Emergency Contraception After Missed Birth Control Pill

The efficacy of emergency contraceptive pills?

Hello doctor, I started taking the emergency contraceptive pill on the first day of my period, January 31.
I usually take the pill at 9 PM.
On February 6, I forgot to take it at 9 PM on the seventh day, but I took it at 2 AM on February 7.
After taking the pill, I had sexual intercourse and discovered that the condom had a hole (my period has not yet ended).
I would like to know what the chances of pregnancy are in this situation and whether I need to take an additional emergency contraceptive pill.
Thank you, doctor.

Nai, 20~29 year old female. Ask Date: 2023/02/07

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, if a contraceptive pill is missed and the time exceeds 12 hours, in addition to taking the missed pill, it is best to use an additional barrier method for seven days.
If the missed pill is over 24 hours, stop taking the current contraceptive pill for seven days (including the days the pill was missed), and then continue with the next cycle.
If a pill is missed and there is no expected withdrawal bleeding during the subsequent pill-taking period, pregnancy should be suspected.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2023/02/07

More Info

When it comes to understanding emergency contraception after a missed birth control pill, it's essential to consider a few key factors regarding the timing of your pill intake, the nature of your sexual activity, and the effectiveness of emergency contraceptive methods.

In your case, you started taking your birth control pills on January 31, which is the first day of your menstrual cycle. You mentioned that you typically take your pill at 9 PM but forgot to take it on February 6, the seventh day of your cycle. You took the missed pill at 2 AM on February 7, which is within a reasonable time frame to still maintain the effectiveness of the birth control method. However, since you had unprotected intercourse after the missed pill, there are some considerations to keep in mind.

1. Effectiveness of Birth Control Pills: Birth control pills are most effective when taken consistently at the same time every day. Missing a pill can reduce their effectiveness, especially if it is missed during the first week of a new pack. Since you missed a pill and had unprotected sex after that, there is a possibility of reduced contraceptive effectiveness.

2. Risk of Pregnancy: The risk of pregnancy after missing a pill and having unprotected sex depends on several factors, including when you missed the pill in relation to your ovulation cycle. If you were still within the first week of your cycle, the risk of ovulation may be lower, but it is not zero. The fact that you had a condom failure further increases the risk of unintended pregnancy.

3. Emergency Contraception: Given that you had unprotected sex after missing a pill and experienced a condom failure, it is advisable to consider taking emergency contraception (EC). Emergency contraceptive pills, such as Plan B (levonorgestrel) or Ella (ulipristal acetate), can be effective in preventing pregnancy if taken within a specific time frame after unprotected intercourse. Plan B is most effective when taken within 72 hours, while Ella can be effective up to 120 hours after unprotected sex.

4. Consultation with a Healthcare Provider: It is always a good idea to consult with a healthcare provider for personalized advice. They can provide guidance on whether you should take emergency contraception based on your specific situation and the timing of your missed pill and unprotected intercourse.

5. Future Considerations: To avoid similar situations in the future, consider setting reminders for taking your birth control pills or discussing alternative contraceptive methods with your healthcare provider that may be more suitable for your lifestyle. Additionally, always have a backup method of contraception, such as condoms, to reduce the risk of unintended pregnancy.

In summary, given the circumstances you've described, there is a possibility of pregnancy due to the missed pill and condom failure. It is recommended to consider taking emergency contraception as soon as possible and consult with a healthcare provider for further guidance. Taking proactive steps can help ensure your reproductive health and peace of mind.

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