When is it safest? What about medications?

<b>Lemontree asks</b>: I am 20 years old and have been on the pill for about 2 years now and at first me and my boyfriend (coming to our 3.5 year anniversary! yay) would always use a condom as well just to be that extra safe. But awhile back we discussed not using a condom for our first time and seeing as I was on pill (which I have never missed) knew we would be safe. We also tried researching online about when the safest time on the pill would be and I couldn't find much information...just that if you take the pill on time etc. then you should be safe all the time and other sites saying always use a condom no matter what (which me and my boyfriend disregard because we are each others firsts and only so no risk of catching anything).
Sarah replies:

Lemontree's question continued)

So seeing as we both couldn't find much information on when that would be we used our logic and thought the best time would be right before I take my placebo pills... and when reading your response to a similar question I see that you said "During that week (meaning placebo), you don't need pills because they've already prevented ovulation and fertilization, so you couldn't become pregnant during that period of time, as without all those preceding signals to be fertile, you can't suddenly become fertile in that week." So does that mean its best to not use a condom during the time I am taking my placebo pills? Seeing as it has already prevented ovulation and cant become pregnant during that time?

Me and my boyfriend still use condom as much as we can, but we both prefer being natural so on some occasions when we know I'm coming towards my placebo pills we don't use one. So from what I read I am thinking during my placebo is just as effective?

Also another query from what I read from that response is that you mentioned "So long as you take your pills as directed and on time, with the exception of a few medications or herbs that can interact with the pill, you're as covered as you get." I was just wondering what herbs you are talking about...and even medications if that's not too much trouble?

You probably could not find much information about a "safest" time on the pill because there isn't one. The pill (and all hormonal methods really) is designed to provide an equal level of protection throughout the entire cycle, including during that placebo period. The pill has already prevented ovulation by the point you reach your withdrawal bleed. PBS has a really cool explanation of how the pill works which may help further explain the hormonal ups and downs that protect you and allow you to have a withdrawal bleed. You can access it here.

In terms of protection, the important question here is what level of protection feels okay to you. While the failure rate with perfectly taken OCPs is very low, it is not zero. By adding condoms to the equation, you add an additional measure of protection that further lowers your risk. So if you are okay with the risk level of just the pill, that's fine. If not, you'll want to keep backing up with condoms. Also, condoms are going to lower your risk of STI transmission. While being each other's "firsts" may lower risks, do understand that it does not completely negate the risk. Some may have engaged in other sexual activities which have risks, but may not consider them "sex" or "risky" when discussing it. Further, while it is not something we tend to want to think about, not everyone is going to be honest. We want to believe our partners, but when it comes to matters of our health, it is wise to err on the side of caution and keep up those annual screenings.

In terms of things which interfere with the pill, a good place to start in answering that is to pull out the patient information sheet that came with your birth control pills. If you've lost the sheet, you may be able to locate a copy via our article Where did that sheet go? In general, some medications for epilepsy (at least one of which is also sometimes used for migraine prevention), HIV/AIDS, tuberculosis, certain anti-fungals, certain antibiotics, and St. John's Wort (the primary suspected herbal issue) are considered to have potential interactions with birth control pills. Because of the potential for interactions, you want to tell your health care provider and/or pharmacist what medications (prescription and over-the-counter) you are taking.

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