3 Questions About Taking The Birth Control Pill

Photographer Monik Markus

Photographer Monik Markus

Knowing how to use the birth control pill in the most effective way can seem confusing, especially considering all the different brands and varying information out there. The most common questions tend to center around the risks of pregnancy if the pill is not taken at the same time everyday, as well as what to do if you miss a pill.

In this article, Heather Corinna clears up all confusion, explaining the basic, must-knows about this form of contraception. She clarifies how to take the pill, when it’s most effective, and when it may not be.

Here are the key points discussed in detail below:

  • It is strongly advised to use the “dual method”, coupling hormonal contraception with condom use.
  • The Pill provides no protection against STIs.
  • If you aren’t using condoms and you are just starting the Pill, wait one full cycle of active pill taking before using it as your only form of birth control.
  • Ideal, perfect pill use is taking it at the same time of day within a few hours difference.
  • A “late” pill varies more in definition among sources, and to some degree from pill to pill. For all birth control pills, if you have taken a pill more than 12-24 hours late, you should consider using a backup method of birth control (i.e. condoms) for the rest of your cycle.
  • A “missed” pill is one that has not been taken within 24 hours of the last pill you took. Read below for what to do if you miss a day or more.
  • Do your research. How birth control pills are taken, when effectiveness is compromised, and what side effects and risks are most prevalent can ALL differ from pill to pill. So make sure to read the pill packet information in full and consult your health provider with any concerns.

This article was originally published on Scarleteen 

BY HEATHER CORINNA | Scarleteen

Anonymous asks:

I had sex with no condom 3 days before I started my period, AND 1 day after I started my period. I’m on birth control BUT I was at the end of my 1st pack I have ever took (taking the non-active pills) and I don’t exactly take them at the exact same time every day but pretty close. I was wondering what’s the possibility of me getting pregnant considering the circumstances, birth control doesn’t take effect until the first month is up, but I’m already taking my inactive pills so that technically means the month is up doesn’t it? Also, I was getting ready to start/was on my period, and I have a regular cycle so I don’t think there’s any way I could have been ovulating but I’m really worried, please help!

And Gail asks…

I’m 16 years old, and I’m on the pill. I’ve been on it for little over a month, and recently me and my partner have been doing it without a condom (we’re clean) since I’ve been on them for a month now. Question is, I’m not a perfect user. I take my pill within a 30 min. range, never exactly right on time, what’s my chance of pregnancy?

And Hockeylover asks…

I’ve been on the pill for about a year now and I’m sexually active with my boyfriend. This past month I had sex with my boyfriend and the condom didn’t break but may have leaked or something because my boyfriend seemed to think that something minor could have been wrong. A few days after that I forgot to take a pill until about 12 hours after the fact. Now, my pill pack is finished and it is time for me to have my withdrawal bleed which has always occurred at the same time. Today, however, I have experienced nothing but minimal spotting, which is unusual.

Also – just for future reference as I was always curious – I know that it is extremely difficult to become pregnant while on the pill as long as it is taken properly. However, if pills were forgotten or whatnot I realize that it is possible to get pregnant but I was wondering whether one would still experience the withdrawal bleed or whether this would not occur (just like a period doesn’t occur if someone is pregnant). Does any blood that comes during a withdrawal bleed while on the pill signify that no pregnancy has occurred? Am I at risk?

Heather Corinna replies:
Since there are so many different pill brands, so much information to sort through, and since with adolescents and/or young adults information on some aspects can vary slightly, and we get so many questions about the pill, it seems it’s high time to give the most basic rundown I can speaking to concerns about how to take the pill, when it’s effective, and when it may not be.

Let’s start with a super-simple summary of how combination birth control pills work.

First, take a look at our piece which explains how the fertility and menstrual cycle works, so you have some context. Got the gist?

So, the pill acts to alter that natural cycle so that you don’t become pregnant, via synthetic hormones (usually estrogen and progesterone) to contradict your real ones. The pill works to do that in three ways:

  • by keeping your follicles from maturing and your body from ovulating (releasing a mature),
  • by thickening cervical mucus so sperm have a terribly tough time getting anywhere near an egg if by chance one is still released, and
  • by preventing implantation of an embryo by keeping the endometrium thin in the event that both somehow still manage to happen.

At the start of your pill pack, the hormones in your pills effectively have a little chat with your pituitary gland and tell it to suppress FSH — your follicle-stimulating hormone — so that an egg doesn’t mature, nor will the cells around it grow to form a follicle that releases estrogen at the beginning of your cycle, which would stimulate your body to prepare thicker endometrial lining through the cycle to sustain a pregnancy.

