Is this ok?

[Juliaho90]

Hi there, earlier this month when I was done with my 7 day break after completing 21 Yasmin pills, I had protected sex (male condom) with my partner the morning before starting a new pack of pills. So I end my 7th day on Tuesday and start my new pack of pills on Wednesday. I had protected sex with my partner on Wednesday morning and then an hour later started my new pack of pills. Technically I didn’t miss a pill because I was supposed to start on Wednesday and I did, but I had sex before taking the pill, so is that safe still?

[Elise]

Hi Juliaho90, there is no risk associated with what you describe as the timing of sex doesn't have any effects on the effectiveness of your hormonal birth control. What does effect it is the dose interval of taking your pills, which as you note was maintained correctly.

This is because what the combination pill does in your body is effect the ways that your anatomy would try to work to be able to conceive a pregnancy in three ways: it prevents ovulation, to thicken cervical mucus so sperm cells are less able to get to or into the cervix, and by making the lining of the uterus less hospitable for a fertilized egg to implant in. Maintaining the dosages of the synthetic hormone in your body as per the manufacturer's instructions is the important thing, and engaging in sex, unprotected or protected, does not change this, only maintaining the required consistent frequency does.

Furthermore, even if you had completely missed the pill, you engaged in protected sex, which means that the chance of pregnancy would have been very low, as it sounds like it didn't break, you remembered to use it, and followed the instructions on how to use it (forgetting to use a condom or occasionally using it incorrectly are what account for the stat of condoms being 86% effective across one year of typical use - this means that for sexual partners who use a condom as a form of birth control for a whole year, that in that typical year they will use it incorrectly or forget it, and then of all people using the condom in a typical manner (sometimes getting it a bit wrong), then 14/100 people would get pregnant, so in other words, even using it imperfectly, 86/100 people will still not get pregnant).

I bring this up in part because I've noticed you have a tendency to second guess the effectiveness and become highly concerned risk profile of situations in which you are using one of the most highly effective combinations of birth control available, 99.99% effective with perfect use, 98.7% effective with typical use

It sounds like even that tiny chance causes you a decent amount of stress, so that you get concerned about fringe cases that don't have an impact on the effectiveness on the methods you have chosen. There appears to be a pattern arising where you get concerned about this, seek reassurance from us but then because this relief isn't actually addressing the underlying lack of confidence you have that you are using the method correctly, or that you can trust it, the cycle then repeats at the same trigger. We are of course happy to help, however this sounds like a very stressful situation to be in and that by us not addressing the root of the issue with you, that we are only feeding into this anxiety cycle, which means in a way, we are not helping resolve your concern. Is this something you would be comfortable looking at with us?

In the immediate term, you might find it useful to re-read our articles on the combined pill and condoms to really solidify your understanding of how they work.

Following on from that, would you be open to discussing this a bit further? We could discuss what you'd need to trust your use of birth control, or if there is a particular fear you have about being able to end an unwanted pregnancy in the event that the very very low chance that you became pregnant? Or, discussing whether you'd like to look at a form of birth control like an IUD which is 99+% effective in one year of perfect or typical use; because there is no real element for user error in order to assuage your anxiety about using it incorrectly? It is okay if you'd prefer not to discuss some or any of these things, and I hope it is not too confronting for me to be asking, I just think that it may be more helpful to look at all or any of these points to assist you with these concerns in a more long term way.

[Juliaho90]

Hi Elise, thanks for getting back to me. You are right about the anxiety, I just found it so difficult to believe it is a non risk situation as we had sex before I took the pill, even though I did not miss any pill, I took it on the day I was supposed to. How does the timing of sex not matter when it comes to the pill though? Could you explain a bit more about that?

I’m hoping that if I understood that, I would feel less anxious and more confident that the pill would work as it is supposed to.

[Elise]

Hi Juliaho90, essentially the way the pill works has to do with the presence of the synthetic hormones that the pills contain in your body, they interact with your body's systems and cause the effects outlined above (prevent ovulation from happening, to thicken cervical mucus so sperm cells are less able to get to or into the cervix, and by making the lining of the uterus less hospitable for a fertilized egg to implant in.)

The pill interacts with these systems over time, this is why there is a period at the very start of taking the pill during where you have to wait for the protection to start. It's not just a reset every day, rather, continuing to take the pill each day ensures that there is enough of the synthetic hormones in your body for them to keep doing their job, so that the the biological processes that they're suppressing not to start up again because there is a break in the dosage.

Having sex has no effect on the biological processes at work here (having sex won't cause them to start up again or reduce the amount of the synthetic hormones present). The only thing that effects this is continuing to maintain the correct dosage of the pill as directed, does that make sense? Let us know if it does or there is an area you are unclear on.

