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» Scarleteen Boards: 2000 - 2014 (Archive) » EXPERT ADVICE » Emergencies and Crises » Extra pill (Page 1)

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Author Topic: Extra pill
clairbaire123
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On my second day of my new pill pack, I accidentally took two pills, maybe 20 minutes apart. I wasnt thinking. How does this affect my effectiveness for the remaining cycle? Do i have decreased effectiveness and should I just take another pill from my next pack to make up for the "missing" one this cycle?
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Heather
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It's a really good idea, when using any medication, to get in the habit of calling your pharmacist with questions like these. After all, that's their job, they're paid to do it, and it's part of the service they provide you.

So, why don't you try calling in today for this, just because it's generally good form, and just to get a second opinion?

Taking an extra pill won't decrease effectiveness: it's just more likely to increase side effects, so it's something you want to try to avoid, especially since we generally want to avoid any extra hormones we don't need to be taking, in general.

I'd advise you take your pill tomorrow as usual, so you'll need to borrow one from a next pack when you get to the end of the active pills and are short one.

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clairbaire123
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In situations like this, is it best to contact the pharmacy or an obgyn advice nurse? Just so I know who best to call?
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Heather
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You could call either.

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clairbaire123
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I spoke to an obgyn nurse and she said to just continue taking my pills but not to make up the missing pill at the end of the cycle. I asked her if that meant my placebo week would be 8 days instead of 7 and she said yes
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clairbaire123
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I spoke to a pharmacist just now and she said to skip a day and continue as normal and to use precautions for a week but the obgyn nurse said I dont have decreased effectiveness.

So they both said different things and Im a bit confused!

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clairbaire123
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Nvm I misunderstood my obgyn nurse, she said that my placebo week would be a day early and I would start my next pill pack a day early too. She said my effectiveness isnt compromised at all since I didn't miss any pills and a backup method isnt required in terms of the pill having any decreased effectiveness.

I'm unsure of how best to move forward in this situation, I will continue to take my pills as directed although since Im uncomfortable with not taking an active pill every day for the cycle, I'll take one from the next pill pack to make up for this one as you suggested.

In terms of backup method concerning pill effectiveness, would you say a backup method is needed due to a decrease in my effectiveness concerning the extra pill? I know you generally suggest using a backup method always although I want to know if it is needed due to a decrease in effectiveness?

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Heather
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I'm not sure why you keep asking about decreased effectiveness, since neither myself nor the nurse told you that was an issue: in fact, it sounds like both of us have been clear it's not.

I also think her advice to you on moving forward sounds just fine, and would always suggest you follow the directions a healthcare provider gives. If and when it conflicts with ours, most times I'd say to still go with your healthcare provider.

Too, she's actually not suggesting anything that different from what I was: you will still take a pill tomorrow. You're just moving up your placebo week by one day, and not shortening it.

Really, given your posts here, I think it's pretty clear that due to your level of worry about pregnancy, using a backup method -- any time, not just now -- should be a given for you.

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clairbaire123
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I thought that if I move my placebo week up a day, Im shortening my active cycle down one day? So I dont take a pill from the next pack to make up for the one Im missing at the end?

I wanted to doublecheck because the pharmacist said to back up for a week and I wasnt sure why.

Yeah, I will use backup, I just wanted to plan for the future if ever there is a mishap or condom break or something unplanned, that I can count on my pills and don't need to take ec.

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Heather
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You'd backup for a week -- and if you're using condoms properly, a break is SO unlikely -- because of that one-day move. Just in case. To play it safe, that's all.

But really, again, I think always backing up with condoms is clearly important for you, and so long as you're clear about that with your partner, and are both working to make sure they are used properly, there's nothing for your pill to even do, which means that even with small flubs like this, you likely will have nothing to fret about.

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clairbaire123
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"I'd advise you take your pill tomorrow as usual, so you'll need to borrow one from a next pack when you get to the end of the active pills and are short one."

So I dont follow through with this?

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clairbaire123
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Im getting slightly confused, when do I back up for a week, do I back up my placebo week because I shortened my active cycle?

I thought in order to take my pills properly I should always take a pill each day of an active pill, hence 21 days and I should never miss a pill. which is why your instructions to borrow a pill from the next cycle made sense to me!

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Robin Lee
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It sounds like you're getting conflicting information. What we know about the pill is that the most effective way to take it is to take a pill every day, regardless of whether one might have doubled up by accident.

You'll need to decide what advice you're most comfortable taking.

In terms of backing up, you always have the option of backing up whether you"need" to or not. Sounds like you might feel most comfortable backing up until the end of this cycle.

