Emergency Contraceptive Pills: Key Questions Answered

Pre-medication issues

Hello doctor, I have done some research and consulted with an obstetrician about taking emergency contraceptive pills, but I still have some questions that I don't quite understand.
I have been taking a 21-day oral contraceptive pill for several months, but since my boyfriend and I are in a long-distance relationship, our meeting coincides with the fifth pill of a new pack.
I would like to ask:
1.
Many people say that the pill needs to be taken for at least seven days to provide sufficient contraceptive effectiveness.
I am unclear whether this refers to the first seven days of the very first pack or if it applies to the first seven days of each new pack every month, during which double contraception (such as condoms) is necessary.
Or does the contraceptive effect begin with the first pill of the second or third pack after finishing the first pack?
2.
If I am taking contraceptive pills and use an enema for bowel relief, will it affect the efficacy of the medication? I understand that diarrhea and vomiting can impact absorption, but I'm unsure if using an enema for bowel relief would have any effect.
Thank you, doctor.

Leo, 20~29 year old female. Ask Date: 2018/04/06

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Many people say that it takes at least seven days of taking the pill for sufficient contraceptive effectiveness, but I don't understand whether this refers to the first seven days of the initial pack or if it applies to the first seven days of each new pack every month, requiring additional contraceptive measures (like condoms).
Or does the contraceptive effect begin with the first pill of the second or third pack after finishing the first pack? Answer: Sufficient contraceptive effectiveness is achieved only after taking the first pack for more than seven days.
2.
If I am taking birth control pills and using an enema for bowel relief, will it affect the effectiveness of the medication? I know that diarrhea and vomiting can impact absorption, but I'm unsure if using an enema would have any effect.
Answer: Using an enema for bowel relief will not affect the effectiveness of the medication.

Reply Date: 2018/04/06

More Info

When it comes to understanding emergency contraceptive pills (ECPs) and their effectiveness, it's essential to clarify several key points regarding their use, timing, and interactions with other medications or conditions.

1. Timing and Effectiveness of Birth Control Pills: The general guideline for hormonal contraceptives, including the 21-day birth control pills you mentioned, is that they typically take about seven days of consistent use to reach full effectiveness. This means that if you start a new pack, the first seven pills of that pack may not provide reliable contraception unless you have been taking the previous pack correctly. If you have been taking your pills consistently for several months, the effectiveness of the new pack begins to build from the first pill of that pack, but it is advisable to use backup contraception (like condoms) for the first seven days of a new pack. Therefore, if you are on the fifth pill of a new pack, you should ideally have been using backup contraception for the first seven days of that pack to ensure maximum protection.

2. Impact of Laxatives on Contraceptive Effectiveness: Regarding the use of laxatives, such as an enema, it is important to note that the primary concern with hormonal contraceptives is their absorption in the gastrointestinal tract. If you experience diarrhea or vomiting shortly after taking your birth control pill, this can interfere with the absorption of the hormones, potentially reducing the effectiveness of the pill. However, using a laxative like an enema does not typically affect the absorption of oral contraceptives, as it does not induce diarrhea or vomiting. Therefore, if you are using a laxative for constipation relief, it should not impact the effectiveness of your birth control pills.

3. Emergency Contraceptive Pills (ECPs): If you have had unprotected intercourse or a contraceptive failure (like a broken condom) and are concerned about pregnancy, ECPs can be taken as a backup method. They are most effective when taken as soon as possible after unprotected intercourse, ideally within 72 hours, but some types can be effective up to 5 days later. ECPs work primarily by delaying ovulation and preventing fertilization. They do not terminate an existing pregnancy.

4. Menstrual Cycle Considerations: If you are on hormonal birth control, your menstrual cycle may be regulated, and you may experience lighter periods or even missed periods. This is a common effect of hormonal contraceptives. If you miss a period while on the pill, it is advisable to take a pregnancy test, especially if you have missed pills or had any contraceptive failures.

5. Consultation with Healthcare Providers: It is always best to consult with a healthcare provider for personalized advice, especially if you have concerns about your contraceptive method or if you experience any unusual symptoms. They can provide guidance tailored to your specific situation and help address any lingering questions you may have.

In summary, understanding the timing and effectiveness of birth control pills, the impact of other medications, and the use of emergency contraception can help you make informed decisions about your reproductive health. Always consider consulting with a healthcare professional for the most accurate and personalized advice.

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