Birth Control Pills: Your Questions Answered

Regarding contraceptive pills?

Hello! I started taking the oral contraceptive pill purchased from the pharmacy on the first day of my period, which was on January 4th.
Since my menstrual cycle is irregular, I considered the day I started bleeding as the first day.
If I had sexual intercourse on January 6th, is there a possibility of pregnancy? I took emergency contraception afterward because I was concerned.
On January 7th, I accidentally forgot to take my pill, and I realized it at 11 PM on January 8th, so I took two pills at that time.
Does this mean that I no longer have contraceptive protection? I continued taking the oral contraceptive, and I had sexual intercourse again on January 13th.
Is the chance of pregnancy high? Also, does taking emergency contraception disrupt the menstrual cycle? On January 20th, I noticed some bleeding.
A few days before the bleeding, I felt symptoms similar to premenstrual discomfort, but my period is not due until around February 4th, and the bleeding seems light and red.
Could this bleeding be my period? I continued taking the oral contraceptive on that day, as I only had one more day left to finish the 21 pills.
When should I start the next pack? Thank you!

Qing, 20~29 year old female. Ask Date: 2018/01/21

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On January 4th, I started taking the oral contraceptive pill purchased from the pharmacy on the first day of my menstrual period.
Since my menstrual cycle is irregular and I wasn't entirely sure if it was indeed the first day, I considered the day I started bleeding as the first day! If I had sexual intercourse on the 6th, is there a possibility of pregnancy? I later took emergency contraception because I was worried.

Answer: If you started taking the oral contraceptive on January 4th and had sexual intercourse on the 6th, the likelihood of pregnancy is low.

I accidentally forgot to take the pill on January 7th, and when I realized it at 11 PM on the 8th, I took two pills.
Does this mean I no longer have contraceptive protection?
Answer: Forgetting to take the pill on January 7th and then taking two pills on the 8th still provides contraceptive protection.

I continued taking the oral contraceptive, and I had sexual intercourse again on January 13th.
Is the chance of pregnancy high?
Answer: The chance of pregnancy is very low.

I would like to ask if taking emergency contraception will disrupt my menstrual cycle?
Answer: It will not disrupt your menstrual cycle.

On January 20th, I noticed some bleeding.
A few days before the bleeding, I felt symptoms similar to those before my period, but I should not expect my period until around February 4th, and the bleeding seemed light and red.
Is this bleeding considered the start of my menstrual period?
Answer: This does not count as the start of your menstrual period.

I continued taking the oral contraceptive on the day of the bleeding, as I had one more day left to finish the 21 pills on January 21st.
When should I start the next pack of pills?
Answer: Since your menstrual cycle is irregular, you should start the next pack of pills on February 4th.

Reply Date: 2018/01/21

More Info

Understanding birth control pills and their implications can be quite complex, especially when combined with various factors such as irregular menstrual cycles, missed doses, and the use of emergency contraception. Let's break down your questions and concerns regarding the use of oral contraceptives.

1. Starting Birth Control Pills: You mentioned that you started taking the pill on the first day of your bleeding, which is generally the correct approach. However, if your menstrual cycle is irregular, it can be challenging to determine the exact first day. Typically, if you start taking the pill during your period, you are protected against pregnancy right away. If you started on a day that was not the first day of your period, it is advisable to use additional contraception for the first seven days.

2. Risk of Pregnancy After Unprotected Sex: If you had unprotected sex on January 6th and started the pill on the first day of your bleeding, you may not have been fully protected yet, depending on when you actually started the pill. Since you took emergency contraception afterward, this would significantly reduce the risk of pregnancy from that encounter.

3. Missed Pill: Missing a pill can affect the effectiveness of your birth control. Since you missed a pill on January 7th and took two pills on January 8th, you should still be protected, but it’s crucial to follow the instructions provided with your specific pill. Most guidelines suggest that if you miss one pill, you should take it as soon as you remember and continue taking the rest as scheduled. If you miss two or more pills, additional contraception is recommended for the next seven days.

4. Subsequent Sexual Intercourse: If you continued taking the pill correctly after the missed dose, your risk of pregnancy from the sexual encounter on January 13th would be low. However, if you missed pills or did not take them consistently, the risk could increase.

5. Effects of Emergency Contraception on Menstrual Cycle: Taking emergency contraception can indeed disrupt your menstrual cycle. It may cause your next period to come earlier or later than expected, and the flow may be lighter or heavier than usual.
6. Understanding the Bleeding on January 20th: The bleeding you experienced on January 20th could be a withdrawal bleed from the birth control pills or a side effect from the emergency contraception. Since you mentioned it felt similar to pre-menstrual symptoms, it’s possible that this is your period, but it could also be breakthrough bleeding, which is common when starting or adjusting hormonal contraceptives.

7. Starting the Next Pack of Pills: After finishing your first pack of pills (21 days), you should start the next pack immediately after finishing the last pill of the current pack, regardless of whether you are experiencing bleeding. This is important to maintain continuous contraceptive coverage.

In summary, while there are many factors at play, if you have taken your birth control pills correctly after the initial missed dose and used emergency contraception as needed, your risk of pregnancy should be low. However, if you have any concerns about potential pregnancy or irregularities in your cycle, it is always best to consult with a healthcare provider for personalized advice and guidance. Regular follow-ups and open communication with your healthcare provider can help manage any uncertainties regarding your reproductive health.

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