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Robin

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clairbaire123
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I am getting conflicting information and I feel like Im not comfortable with any advice because they contradict what Ive been told.

The advice that made the most sense was heather telling me to take a pill from the next pill pack to make up the one missing at the end of this cycle because I thought that as the most effective way to take the pill but now Im confused because she told me to backup for a week due to the one day move. What one day move, if Im taking all my pills everyday (making up the missing one)?

I want to know how best to work with my pill because quite honestly, if my pill isnt working, then Im going to back up condom use with another method. I prefer to think of my birth control methods effectiveness solely on their own, so if any mishap happens with condoms, then I know whether or not EC is needed and dont need to come back here and ask questions. Thats why Im trying my best to figure out what is needed *first* before I can decide what Im comfortable with.

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Heather
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There's really nothing we can do about you not getting the exact same info from us and the nurse. We're not all always going to have the same approaches, just like two doctors won't. In instances like that, it's up to the user/patient -- that's you -- to make a choice about which advice to take.

Like I said, I think that BOTH what I suggested and what the nurse did are sound. But you have to pick one, and that's just how it goes, unless, perhaps, you want to make one more call, to your pharmacist, and see if they've got a tiebreaker?

Ultimately, with your pill, you want to take one pill, every day, and only one, around the same time of day. That's how the pill is used.

But, like any method, it doesn't work for everyone, and like any method, it can't offer 100% effectiveness.

But, if you're using condoms every time, and properly, AND using your pill properly, then even with a little messup like this one, it is beyond unlikely you will have a pregnancy to worry about.

Okay?

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clairbaire123
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You suggested taking a pill from the next pack and she said to just move up everything a day thus not taking a pill from the next pack. Thats where I started to get confused. But now I understand what you're saying. Im trying to make the best decision in which my pill does not have decreased effectiveness because Im already at the 92% rate. I feel most comfortable with what you suggested about taking a pill from the next pack, I dont feel comfortable with missing a pill even if I did take two pills in one day.

I measure pill effectiveness by the *need* of a back up method, its how I take comfort in knowing my pill works to the best of its ability. I use backup despite my asking if backup is needed. If I do what you say, is it *required* to use the one week backup method if Im not doing the one day move? or am I back to how my pills would have been if I had not taken the extra pill because I didnt miss any pills.

[ 02-19-2013, 02:14 PM: Message edited by: clairbaire123 ]

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Heather
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Effectiveness of a method is something that isn't measured arbitrarily, but quite specifically. It's based on who -- during one year of use -- doesn't become pregnant and who does.

NO method has an effectiveness rate of 100%. Not even sterilization. Your pill, as a method, has a perfect use rate of around 99%, and a typical use rate of 92%. That means, in one year of perfect use, less than 1 in every 100 people using it will become pregnant. In one year of typical use, 8 of every 100 users will become pregnant.

I'm not sure how that squares with how you think about effectiveness, but ultimately, whether or not to use a second method generally is going to depend on a) how reliable a method is, and in real life, so like, you made a flub, so probably are more a typical use person (as most people will be), and b) how much effectiveness a given person wants.

But we know, from a lot of study, that the MOST effective contraception is dual contraception: when TWO methods are used, not just one. especially when people aren't using any long-term methods, like the IUD or implant.

That said, sounds like you want to go with what I initially suggested with making up your pill: so why don't you go ahead and do that?

If you do that, I don't see any reason your pill would be any less effective because you took that extra pill.

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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clairbaire123
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Since Im going to make up my pill at the end of the cycle, if ever I do have a condom break or a condom slip on my pill free week, I would not need EC because my pills are not less effective?

I apologize, I know Im being incredibly stubborn, I like to be incredibly careful and I do use back up, although I like to have a back up for my back up. So if my condoms ever fail or slip or we dont do it perfectly, I know to get EC ASAP and not have to come here and ask if its needed! Im trying to think in terms of what ifs.

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Heather
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I can't tell you how much protection you want or are comfortable with: that's something only you can decide, and which you truly have to decide for yourself.

But honestly, I really feel like we're getting stuck in a loop here that isn't sound.

When used properly? Condoms are 98% effective: nearly as effective as your pill. Breaks are VERY uncommon (only about one in every 2,000 uses), and slips aren't likely when condoms fit the wearer well and are used properly. So, I really think the wisest thing to do from here would be either (or both):

a) to talk about how to use condoms properly every single time, which is typically totally easy, and/or
b) to talk about you perhaps using a more effective method than the pill so you can worry a lot less.

