Emergency Contraception: What to Do After a Missed Pill?

Emergency contraceptive pill

The doctor would like to ask, I started taking my third pack of the oral contraceptive pill this month.
I took the first pill on the evening of April 5th at 9:30 PM, but I forgot to take it on April 6th.
I took a pill on April 7th at 6 PM to make up for it, and then I took another pill that same evening at 9:30 PM as per my usual schedule.
I had intercourse with my boyfriend in the early morning, and the condom broke, resulting in ejaculation inside.
Should I take emergency contraception, or should I just continue taking the oral contraceptive at the same time as before? What is the likelihood of pregnancy?

Fang, 10~19 year old female. Ask Date: 2022/04/08

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello,
Each type of combination oral contraceptive pill comes in different formulations.
It is important to take the contraceptive pills as directed.
If you forget to take a pill, you should take it as soon as you remember, and continue taking the next pill at the usual time.
If you miss a dose of an active pill for more than 12 hours, in addition to taking the missed pill, it is advisable to use an additional barrier method of contraception for the next seven days.
If you miss a pill for more than 24 hours, you should stop taking the current pack of contraceptives and refrain from taking them for seven days (including the days you missed), then continue with the next cycle.

In your situation, you may consider using emergency contraception, but its effectiveness is not 100%, with a failure rate of about 3%.
If you miss a pill and do not experience the expected withdrawal bleeding during the subsequent pill-free interval, you should suspect the possibility of pregnancy.

Thank you! Wishing you safety and health.

Dr.
Zhang

Reply Date: 2022/04/08

More Info

When it comes to emergency contraception and missed pills, it's essential to understand the implications of your situation. Based on the details you've provided, you were taking a combined oral contraceptive pill (often referred to as "the pill") and experienced a missed dose, followed by a condom failure during intercourse. Here’s a breakdown of what you should consider and the steps you can take.

Understanding the Situation
1. Missed Pill: You mentioned that you forgot to take your pill on April 6 but took it on April 7 at 6 PM, and then took your regular dose at 9:30 PM that same day. Generally, if you miss a pill, the recommendation is to take it as soon as you remember. Since you took the missed pill within 24 hours, you should still be protected, but it’s crucial to follow the specific instructions provided with your contraceptive.

2. Condom Failure: The condom breaking during intercourse introduces a risk of pregnancy, especially if ejaculation occurred inside the vagina. If you were not fully protected due to the missed pill, this increases the likelihood of pregnancy.

Emergency Contraception
Given that you had a missed pill and experienced a condom failure, it is advisable to consider emergency contraception (EC). Here are your options:
- Emergency Contraceptive Pills (ECPs): These are most effective when taken as soon as possible after unprotected intercourse. There are two main types:
- Levonorgestrel (Plan B): This can be taken up to 72 hours after unprotected sex and is most effective the sooner it is taken.

- Ulipristal Acetate (Ella): This can be taken up to 120 hours (5 days) after unprotected sex and is effective throughout this time frame.

- Continuing Your Regular Birth Control: You should continue taking your regular birth control pills as prescribed. If you take emergency contraception, it may affect your regular cycle, so be aware of potential side effects like irregular bleeding.

Pregnancy Risk Assessment
The risk of pregnancy in your case depends on several factors:
- Timing of Ovulation: If you were close to ovulation when the condom broke, the risk of pregnancy is higher. If your cycle is regular and you know when you ovulate, this can help assess risk.

- Effectiveness of the Pill: If you took your missed pill correctly and continued with your regimen, the effectiveness of your birth control may still be intact. However, the missed dose does create a window of vulnerability.

Recommendations
1. Take Emergency Contraception: Given the condom failure and the missed pill, taking emergency contraception is a prudent choice to minimize the risk of unintended pregnancy.

2. Continue Your Birth Control: After taking emergency contraception, continue taking your regular birth control pills as scheduled. This will help maintain your contraceptive coverage.

3. Monitor Your Cycle: After taking emergency contraception, be aware that your next period may be earlier or later than expected. If your period is more than a week late, consider taking a pregnancy test.

4. Consult a Healthcare Provider: If you have any concerns or if you experience unusual symptoms, it’s always best to consult with a healthcare provider. They can provide personalized advice based on your medical history and current situation.

Conclusion
In summary, due to the missed pill and the condom failure, it is advisable to take emergency contraception to reduce the risk of pregnancy. Continue with your regular birth control regimen and monitor your menstrual cycle closely. If you have further questions or concerns, don’t hesitate to reach out to a healthcare professional for guidance. Your health and peace of mind are paramount, so taking proactive steps is essential.

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