Do I actually have to take my birth control at the exact same time every day?

[Jay27]

I always end up taking my pills sometime between 10 pm and 1 am, very rarely 2 am. My alarm is set for 11 pm every day but sometimes I go to bed early or stay out late.

I’m on Slynd, which is a progestin only pill and its website says it has a “24 hour safe window.” I’ve been on it for just over 2 months. I’ve been getting light periods in the middle of the month while I’m still taking the active pills. I don’t have any symptoms besides the bleeding but it’s so inconvenient! Am I doing anything wrong? Would taking it in a 3-4 hour window cause breakthrough bleeding?

Also, could alcohol be causing this? I go out a couple times a month and only have 1 or 2 drinks max each time. I’ve think I’ve only had 3 or 4 drinks total this month. My doctor never told me whether alcohol can make birth control pills ineffective.

[Sam W]

Hi Jay27,

So, if your pill manufacturer says you have a 24 hour window before a pill is considered missed, then you can assume that taking it a few hours later or earlier than the day before will not compromise the effectiveness.

Since you've only been on this pill two months, that may explain why you've been bleeding in the middle of the month, as your body may still be adjusting to the pill. It could also be that this is a side effect of the pill for you, although that's one of those things we can't tell you for sure as we're not your healthcare provider.

As far as alcohol, that's not something that in and of itself can influence the effectiveness of the pill. If you're curious, this article goes into more detail about what things do and don't effect hormonal birth control: Something You Can Worry About Less: Interference and Hormonal Birth Control

[Jay27]

My doctor is seeing me in late December to talk about it. She said it could take 4 months to adjust. I’m so tired of the side effects! It’s reduced my cramps by like 90% but bleeding mid month and feeling super tired every day is so hard to deal with. Do you think that bleeding for like 20 days a month could be causing the fatigue? Even though it’s light? I change my pads every 4 hours but I’m not even close to soaking through them. Idk if I should get my iron levels tested.

[Sam W]

I'm glad you have an appointment scheduled to check in on this! If you're bleeding for that long, that could be contributing to your fatigue, though there are a ton of things that can lead to fatigue that could also be at play. Did you notice the fatigue starting after being on the pill for awhile?

And, just to check, if you're sexually active are you up to date on all your STI tests? Because sometimes bleeding can be a symptom of infection.

[Jay27]

I’ve struggled with fatigue for a while but before I got on the pill, it was never so bad that I was falling asleep in class even after 8 hours of sleep, and then I’d need a 2 hour nap later.
My sleep has been messed up lately because of personal issues that are making me anxious. But until a week ago, I was sleeping normally and still being tired.

I got negative tests for syphillis, HIV, gonorrhea, and chlamydia in March. I got tested for gonorrhea and chlamydia again along with my HPV test in August and all of those came back negative. I haven’t had sex since July. My gf and I are each other’s first and only sexual partners. I’ve been getting tested just in case and to get in the habit of it. Should I try to get more tests?

[Sam W]

If you and your girlfriend are monogamous, which it sounds like you are, then it doesn't sound like you need an additional test.

That fatigue sounds so rough! I would definitely bring it up with your healthcare provider when see them, just so they can help you figure out if it's more life stuff that's causing it or if there are underlying causes that might need addressing.

[Jay27]

We’re monogamous. I went to my college health center for it last month, and they said i need to call my insurance company to ask if they would cover a repeat of blood work that I got 2 months ago. I had like 12 tubes of blood drawn in August and got normal results for almost everything except FSH and LH. They also wanted me tested for mono and Lyme disease. The problem is that my fatigue has been so bad and I have a lot of anxiety so I haven’t been able to make the call.

[Sam W]

Would your girlfriend or another person you trust be able to help you make the call? Even if you have to be the one to talk to the provider and give details, having someone else start the process might help make both the fatigue and the anxiety less of a barrier.

[Jay27]

My gf is abroad so she can’t help. One of my college counselors offered to.

[Heather]

I also would be happy to make a health call for you if you'd like if you can fill me in on all the information. I live with CFS (chronic fatigue syndrome) and other chronic pain and illness, so I totally get being too tried or just worn out with a lot of healthcare engagement to make calls for appointments. That kind of fatigue is very real, and I'm sorry you're living with it.

[Jay27]

That would be so helpful! I skipped class and just woke up from a 2 hour nap. I’ve also been feeling very anxious lately about class registration because I don’t know if I’ll have to work around the fatigue. Idk if it’s enough info but this is what the college health center told me I need. I have United healthcare.

