Missed Birth Control Pills: Potential Pregnancy Risks

Forgot to take it beforehand?

Hello, doctor.
My girlfriend has been taking the Yaz 24+4 oral contraceptive pill for a long time.
She got her period on March 19, and we had unprotected intercourse with ejaculation on the 26th and 27th.
After the 28th, she forgot to take the last four placebo pills.
As a result, she started bleeding on April 1.
Is this bleeding considered a menstrual period? Since we are unsure if it is her period, she hasn't started taking the contraceptive pills again.
As of now, May 17, her period still hasn't arrived.
Is there a chance she could be pregnant?

nan, 20~29 year old female. Ask Date: 2020/05/17

Dr. Wu Xianghui reply Obstetrics and Gynecology

For pregnancy concerns, please take a home pregnancy test or consult with a gynecologist for evaluation four weeks after sexual intercourse.

Reply Date: 2020/05/17

More Info

When it comes to missed birth control pills and the potential risks of pregnancy, it’s essential to understand how hormonal contraceptives work and the implications of missing doses. Your girlfriend has been using a combined oral contraceptive pill (COCP), specifically the Yaz (or Yazmin) 24+4 regimen, which contains both estrogen and progestin. This type of birth control is designed to prevent ovulation, thicken cervical mucus, and thin the uterine lining to reduce the likelihood of pregnancy.

In your case, your girlfriend had her period on March 19 and had unprotected intercourse on March 26 and 27. After that, she missed the last four pills of her pack, which are placebo pills. The key point here is that if she missed taking the active pills (the ones containing hormones) and had unprotected sex during that time, there is a risk of pregnancy. The effectiveness of the pill is significantly reduced if active pills are missed, especially if they are missed in the first week of a new pack.

The bleeding that started on April 1 could be a withdrawal bleed, which is common when stopping hormonal contraceptives, or it could be an indication of an early pregnancy. Since she has not had her period by May 17, it is advisable to take a home pregnancy test. If the test is positive, she should consult a healthcare provider for further evaluation and guidance.

If the test is negative and she still does not get her period, it could be due to several factors, including hormonal imbalances, stress, or other underlying health issues. It’s also worth noting that some women experience irregular cycles after stopping hormonal birth control, which can lead to missed periods.

In summary, if your girlfriend missed taking her active birth control pills and had unprotected intercourse, there is a possibility of pregnancy. The bleeding she experienced could be a withdrawal bleed, but the absence of her period by May 17 warrants a pregnancy test. If she is concerned about her menstrual cycle or potential pregnancy, it is crucial for her to consult with a healthcare provider for personalized advice and management options.
In the future, to avoid such situations, it’s important to take birth control pills consistently and as directed. If a pill is missed, the general recommendation is to take it as soon as remembered, and if it’s close to the time of the next dose, skip the missed pill and continue with the regular schedule. If two or more pills are missed, additional contraceptive methods should be considered until the pills have been taken consistently for seven consecutive days.

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