between 6:00 and 6:45am) for about 5 and a half weeks and I've noticed no real side effects or anything. The first 3 days I had a headache, but that's about it. The wedding is in 24 days. How do I know that these birth control pills are actually working inside of me? I guess I'm kinda nervous, and was wondering if there are any for sure ways to tell that the pills are running their course? Thank you.
Unfortunately, we don't come with an "oven ready" light that lets us know any medication we're taking is working. This includes birth control pills. So the only thing you really can do is make sure you're taking your pills correctly (same time everyday, not doing/taking anything to interfere, etc.) and then trust that they are working.
On their own, birth control pills are quite effective. According to our article Combined Oral Contraceptives (The Pill), the failure rate for a perfect pill user is less than 1% and for an average user is around 9%. "Perfect use" involves literally taking the pill absolutely perfectly (never missing a pill, no late pills, no medications or illnesses that would interfere, etc.). Either way, there are going to be some people who may become pregnant on the pill, but the vast majority won't. In order to have the best results while relying solely on the pill, obviously you're going to want to try your hardest to make sure that you are a perfect pill user and then making sure that you are backing up your birth control if you do have incidents that might compromise your pill (if you went on antibiotics or were ill, for example).
Overall though, it's up to you to decide what level of risk is alright for you and your partner when it comes to pregnancy. If you're okay with the small risk that still exists with the pill, then that's fine. If you are not feeling so comfortable with the protection provided by the pill (especially since, as you noted, you can't "see" that it's working), then it is really easy to backup with a second method. By combining methods, you give yourself additional protection and further lessen the likelihood of pregnancy. Since you already have a hormonal method (the pill), you'll want to look at the many non-hormonal methods available. Condoms (and condom-safe lube) are easily available pretty much everywhere, relatively inexpensive, and easy to use. You could also speak with your doctor about getting a diaphram, cervical cap, or Lea's Shield. For people who really want to reduce their risk as much as possible (outside abstaining completely), using a combination of methods is probably a good idea.
You may want to check out the following pages for more information: