Birth Control Pills and Pregnancy Risks: Your Questions Answered

Birth control pills & pregnancy probability

Hello, doctor.
I visited a gynecologist due to irregular menstrual periods in January.
After a brief ultrasound, the doctor suggested that my irregular periods might be due to endometriosis and prescribed me four medications: 1.
Domperidone 10mg/tab 2.
Prochlorperazine Maleate 5mg/tab 3.
OVULAN (Ethyl Estradiol 0.05mg, Levo-Norgestrel 0.25mg/tab, orange pill) 4.
VISANNE (normal dosage is 2mg, but the doctor halved it, so the dosage is 1mg).
I started taking the medications on January 22 and have not missed any doses.
I take them regularly after dinner in the evening (though not at a fixed time; for example, tonight at 7 PM, tomorrow at 8 PM, and the day after at 10 PM, etc.), but always after dinner until bedtime.
On the morning of February 4, I had sexual intercourse with my boyfriend, using a condom throughout the act.
Afterward, I performed a water test on the condom, and there were no leaks or breaks.
However, I was quite anxious, so that evening I went to Pharmacy A to ask if the medications prescribed by the gynecologist had contraceptive effects.
The pharmacist there told me that taking them continuously for two weeks would provide contraceptive protection and advised me not to worry.
Later, I saw online that some people mentioned that the dosages of menstrual regulation medications differ from those of emergency contraceptives, which made me concerned.
On February 6, I went to Pharmacy B for further clarification.
The pharmacist there said that it would take one to two months to determine if there was a stable concentration of the medication in my body and mentioned that the concentration of my contraceptive pill was too low to be effective.
The pharmacist at Pharmacy B then recommended that I take an emergency contraceptive (I informed them that we used protection and that there were no breaks or leaks, but they said that many condoms are of poor quality and it’s uncertain if it really didn’t break, so they advised me to take the emergency contraceptive).
I took the emergency contraceptive, "妊止," along with the medications prescribed by the clinic.
Afterward, I called the gynecological clinic to inquire whether the medications prescribed had contraceptive effects (noting that one of them, OVULAN, is a contraceptive).
The clinic's pharmacist confirmed that it does have contraceptive effects and that taking it continuously for a week would provide protection.
They advised me not to ask random pharmacies, as they are a specialized gynecological clinic and there might be differences in understanding.
They also mentioned that newer contraceptives tend to have lower concentrations, but that does not mean they lack contraceptive efficacy.
On the morning of February 7, I had sexual intercourse with my boyfriend again, using a condom, and the water test showed no breaks or leaks.
However, I noticed that my boyfriend's penis tends to soften a bit while wearing the condom, causing it to shift slightly during intercourse, but I made sure to pull it back down.
I’m unsure if this could cause any issues, and during both instances, my boyfriend did not ejaculate.
1.
Doctor, I would like to ask why the information provided by the pharmacists differs.
The pharmacist at Pharmacy B said they do not know if the concentration in my body is sufficient for contraceptive efficacy and mentioned that the dosage might be too low.
In contrast, the pharmacist at Pharmacy A said that as long as I take the medication, my body’s concentration would be adequate.
Finally, the clinic's pharmacist stated that there is indeed contraceptive efficacy and that a lower dosage does not affect it, as it is intended to minimize strong side effects.
2.
Doctor, I would like to know if the medications prescribed by this doctor will have contraceptive effects (but my visit was primarily for menstrual regulation and treatment of endometriosis).
3.
Doctor, regarding the "VISANNE" that the clinic prescribed, which is halved (1mg), I found online that this medication suppresses ovulation.
Will this reduced dosage still effectively suppress ovulation?
4.
Doctor, based on what I mentioned, we performed a water test on the condom and checked for any breaks.
However, since my boyfriend's penis may soften while wearing the condom, causing it to shift slightly, I continuously pulled it back down.
Could this potentially lead to any issues? Thank you for your answers, and I appreciate your help.

Niming, 10~19 year old female. Ask Date: 2021/02/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the chances of pregnancy should be low; please monitor the situation.
Wishing you good health.

Reply Date: 2021/02/08

More Info

Understanding birth control pills and their effectiveness in preventing pregnancy is crucial, especially when considering the nuances of individual health circumstances and the medications involved. Based on your detailed account, let's address your concerns systematically.

1. Variability in Pharmacist Advice: It's not uncommon for different pharmacists to provide varying information, especially regarding medications like birth control pills. This can stem from differences in their training, experience, or understanding of specific medications. The key point here is that the effectiveness of birth control pills, including those prescribed for conditions like endometriosis, can depend on consistent use and the specific formulation of the pills. Generally, most modern birth control pills, including those containing Ethyl Estradiol and Levo-Norgestrel, are effective when taken as directed.
2. Effectiveness of Your Prescribed Medications: The medications you were prescribed, particularly OVULAN and VISANNE, do have contraceptive properties. OVULAN is a combined oral contraceptive pill, and while VISANNE is primarily used to treat endometriosis, it can also suppress ovulation. The effectiveness of these medications increases with consistent use over time. Since you have been taking them regularly since January 22, you are likely to have achieved a level of hormonal stability that provides contraceptive protection, especially after two weeks of consistent use.
3. Impact of Reduced Dosage on Ovulation Suppression: Regarding the VISANNE dosage, while the standard dose is 2 mg, taking 1 mg may still provide some level of ovulation suppression, but it may not be as effective as the full dose. However, the primary goal of VISANNE is to manage endometriosis symptoms rather than solely to act as a contraceptive. It's essential to follow your healthcare provider's guidance on dosage and to discuss any concerns about efficacy with them.

4. Condom Use and Potential Risks: Regarding your concerns about the condom moving or becoming soft during intercourse, as long as the condom remains intact and does not break, the risk of pregnancy is significantly reduced. The fact that you performed a water test and found no leaks is reassuring. However, if the condom does slip off or break, there is a risk of pregnancy, which is why using additional contraceptive methods or emergency contraception can be prudent if there are any doubts.

5. Emergency Contraception: Taking emergency contraception (like the one you mentioned, 妊止) after unprotected intercourse is a common practice to prevent pregnancy. Since you were already using birth control pills, the need for emergency contraception may be less critical, but it can provide additional peace of mind if there were any concerns about the effectiveness of the condom.

In conclusion, the medications prescribed to you do have contraceptive effects, especially with consistent use. It's essential to maintain open communication with your healthcare provider about any concerns regarding your medications and their effectiveness. If you have further questions or uncertainties, consider scheduling a follow-up appointment with your doctor to clarify any lingering doubts and ensure that you are on the right track with your treatment and contraceptive methods.

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