Your pituitary gland (being highly impressionable, you know the type) steps it up and doesn’t produce that FSH, so that maturation doesn’t happen and the lining of your uterus doesn’t thicken the way it would to sustain a pregnancy. At the time your LH surge would normally happen — around halfway into your cycle — the way the pill controls progestin keeps that surge from happening, too, which suppresses ovulation. Thus, no egg is released to be fertilized by sperm. As a backup, it’s at the same time keeping cervical mucus thick: to get why that matters, imagine trying to push a piece of thread head first through school paste: that’d be quite a challenge, and is what it’s like for sperm to try and move through that mucus to get into the cervix.

When you go off your active pills, and into the placebo (inactive pill) period you get your withdrawal bleed, because taking those hormones away allows for the breakdown of a thin uterine lining you had there (and because the pill keeps it thinner, often people on the combination pill experience lighter, shorter periods).

And when you start your next pack, you start that cycle all over again.

But while we know that the pill, in perfect use, is highly effective, we also know that a) some people do become pregnant while on the pill and b) in typical pill use, lower rates of effectiveness have been shown in studies for adolescents than for adults. Here’s the scoop on what perfect use is, how to have the pill be as effective as possible for you, what a missed pill is and what you should do, when it’s time to worry about pregnancy and when it’s not.

First starting the pill and birth control backups

With all BCPs (birth control pills), to be as safe as possible, and in the interest of having as much protection as possible, it is strongly advised to back up the pill with condom use when using the pill as birth control.

Most effectiveness rates for the pill are lower for younger women, usually because plenty of younger women are having to hide the pill and/or be sneaky in taking them, so it’s more likely that younger women, rather than older women, will miss pills and/or take pills late, which can reduce effectiveness. Too, younger women who don’t tell their general doctors they are using the pill may not be warned in advance about drug interactions with the pill and general medications (usually that’s only the case with one class of antibiotics and some herbal supplements) or that some illness can reduce effectiveness.

STIs should also be a big concern, especially when you’re under 22, since adolescents and young adults are both at the highest risk for STIs of any group, and younger women also are at higher risks of long-term complications from STIs. The pill provides no protection against STIs… and also often seems to provide a bit of a sense of false security in terms of infections, since so many women are most worried about pregnancy. Condoms provide that protection, and in addition, the one-two punch of the pill AND condoms (so long as one is used perfectly, and better still if both are used properly) almost guarantees you will not become pregnant.

If you are NOT going to back up with condoms, and are just starting the pill, we strongly advise you to wait one full cycle of active pills before using ONLY the pill as birth control, even though for many people, the pill may likely be fully effective within seven days, and for some, even sooner. If you have gone without a backup method in those first seven days and had sex with only the pill, it is advised to call your healthcare provider and ask about emergency contraception. You may also want to consider doing so if you went without a backup in that first cycle.

Two ways to start taking the pill for the first time

A first day start means you start taking the pill on the first day of your menstrual period. With a first day start, the pill may be effective as early as that first day, but waiting one full cycle before going without a backup is strongly advised.

A Sunday Start is when you start the pill on the first Sunday AFTER your period begins (or, if it starts on a Sunday, on that Sunday). When you start with a Sunday start, the pill may be effective as early as within one week, but waiting one full cycle before going without a backup is strongly advised. The Sunday Start method was devised primarily for women who would prefer they have their withdrawal bleeds (your period wile using the pill) on a weekday, rather than on weekends, as it makes that more likely.

Unless your healthcare provider suggests one way of starting is better for you, how you start is your call, based on your preferences. These two ways are ONLY relevant when you first start taking the pill. For every cycle thereafter, you’ll start your new pack when you finish the pack before.

What’s taking it on time and what isn’t?

You want to do your level best to take your pill as close to the same time every day as is possible, ideally within a window of a few hours: if you do that, every day, then you’re a perfect pill user — that doesn’t mean you get a gold star (unless you want one, in which case, by all means, star yourself!), but it does mean that unless you have any other misuse you can rest assured you have the highest effectiveness in terms of pregnancy protection possible from your pill.

To simplify that, what’s important is not that you take the pill at the EXACT same time every day (as in, “Oh god! I usually take it at 10:32, and it’s 11:03!”), but at the same time of day: for instance, always in the morning, or always before you go to bed. That gets pill-taking into your regular routines so that you’re most likely to remember to take them. For instance, Gail says she’s not a perfect user, but, in fact, she is, and it sounds like our user with the first question is, too. For that matter, even Hockeylover isn’t that far off: with combination pills, while you probably don’t want to get in the habit of taking them with a 12-hour difference, just because it can be easier to space out pills that way, but she hasn’t put her effectiveness at risk.

A “missed” pill is one that was not taken within 24 hours of the last pill you took. A missed pill should always be taken as soon as you realize you have missed it, but there is likely no risk from one missed pill or a need for EC. A “late” pill varies more in definition among various sources, and to some degree from pill to pill, but with any type of pill, if you have taken a pill more than 12-24 hours late, you may want to consider using a backup method of birth control for the rest of your cycle to play it safe.

