Pre-Contraceptive Pills: Effectiveness and Concerns

Emergency contraceptive pill issues

Hello Doctor: My menstrual period this time was from March 30 to April 5.
Before my period, I took emergency contraception.
Starting from the first day of my period on March 30, I began taking preemptive birth control pills for the first time, specifically the brand Alesse.
Today marks the 13th day of taking the pills, and I have not missed any doses, taking them consistently at 7 PM each day.
On April 7, which was the 9th day of taking the pills, I had unprotected intercourse with my boyfriend for about 3 minutes, but he did not ejaculate.
On April 8, 9, and 10, we engaged in sexual intercourse with condoms; on April 8 and 9, he withdrew and ejaculated outside, while on April 10, he ejaculated inside but withdrew immediately afterward.
We also used water-based lubricant, and the condoms did not break.
According to my app, I can see that during these days, I was 4-5 days before my expected ovulation, indicating a potential risk of pregnancy.
However, since I have been taking preemptive birth control for the first time, I would like to ask the following questions: 1.
Given my sexual activity during these days, is the risk of pregnancy high? 2.
When does the contraceptive effect of the birth control pills begin after starting them on the first day? 3.
Does taking the birth control pills eliminate the risk of the fertile window, since ovulation should not occur? 4.
I have been experiencing breast tenderness after starting the birth control pills; could this be a side effect? Thank you very much for your answers, and I wish you peace and well-being.

An, 20~29 year old female. Ask Date: 2021/04/11

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, starting to take birth control pills on the fifth day of your menstrual cycle is effective for contraception as long as you continue to take them consistently.
Some breast tenderness is normal.
Wishing you good health!

Reply Date: 2021/04/11

More Info

When it comes to understanding the effectiveness of pre-conception pills, commonly known as oral contraceptives, there are several important factors to consider, especially in the context of your recent experiences and questions.

1. Pregnancy Risk During Intercourse: Based on your timeline, you began taking the oral contraceptive pill (OCP) on the first day of your menstrual cycle (March 30), and you have been consistent with your daily intake. Generally, if you start taking combination OCPs (which contain both estrogen and progestin) on the first day of your period, they are effective immediately. Therefore, the risk of pregnancy from the intercourse that occurred on April 7, when you were already on the pill for nine days, is quite low. The subsequent sexual encounters on April 8, 9, and 10, while using condoms, further reduce the risk of pregnancy.
2. Onset of Effectiveness: For most combination OCPs, if you start taking them on the first day of your period, they provide contraceptive protection right away. If you had started the pill at any other time in your cycle, it typically takes about seven days for the pill to become fully effective. Since you started on the first day of your period, you can be confident that you were protected during your sexual activities after the first day of taking the pill.

3. Ovulation and Safe Periods: The use of OCPs effectively suppresses ovulation, meaning that you should not ovulate while taking them correctly. This significantly reduces the chances of pregnancy, as ovulation is a key factor in conception. Therefore, the concept of "danger days" or "safe periods" becomes less relevant when you are consistently taking your OCP as prescribed. However, it is important to remember that no contraceptive method is 100% effective, so using condoms as a backup method is always a good practice.

4. Side Effects: Breast tenderness or swelling is a common side effect of hormonal contraceptives, including OCPs. This occurs due to the hormonal changes that the body undergoes when starting the pill. While this side effect can be uncomfortable, it is generally not a cause for concern unless it is severe or accompanied by other troubling symptoms. If you find the discomfort to be significant or if you have other side effects that concern you, it would be wise to consult your healthcare provider.

In summary, based on your adherence to the oral contraceptive regimen and the timing of your sexual activities, the likelihood of pregnancy is low. The pill should have provided effective contraception from the first day of use, and the use of condoms further enhances your protection. Breast tenderness is a common side effect, but if you have any concerns about your health or the effectiveness of your contraceptive method, do not hesitate to reach out to your healthcare provider for personalized advice and reassurance.

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