Contraceptive Pills: Pregnancy Risks and Missed Doses

Pregnancy, contraception, preemptive medication?

Hello Doctor, I would like to inquire: My last menstrual period started on December 16, and I immediately began taking the oral contraceptive pill, Alesse.
On December 31, I forgot to take the pill, and that night I had intercourse with ejaculation.
I did not take a second pill within 12 hours, and I took two pills the next morning at 11 AM on January 1.
Then, I forgot to take the pill again on January 2 and did not take any within 12 hours.
On January 3 at 9 PM, I took two pills, and on January 4 at 10 AM, I took one pill, followed by another pill at 9 PM on January 4.
During the period from January 1 to January 5, I experienced frequent dizziness and discomfort.
The last pill was originally scheduled for January 5, but I finished early.
All these days were during the last week of the placebo period.
However, I had been taking the pills on time without any missed doses or catch-up doses before December 31.
I have been on the contraceptive pill for 8 months, and I would like to ask: 1.
Has my chance of pregnancy increased? (It has been 4 days, and my period has not arrived!!! Usually, my period comes 4 days after finishing the pills.) 2.
Is my method of taking the catch-up pills incorrect? How should I modify it? 3.
If I took the contraceptive pills on time for the first three weeks, will missing a pill during the ovulation period still lead to ovulation? Counting 14 days from the first day of my last period, would it coincide with the day I forgot to take the pill, potentially leading to ovulation?

Cai Ling, 20~29 year old female. Ask Date: 2019/01/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you should start taking the birth control pill on the fifth day of your menstrual cycle.
If you take it consistently, it will be effective for contraception.
If you forget to take a pill on a certain day, you can take the missed pill the next day.
However, if you have missed several pills this month, the contraceptive effectiveness may be reduced.
If your period is more than a week late, it is advisable to see a gynecologist.
Wishing you good health.

Reply Date: 2019/01/08

More Info

When it comes to understanding contraceptive pills and the associated risks of pregnancy, especially in the context of missed doses, it's essential to grasp how these medications work and the implications of inconsistent use.

Contraceptive pills, such as the one you mentioned (艾斯利安), are designed to prevent ovulation, thicken cervical mucus, and thin the uterine lining to reduce the likelihood of pregnancy. When taken consistently and correctly, they are highly effective. However, missing doses can significantly compromise their effectiveness.

1. Increased Risk of Pregnancy: Given that you missed a dose on December 31 and had unprotected intercourse that same day, there is indeed a heightened risk of pregnancy. The effectiveness of the pill can be reduced if doses are missed, particularly during the first week of the cycle. Since you mentioned that you had been taking the pills correctly for the first three weeks, you may still have some protection, but the missed doses during the last week could allow for ovulation to occur, especially if the missed doses were close to the time of ovulation (which typically occurs about 14 days after the first day of your last menstrual period). If your period is late and you suspect pregnancy, it would be wise to take a home pregnancy test for confirmation.

2. Correcting Missed Doses: The way you handled missed doses—taking two pills at once after forgetting—can be appropriate, but it depends on how many doses were missed and when. Generally, if you miss a pill, you should take it as soon as you remember. If you miss more than one pill, the guidance can vary based on how many you missed and when in your cycle it occurred. For future reference, if you miss a pill, follow the instructions provided with your medication or consult your healthcare provider for specific advice. It’s also beneficial to set reminders or alarms to help you remember to take your pill daily.

3. Ovulation and Missed Pills: If you miss a pill during the last week of your pack, it can indeed lead to ovulation. The hormonal levels that prevent ovulation can drop if the pills are not taken as directed. If you missed a pill during the time leading up to ovulation, it is possible that ovulation could occur, which would increase the risk of pregnancy if you engage in unprotected intercourse.
In summary, the risk of pregnancy is elevated due to the missed doses, particularly since you had unprotected intercourse shortly after missing a pill. If your period does not arrive as expected, taking a pregnancy test is advisable. For future use, ensure to follow the guidelines for missed doses closely and consider discussing with your healthcare provider about alternative contraceptive methods if you find it challenging to remember daily pills.
Lastly, if you continue to experience symptoms like dizziness or discomfort, it would be prudent to consult your healthcare provider to rule out any other underlying issues or side effects related to the contraceptive pills.

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