[ 02-19-2013, 02:31 PM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
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Heather
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Also: it sounds like you might be under the impression that you have less protection from your pill during the placebo week. If that's so, know that's not correct. The pill offers the same level of protection every day of the cycle when taken properly, including during the placebo week.

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Heather Corinna, Executive Director & Founder, Scarleteen
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clairbaire123
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This is my understanding of the conversation, my pills are as effective as they would be even though I took an extra pill, throughout my entire cycle even the placebo week, if I take a pill from the next pack to make up for the one Im missing at the end of this cycle. If im understanding you correctly. The pharmacist said to back up for a week because she told me to skip tomorrows pill. It is only when a pill is missed that decreased effectiveness occurs?


Can I go w/ B please!

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clairbaire123
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Oh ok! Yeah I thought that I would have less protection on the placebo week because of the one day move but since Im not doing that, I wanted to ask if the decreased protection still applies!
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Heather
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I don't know how many more ways to say that I don't expect you WILL have decreased effectiveness. I could try writing it on the chalkboard 100 times? [Razz]

And yep: missing pills -- not taking extra -- is what may or can cause decreased effectiveness.

So, want to talk about potentially switching to a method besides your pill? It's been sounding to me like you'd feel better using something more effective in typical use and less goofproof.

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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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clairbaire123
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Eek sorry! I just got so confused because of the whole 1 day move and decreased protection because of shortening my pill cycle. I was concerned about the placebo week. Totally on the same page now thanks [Smile]

Yes please! I know about the depo shot but Ive heard scary stories about that and not getting a period and Im somewhat uncomfortable with that. Im not very familiar with other methods.

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Heather
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Well, I'd first ask how you feel using your pill. In other words, do you like it in terms of side effects and side benefits?

If so, then it usually makes the most sense to first talk about methods that are easier to use, but which have the same hormones and work the same way your pill does. Those two would be the patch or the ring.

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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clairbaire123
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Yes, I do like the side effects and the benefits!

Can you tell me more about the path and ring the pls?

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Heather
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Sure can!

So, they both work the same way as your pill does, with the same hormones: they suppress ovulation, thicken cervical mucus and thin the uterine lining.

The patch is something you need to remember to change one a week: the ring, once a month.

The patch can go nearly anywhere on your body -- it's like a nicotene patch -- except for on the breasts. The ring is inserted into the vagina, and you keep it there for three weeks, until the placebo week, when you go ring-less. Same goes for the patch.

[ 02-19-2013, 03:47 PM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
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clairbaire123
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How large is the patch? Is it difficult to insert the ring, thats something Im unfamiliar with, inserting something into the vagina myself, I dont even use tampons haha ><"
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Heather
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I'd say learning to use the ring is like learning to use a tampon, even though you don't use them: it's not hard at all, it just can take a little practice when you first start using it, that's all.

Mind, you have been engaging in vaginal sex, so you already know that that is also something that often isn't hard, but can take practice. [Smile]

The patch is relatively small just two by two inches or so.

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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clairbaire123
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Do the healthcare providers tell you how far up it should be in the vagina and so forth?

I have another question about the pill, I switched pill brands, the other brand was too low of a dose so I switched to a higher dose. after my usual placebo week, when I was to start up again, instead of using my previous brand, I just started on my new brand. Since the placebo week wasn't any longer than usual, did I switch brands the appropriate way? My nurse didnt really instruct me, just switched my brand. This new brand is the one I took two pills on this morning!

Where is the patch usually placed? or does it depend on the individual?

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Molias
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Here's some more information about the patch and the ring:
The Contraceptive Patch
The Vaginal Ring (Nuvaring)

For your question about switching pill brands, I'd call your doctor; you said the nurse didn't give you much information and they really should have explained that to you. So I'd call the office of the nurse or doctor who prescribed the new pills to you and check with them.

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clairbaire123
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I spoke with a nurse at the obgyn, she said I did it the right way and to follow the same instructions concerning taking two pills in one day. I think I'll still follow heathers advice though, don't want to miss a pill. My nurse still said no decrease in effectiveness.

thanks for the info! So diarrhea and vomiting don't affect the patch and vaginal ring?

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Karybu
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No, diarrhea and vomiting would not affect the patch and vaginal ring, since neither one of those pass through your digestive system to be absorbed by the body the way the pill does.

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"Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing." -Arundhati Roy

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clairbaire123
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Oh ok thank you!

Even though I forgot to mention that this new pack that I took two pills on in one day today is a new brand, a different one from my last pack, can I still follow the directions Heather told me about just making up my missing one at the end? & it effectiveness wont be decreased?

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Robin Lee
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It being a new brand shouldn't impact effectiveness in any way. All brands do the same thing. [Smile]

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Robin

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