With ALL pills if you have missed a pill, the right thing to do is to take that pill as soon as you know you missed it. If it’s on that same day, take it when you realize. if you realize you missed a pill when you go to take the next day’s pill, take both pills at the same time. If you realize you messed up and missed a pill days later — while still taking the other pills on time — then take that pill then. The same goes if you’ve missed two or three pills rather than just one. When you miss a pill, we advise using a backup method of birth control for the rest of that cycle.

If you’ve missed more than three, with most pills, you’ll want to wait to take any more pills until the following Sunday, then just start a new pack entirely, but use a backup for that cycle as well as the time in between. If you have missed several pills and have had sex in that cycle without a backup method, we advise emergency contraception. When in doubt, always contact your healthcare provider or pharmacist and ask what to do.

How do you know if you become pregnant while on the pill?

The same way you would if you were not: you’ve really just got to take a test. The most common symptom of pregnancy is a missed or late period, or a period that comes around the time you’d expect it but is very unlike what your period (or withdrawal bleed, when you’re on the pill) is usually like. So, when on the pill, if you become pregnant, you most likely will NOT have your withdrawal bleed. But ultimately, you’re unlikely to become pregnant while on the pill unless you have not taken it properly, so if you know you have not and are concerned about pregnancy, just take a pregnancy test (and the pill, for the record, doesn’t get in the way of pregnancy test accuracy).

I always tell women that I personally feel like a box of a few pregnancy tests in the cabinet is about the cheapest therapy there is: for a pretty small investment, you can have a real sanity-saver handy right when you need it. Even if you think you’re just being paranoid, there are times when spending that ten or fifteen bucks to verify you’re being paranoid is seriously worth it.

Read up and play it safe

With ALL pills, read your pill packet information. Pills — how they’re taken, when effectiveness is compromised, what side effects and risks are most prevalent, and the best ways to take them — can ALL differ from pill to pill. So, be sure if you’re on the pill, to read those inserts and to talk to your healthcare provider prescribing the pill for you and ask ANY questions you have: there’s just no reason to fly blind with your birth control.

Please understand that more often than not, we DO err on the side of caution here at Scarleteen, both because in many aspects the population we serve is unique (and largely underrepresented in many studies on everything to do with sexuality and sexual health) and because while we are not legally liable for information here, we are certainly accountable for the information we give you and want to be sure we’re doing the best we can to help you stay as safe as you want to be if you’re going to be sexually active. We always review a myriad of credible sources with our information, and do our level best to look at that information as a whole and draw whatever conclusions from all of it which we feel the most confident will help you to be the most safe.

As usual, we will always encourage you to seek out a second opinion from your healthcare provider whenever you like or feel a need. Don’t forget that part of the service your healthcare providers provide is information: when you’re starting any medication — be that the pill or something else — ask as many questions as you have, don’t hold back! It’s your doctor or nurses’ job to be sure you know how to use your medication properly and understand all you can about it.

heatherHEATHER CORINNA is an activist, artist, author and the director of Scarleteen, the inclusive online resource for teen and young adult sex education and information. She is also the author of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College and was a contributor to the 2011 edition of Our Bodies, Ourselves. She’s received the The Champions of Sexual Literacy Award for Grassroots Activism (2007), The Society for the Scientific Study of Sexuality, Western Region’s, Public Service Award (2009), the Our Bodies, Ourselves’ Women’s Health Heroes Award (2009), The Joan Helmich Educator of the Year Award (2012), and The Woodhull Foundation’s Vicki Award (2013).

Reacquainting With Condoms After 11 Years On The Pill

Switching to condoms as one’s only birth control at 30 years old can be a dramatic shift in mindset from the comfort of quick-fix Pills to latexy shopping adventures with a partner. Here, Rose Crompton from the Condom Monologues collective shares her dramatic contraceptive story that spans over a decade, told in 1000 words.

Here are some things she’s learned along the way:

  • Throughout life, every person should take the time to reflect and re-evaluate their contraceptive choices as their body changes.
  • There is important knowledge about condoms that’s not taught in sex education, such as the importance of fitting and experimenting with different brands and types. There are condom sampler packs to guide your discovery of the best condoms for you and your partner(s).
  • If there is an opportunity to shop for condoms with your partner then you should. It can be like an extension of foreplay!
  • Shopping online provides way better selection and price.

This piece is originally published here.

BY ROSE CROMPTOM at CONDOM MONOLOGUES | CondomMonologues.com

“Which ones should we get?” I asked my boyfriend. Well, he’s a man and he’s the one that has to wear them, so naturally I assumed he’d know best. “I dunno,” was the mumbled response. I’d not been “hat” shopping in over a decade. For nearly 11 years I was on the Pill and in three monogamous relationships, for the majority of that time, so ‘safe’ meant not getting pregnant.

