Pregnancy Risks After Missing Birth Control Pills

The probability of pregnancy after missing a dose of emergency contraception for the first time?

Hello, Doctor.
This is my first time taking pre-exposure prophylaxis (PrEP).
I started taking it on the first day of my period, January 19, and have been taking it every day around 9-10 PM without missing any doses until I missed one on February 6.
Here’s the situation:
On February 5, I had unprotected intercourse (no ejaculation inside) for the first time since starting the medication.
On February 6, I missed a dose and had unprotected intercourse with ejaculation inside.
I took the missed dose on February 7 at 9:30 AM (about 11-12 hours late) and took my regular dose that evening at 9:30 PM, followed by more unprotected intercourse.
On February 8, I had protected intercourse in the morning and took my last pill that night.
I did not have any sexual activity after February 8.

I would like to ask:
1.
Since this is my first pack of PrEP, I am concerned that the drug concentration may not be stable.
Given the situation (missing a dose on February 6 and having unprotected intercourse those two days), is there a possibility of pregnancy?
2.
Does this month still provide contraceptive effectiveness? Do I need to use additional contraceptive methods?
3.
After the intercourse on February 5, I experienced slight bleeding, which I initially thought was due to roughness, but I continued to have some bleeding on February 6 and 7 (about the amount typical on the fifth day of menstruation), and it was less on February 8 and 9.
Is this due to my body adjusting to the medication for the first time, or is it related to the missed dose?
4.
When is the best time to take a pregnancy test for accurate results?
5.
After missing the dose on February 6 and finishing this pack on February 8, should I stop taking the medication for 7 days as originally planned starting February 9?
Thank you!

Amanda, 20~29 year old female. Ask Date: 2023/02/10

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Missing one pill should not affect its effectiveness.
2.
If you do not continue using it, then it will not provide contraceptive protection.
3.
This cannot be determined, as both emergency contraceptive pills and regular contraceptives are hormonal medications that can affect uterine bleeding.
4.
If it was before February 8, generally you can take a pregnancy test two weeks later, after February 23.
5.
Yes.

Reply Date: 2023/02/10

More Info

When it comes to understanding the risks associated with missing birth control pills, particularly in the context of your situation, it's essential to consider several factors regarding the effectiveness of oral contraceptives, the timing of sexual intercourse, and the body's response to hormonal changes.

1. Risk of Pregnancy After Missing a Pill: In your case, you missed a pill on February 6th, which is concerning because you had unprotected intercourse on that day. The effectiveness of birth control pills can be compromised if a dose is missed, especially if it is missed within the first two weeks of starting a new pack. Since you had unprotected intercourse shortly before and after missing the pill, there is a possibility of pregnancy. Generally, if a pill is missed and taken within 12 hours, the contraceptive effect is maintained. However, since you missed it for about 11-12 hours and had unprotected sex, the risk of pregnancy increases.

2. Current Contraceptive Effectiveness: After missing a pill, the contraceptive effectiveness may be reduced. It is recommended to use a backup method, such as condoms, for at least seven days after missing a pill to ensure protection against unintended pregnancy. Since you had unprotected intercourse on February 6th and continued to have unprotected sex on February 7th, it is advisable to consider emergency contraception if you are concerned about pregnancy.

3. Spotting and Bleeding: The light bleeding you experienced after starting the pill could be attributed to several factors. It might be a side effect of your body adjusting to the hormonal changes introduced by the birth control pill, especially since this is your first month on it. Missing a pill can also lead to breakthrough bleeding or spotting. If the bleeding continues or becomes heavy, it would be wise to consult a healthcare provider to rule out any other issues.

4. When to Take a Pregnancy Test: To accurately determine if you are pregnant, it is best to wait until at least the first day of your expected period. This typically allows enough time for the hormone hCG (human chorionic gonadotropin) to build up in your system if conception has occurred. If you take a test too early, you may receive a false negative result.

5. Continuing the Birth Control Regimen: After finishing the pack on February 8th, you should follow the standard protocol for your birth control method. This usually involves taking a seven-day break before starting the next pack. However, if you have concerns about potential pregnancy, it may be prudent to consult with your healthcare provider for personalized advice on how to proceed.

In summary, missing a birth control pill can increase the risk of pregnancy, especially if unprotected intercourse occurs around the time of the missed pill. It is crucial to use backup contraception during this time and to monitor any unusual bleeding or symptoms. If you have any doubts or experience significant changes in your cycle, consulting a healthcare professional is always a good practice.

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