I need to get a full metabolic panel and a complete blood cell count for my fatigue. I already had those tests in August of this year so I don’t know if it’ll be covered for me to get them again so soon. I also need new tests for the Epstein Barr virus (aka mono) and a western blot Lyme disease test. I’ve never had those before.

[Heather]

Why don't you email me all the specifics, then, and I can do that for you tomorrow. My email (written this way to keep me from getting bot spam) is h.corinnaATscarleteenDOTcom.

What I will need is:
• your legal name, address and contact info
• your birthdate
• your insurance number
• the phone number I am calling
• the windows (days and times) you have open for appointments

That should do it!

[Jay27]

Thanks! I also have a planned parenthood appointment in less than 2 days because I just can’t deal with this anymore.

[Heather]

I'm very sorry to tell you that this having spotting or bleeding you can't predict, sometimes for weeks at a time, is also a thing you'll likely experience with perimenopause, just so you can brace yourself in advance.

This might sound like a foolish question, but by any chance did you start taking your pill (the month you first started on it) in the middle of your cycle, or did you start it at the same time as your period?

[Jay27]

I guess I have about 20 years to prepare
I started the pill in the end of august but I didn’t get my period at all that month. I have PCOS so sometimes it just skips a month or two. I didn’t want to wait.

Also, I just remembered that my mom had this problem and it ended up being a benign growth that her uterus was trying to flush out and she needed a D&C.

[Heather]

Better to know 20 years ahead, if you ask me.

Since it wasn't timed with your period, it IS possible that that's the reason for your mid-cycle bleeding, and if that's the case, it should stop doing that in a couple more cycles. When started with a period, that tends to be less likely.

Still, and all the more knowing that family history, I think you're wise to check into it and the fatigue in terms of the heathcare you're arranging.

[Jay27]

Yeah maybe I should get my iron levels checked and get an ultrasound to see if I have fibroids or any other kind of growth. My flow isn’t heavy, but I’m probably still losing a lot of blood over time. My gyno never told me about when to start the pill so I just thought I could start taking it any day. I’m anxious about this pill not working and what if this side effect doesn’t get better? I really want it to work because my cramps are gone but I wish I had energy. Idk if planned parenthood will tell me to switch meds. Or if when I see my gyno in December she’ll refuse to prescribe me anything new because she was already opposed to medication and I had to pressure her into prescribing me this pill.

[Sam W]

Hi Jay27,

I agree that doing due diligence around these symptoms is the way to go, just so if there are other things going on besides pill side effects, you can know sooner rather than later.

It sounds like you have a lot of anxiety not only about the current medication, but also about whether you'll have to switch and what kind of advocating with a healthcare provider that might involve. Since it sounds like you have an appointment in the next day or two, my suggestion would be to try, as much as you can, to hit pause on thinking about those "what ifs" until you have the information from your appointment and know more about the potential next steps. Does that make sense?

[Heather]

(Just FYI, Jay, I have been keeping my eyes open for an email from you since yesterday and am not seeing one. If you still want me to make that call for you, I am done with work today at 5 CST, and will not be back in again until Sunday, so will need the info from you I posted about needing sent to make appointments on your behalf. If you decided you don't want or need me to do that for you, that's cool, too, just LMK?)

[Jay27]

Hi Heather, I’m not sure if I still want to call the insurance company. Could the doctor at planned parenthood order blood work? It just seems easier to go through a doctor instead of asking for it myself. If not, I’ll email you.

[Heather]

Well, you won't usually be able to order your own blood work through insurance, anywhere, period. Or other tests. You need a healthcare provider to order those tests on your behalf. Patients can't just order their own tests, for the most part.

What a given PP provider/branch can do varies a lot between branches, so you can just see what they say tomorrow and also ask about what they can and can't do while you're there.

[Heather]

(I thought you were asking me to call and make healthcare appointments for you, or I would have told you that you or I can't call insurance companies or labs and order you testing before now. Sorry if I misunderstood!)

[Jay27]

It’s okay! My college health center told me that I need to ask the insurance company if I can repeat bloodwork that was taken a few months ago. Maybe there was a miscommunication or they just didn’t know what they were talking about.

[Heather]

It sounds to me like what they were probably trying to do was to help you be sure that any bloodwork they repeated would be covered by your insurance.

[Jay27]

I had an appointment with my psychiatrist and he ordered blood work under the insurance code for anemia so it’s not technically repeating. We don’t know if I have anemia but it’s likely. I’m also getting tested for a bunch of other vitamin deficiencies. I’m going tomorrow.