Standing there, facing a wall of johnnies, there were three main changes I noticed: the packaging of condoms 11 years on was nicer, there were brands other than Durex available, and the price was higher. No wonder the supermarket kept them in security boxes. Ten quid ($16) for 10 condoms, so a pound a fuck essentially, and me and my boyfriend fuck a lot. Giving up the Pill was apparently going to cost me in more ways than I expected!

That said, coming off the pill four months ago was one of the best decisions I’ve made and I’d like to state that this was what was right for me, not what every woman should do, although I do think every woman should take the time to stop and re-evaluate their contraceptive method as their body changes.

The biggest question I’ve faced since is what contraception should my partner and I use instead?

Long term, that’s still a frustrating debate I’m having with myself, my partner and sexual health advisers. For now though, my chap and I are only using condoms and that is how I found myself: Standing in Tesco adding ‘condoms’ to our weekly, big shop shopping list.

Just call me Goldilocks

After much deliberation we went for the clichéd ribs and dots for her pleasure style. You have to start somewhere. They were good, but not quite right. If we’re being honest (and I think we can be here) too much dotting and ribbing can lead to chaffing.

Thankfully, there’s more to safe sex-life than that one style and so the hunt began online to try something new. Scouring the sites we found a ridiculous number of options. Without wanting to sound too Disney about it, there was a whole new world opening up before my eyes. Previously my experience of condoms had been whatever was free and easy to grab from the GP or sexual health clinic as they were only ever used briefly when there was a Pill glitch.FlyingCarpetCondomsAnim

Now though, scouring the various sex e-tailers, there was this whole exotic, rubbery, latex fantasticness that had the potential to be a lot of fun. Maybe shopping for condoms would be a great, new, sexy part to our foreplay?

We came across an American brand called One and they had an interesting pack called Tantric with tattoo style patterns and extra lubrication. Oh, they sound fancy and you can never have too much lube, so we ordered some.

It wasn’t long before the boyfriend and I found ourselves back online, looking for something different the next time. We “um-ed” and “ah-ed” over the various boxes, brands, descriptions, shapes and textures for nearly as long as we’d spend trying to pick a nice bottle of wine to go with dinner.

Obviously, sex is a shared experience and if there is the opportunity to choose together, then you should. Like with any aspect of sex you should both get enjoyment out of what you’re using. There aren’t very many things that we put on our bodies that are as intimate as condoms. It’s going on his most sensitive area and in hers, so when it comes to condom shopping it’s important to find some rubbers that you’re both gonna’ love. Generally, that means experimenting.

Getting comfy with condoms

Through shopping around, I’ve learnt more about condoms in the last four months than I ever learnt at school, or was bothered to listen to after that, because they just weren’t relevant to my life. It’s a bad attitude to have, I know. It’s shocking how the “fit and forget” or pill-popping culture we have today means it’s easy to overlook the humble condom. Especially when you’re in a relationship that uses one of the aforementioned methods.

It’s been a re-education: I’m aware now about the importance of fit and how that effects sensation and minimises the risk of breakage, the safest way to take them off to avoid any ‘accidents’ and I’ll admit that I’m still perfecting my roll on method (anything billed as ultra thin is definitely the trickiest).

The biggest adjustment (and I don’t reckon I’m the only woman who’s come off the Pill to feel this) is becoming confident with the idea that condoms can keep me safe. Not from STDs as that’s not an issue in my relationship, but of pregnancy. A lot of people my age and a bit older seem keen to use Fertility Awareness Methods and the pull-out method, but for many of them pregnancy wouldn’t be so much of a disaster. For me and my boyfriend, it certainly would be.

Making the move from the pill to condoms is scary. Anything you get fitted, implanted or swallow every morning has a success rate of approximately 99 percent. Sure, there are some side effects, but you’re willing to put up with them because it’s a shared ideology that now we have these methods, why bother with condoms that have a slightly lower success rate at all if your aim is to not get pregnant?

Living with that mentality for over a decade, then changing what you use and your body changes too, is a lot to get your head around, but it is doable. On the plus side, not only has it led me to take another look at the whole contraceptive menu – not just what the GP would prefer me to use – but it’s made me and my partner look again at correct condom use and I don’t think it’s a bad thing for any couple to do that no matter how long they’ve been together.

This monologue was written by Rose Crompton (@RoseC_Liec). Monologues are independent stories. The opinions shared are the author’s own. Go here for more monologues.

 

condom-monologuesCONDOM MONOLOGUES Affirming safer sex and sexuality one story at a time… Condom Monologues dispel harmful myths about safe sex and sexual stereotypes that permeate our ways of understanding what is “healthy sexuality”. They accomplish this through sex-positive, pleasure-focused approaches to sexuality that affirm the diversity of people- genders, sexualities, kinks and relationships.
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