Birth Control Pills: Your Questions Answered

Regarding contraceptive pills?

Dear Dr.
Lin Chao-Pei,
Hello! Earlier this year, I consulted you about oral contraceptive pills for 21 days, and I am truly grateful for your patient responses.
I have another question I would like to ask you.
I have been taking Marvelon (a 21-day oral contraceptive) since January of this year, which has been about 10 months now.
Everything has been fine during this period, with my menstrual cycle being quite regular, occurring approximately every 26-27 days.
I consider the first day of my period as Day 1, and I start taking the pills on Day 3.
After completing the 21-day course, my period usually starts again on Day 3 or 4 of the pill-free interval, which is consistently about 5-6 days.
Throughout this nearly one-year period, I have not calculated any safe days or used other contraceptive methods, and the oral contraceptive has proven to be very reliable.
However, I have a small concern this cycle that I would like your guidance on.
On the evening of November 11, I finished taking the 21st pill, and my period started on the morning of November 15.
Then, on the evening of November 17, I had intercourse with my husband (while still having menstrual bleeding).
That same night, I began taking the new cycle of contraceptive pills.
Everything seems to be in order, but this is the first time I have had intercourse between the start of my period and the beginning of the new pill cycle.
Although it was only a short interval of less than three days, I had heavier bleeding previously, so I did not have intercourse during the first three days of my period before starting the new cycle of pills.
This time, the bleeding was lighter, which is why I had intercourse on the third day of my period.
Is there a possibility of pregnancy in this situation? I have asked several pharmacies and pharmacists, and the responses I received were generally along the lines of: "Of course, you won't get pregnant! Why would you take contraceptive pills otherwise?" "You've been taking them for almost a year; how could that happen?" "Even if you didn't take the pill on the third day of your period, it would still be a safe period!" Is my question silly or overly cautious? Is it true that as long as I take the contraceptive pills on time, regardless of any pill-free intervals, I can prevent pregnancy?
Additionally, I would like to ask another question.
My method of taking the pills is to finish the last pill on Day 1, and I usually get my period on Day 4 or 5.
Then, on the third day of my period, which is Day 6 or 7, I start taking the new cycle of contraceptive pills.
Is this method correct, or does it need to be adjusted? I know you are very busy and I apologize for taking your time with my lengthy message.
However, I would greatly appreciate it if you could take a moment to clarify these questions for me.
Thank you very much!

Xiao Xin, 20~29 year old female. Ask Date: 2007/11/19

Dr. Lin Zhaopei reply Obstetrics and Gynecology

1.
It is impossible to get pregnant because it is not the ovulation period.
2.
That's correct, on the third day of menstruation, it is only the beginning of the follicular phase, and there is no egg present.
3.
If contraception is stopped for more than 10 days after menstruation begins, there is a possibility of pregnancy.
4.
It is taken correctly, but it can also be started on the fifth day of menstruation.

Reply Date: 2007/11/19

More Info

Dear Patient,
Thank you for your thoughtful questions regarding birth control pills, specifically the Marvelon 21-day contraceptive pill. It’s great to hear that you have been using it effectively for about ten months and that your menstrual cycle has been regular. Let’s address your concerns one by one.

1. Risk of Pregnancy During Menstruation: You mentioned that you had intercourse on the third day of your period and then resumed taking your birth control pills that evening. Generally, if you have been taking your birth control pills consistently and correctly, the risk of pregnancy is very low, even if you have intercourse during your menstrual period. Birth control pills work by preventing ovulation, and since you are actively taking them, you are protected against pregnancy. The idea that you can’t get pregnant during your period is a common misconception; however, it is important to remember that sperm can survive in the female reproductive tract for up to five days. Therefore, if you were to ovulate shortly after your period, there could be a risk. But since you are on the pill, your ovulation is suppressed.

2. Timing of Pill Resumption: Your method of starting the new pack of pills on the third day of your period is correct. The standard practice is to start taking the next pack of pills after the 7-day break (or after finishing the 21 pills). By starting on the third day of your period, you are ensuring that you maintain continuous contraceptive coverage. This is a common and effective way to use the pill.

3. Consistency in Taking Pills: It’s crucial to take your pills at the same time every day to maintain their effectiveness. If you miss a pill or take it late, it can reduce its effectiveness and increase the risk of pregnancy. However, since you have been diligent in taking your pills for nearly a year, you are likely well-protected.

4. Concerns About Safety Periods: While some people refer to "safe periods" in their menstrual cycle, relying solely on this method can be risky. The effectiveness of birth control pills is significantly higher than trying to track ovulation or safe periods. As long as you are taking your pills consistently, you do not need to worry about timing your intercourse around your menstrual cycle.

5. Additional Questions: Your concerns are valid and not at all silly. It’s always good to seek clarification, especially regarding something as important as contraception. If you ever feel uncertain, it’s best to consult with your healthcare provider for personalized advice based on your medical history and lifestyle.

In summary, as long as you continue to take your birth control pills as directed, you should be well-protected against pregnancy, even if you have intercourse during your period. If you have any further questions or concerns, please do not hesitate to reach out to your healthcare provider. They can provide you with the most accurate information tailored to your specific situation.

Wishing you good health and peace of mind!
Best regards,
Doctor Q&A Teams

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