Contraception: Key Questions About Emergency and Regular Pills

Contraceptive issues?

Hello, doctor.
I have been taking the oral contraceptive pill (Kylian) from July until this month.
However, this month I missed two days and took three pills on the third day, which led to ovulation.
Two days ago, after intercourse, I discovered that the condom had broken.
I went to see a gynecologist and had an ultrasound that confirmed ovulation (but the exact timing of ovulation could not be determined).
I also took the emergency contraceptive pill (Yun Ting) within three hours.
I have the following questions:
1.
How long does it typically take for an egg and sperm to combine and form a fertilized egg?
2.
I read online that taking emergency contraception after ovulation will not result in withdrawal bleeding.
Is this true?
3.
If I continue taking the oral contraceptive pill, will it still be effective?
4.
I found online that if I have been taking the oral contraceptive pill for several months, I do not need to wait until I have taken seven pills to achieve contraceptive effectiveness.
Is this true?
5.
Currently, I am not taking the oral contraceptive pill.
In the past, I would get my period on the third day after finishing 21 pills.
If I stopped taking them two days ago, will I get my period in the next few days?
6.
What is the effectiveness of the emergency contraceptive pill taken within three hours after ovulation? Thank you, doctor.

Lin, 10~19 year old female. Ask Date: 2023/02/14

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, when you forget to take your birth control pill, you should take it as soon as you remember, and continue taking the next pill at the usual time.
If you miss taking an effective 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, stop taking the current pack of birth control pills and refrain from taking them for seven days (including the days you missed), then continue with the next cycle.
If you miss a pill and do not experience expected withdrawal bleeding during the subsequent pill-taking period, you should consider the possibility of pregnancy.
Emergency contraception primarily works by delaying or inhibiting ovulation to prevent the sperm from meeting the egg.
It may also change the cervical mucus to reduce the likelihood of fertilization.
Sperm can survive in the female body for up to five days, but they are most fertile in the first two days.
After ovulation, the egg can survive for up to 24 hours.
If the medication is taken before ovulation, it can delay the release of the egg, and by that time, the sperm may no longer be viable, thus achieving contraception.
However, if ovulation has already occurred and more than 24 hours have passed, the egg is likely dead, so theoretically, taking emergency contraception would not make a difference, but it may still yield "effective" results.
If the body signals ovulation (LH surge) just before taking emergency contraception, the medication may be ineffective.
However, in clinical practice, since the timing of ovulation is difficult to confirm, first-generation emergency contraceptive pills contain Levonorgestrel.
When taken within 72 hours after the incident, the success rate for preventing pregnancy is 52–94%, with quicker administration yielding better results.
Second-generation emergency contraceptive pills contain Ulipristal acetate.
When taken within 120 hours after the incident, the success rate is 98%, with even better effectiveness if taken within 72 hours.
In your case, if your period is more than a week late, it is advisable to consult a gynecologist for evaluation.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2023/02/14

More Info

Understanding contraception, particularly the use of emergency and regular pills, is crucial for anyone who is sexually active and wants to prevent unintended pregnancies. Based on your questions, let’s break down the key points regarding your situation and provide some clarity.

1. Timeframe for Fertilization: After ovulation, the egg is viable for about 12 to 24 hours. Sperm can live inside the female reproductive tract for up to five days. Therefore, if intercourse occurs within this timeframe, fertilization can happen relatively quickly, often within hours. However, the exact timing can vary based on individual circumstances.

2. Emergency Contraceptive Pills (ECPs) and Withdrawal Bleeding: It is true that taking emergency contraception after ovulation may not lead to withdrawal bleeding, which is often a sign of the body’s response to hormonal changes. Withdrawal bleeding typically occurs when the hormone levels drop after stopping hormonal contraceptives. If you take ECPs after ovulation, they may not prevent pregnancy, and the absence of bleeding does not necessarily indicate pregnancy.

3. Effectiveness of Regular Contraceptive Pills: If you continue taking your regular contraceptive pills (like "祈麗安") after missing doses, they can still be effective, but their efficacy may be compromised, especially if ovulation has already occurred. It is essential to follow the instructions provided with your contraceptive pills regarding missed doses to ensure maximum effectiveness.

4. Timing for Contraceptive Effectiveness: For most combination oral contraceptives, if you have been taking them consistently for at least seven days, they provide effective contraception. However, if you missed doses, it is advisable to use a backup method (like condoms) until you have taken the pills correctly for seven consecutive days again.

5. Menstrual Cycle After Stopping Pills: When you stop taking your regular contraceptive pills, your menstrual cycle may take some time to regulate. If you typically experience withdrawal bleeding three days after completing a pack, you may expect a similar pattern after stopping. However, individual responses can vary, and it may take a few cycles for your body to return to its regular rhythm.

6. Effectiveness of ECPs After Ovulation: Taking emergency contraception (like "韻婷") within three hours after unprotected intercourse is beneficial, but its effectiveness decreases if ovulation has already occurred. ECPs are most effective when taken before ovulation, as they primarily work by delaying or inhibiting ovulation. If ovulation has already occurred, the likelihood of preventing fertilization decreases, but it may still alter the uterine lining to prevent implantation.

In summary, while you have taken steps to prevent pregnancy by using both regular and emergency contraception, the timing of your actions relative to ovulation is crucial. If you have concerns about potential pregnancy or the effectiveness of your contraceptive methods, it is advisable to consult with a healthcare provider for personalized advice and possibly a pregnancy test if your period is delayed. Regular follow-ups and open communication with your healthcare provider can help you navigate these concerns effectively.

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