After reading the above, could you please read at the above linked articles about the pill and condoms - they go into a lot of detail about their function and hopefully can help assuage future concerns. If you read any things in the articles that don't completely make sense or you're having difficulty understanding the 'how' or 'why' let us know: we can then expand on those with you so you can feel solid in your understanding. Does that sound okay and doable?

[Juliaho90]

Thank you, I understand now. Does this mean that whenever I start my new pack after my 7 days of hormone free break, i can start the new pack at any time on the start day? I have been taking it in the morning like right when I get up, but because I would be travelling next month, I’d lie to adjust the timing so that I wouldn’t have to get up so early local time. Can I take it in the evening or afternoon?

Also the hormones in the pills, are those naturally occurring hormones found in the human body? I am just curious because you say “synthetic”. Are they man made hormones that aren’t usually found in the body? I’m taking Yasmin by the way

[Sam W]

Hi Juliaho90

Yes, when you start the new pack you can adjust when you take it to fit with your scheduling needs.

As for the hormones in the pills being synthetic, you're right that the hormones they introduce into your body are hormones that, in this case, your body is already producing (like estrogen). The difference is that synthetic hormones are made in a space like a lab, rather than by your actual body.

[Juliaho90]

Thank you, I understand now. However I am starting to experience spotting today but I am 6 days away from my period and I don’t usually get spotting this early. It isn’t a lot, only when I wipe. I also had vomiting and diarrhoea episodes last week as I was sick, but those episodes did not happen close to the time I took the pill. To add I have been taking all my pills on time, not one missed. And I have been on the same Yasmin pill for 2+ years now. Last sex was 23 Nov. Is this normal?

[Sam W]

If you tend to get spotting closer to your period, then this may indicate your period is coming a little earlier than expected. If you notice the spotting carries over when you're not close to your period, then you might want to check in with a healthcare provider to make sure there isn't another underlying issue.

Looking at your posting history, it seems like you have a lot of anxiety around your pill effectiveness and monitoring your period/withdrawal bleeds really closely. Do you have a sense of why that is?

[Juliaho90]

Well I usually get some spotting a day before my period, that’s normal. Or 2 days max. But I never get it 6 days before. And when I say spotting, it appears when you wipe but it does not appear on my panty. That said I am also feeling some cramps earlier than usual. Could that be an indication of a more serious UTI or something? My withdrawal bleed is supposed to come on Saturday, so 4 days from now. I am puzzled as to how I am be spotting when I am on my last pill still.

Is it normal for the withdrawal bleed to shift? I mean for 2 years it has been on day 4 after stopping the pill, could it suddenly come earlier? what’s the reason though, if it is at all possible?

[Nicole]

Hi Juliaho90,

What you are describing does not sound like the usual symptoms of a UTI, so you might be in the clear. If this continues to worry you, then I would consider speaking to a medical professional if this is possible.

Birth control can cause irregular periods and spotting, so that could explain what you are experiencing. In my own experience with birth control, I have experienced a shift in timing with my period. This is even common for people who aren't on birth control. Also, irregular periods/spotting could be due to the state of your uterine lining or stress from everyday life. Please let me know if this answers your questions!

[Juliaho90]

Thanks Nicole. But is it possible to have spotting while I am on the pill still? I always presumed that if I was on the pill, I won’t be spotting or getting withdrawal bleeds until my pill free break.

[Sam W]

As Nicole said above, spotting can happen while someone is on the pill, and for some people it can even be a side effect of the pill.

When you think about the worry you tend to have about slight changes to your cycle or withdrawal bleed, where do those worries tend to come from? Does it feel like they center on being worried that the pill has stopped working? Infection? Something else?

[Juliaho90]

Hi Sam, I worry that the pill is ineffective since I am experiencing some sudden spotting. I also worry that because I haven’t taken the pill at the exact same time, it is ineffective. I take it in the same time window like from 9.30am to 11am or sometimes even earlier than 930am, depending on my schedule. And I stress a lot about it, counting the pills in case I missed out any. Which I haven’t.

Also curious, how does spotting happen when one is still on the pill? Does this mean the hormones aren’t enough?

[Carly]

Hey JuliaHo90 -- the time range you take your pill in is fine. If you don't take it at exactly the same time but still take it on the day you're supposed to your pills will not become ineffective. If you want to be as close as you can to "perfect-use" effectiveness, you'll want to try and take your pills within the same three-hour window each day.

Something I've noticed is that you mostly post worries about using the pill. I'm wondering, what made you decide to use it? Elise brought this up too, but have you ever considering choosing another method, like an IUD? Is there anything else available to you? I'm wondering if switching to something with less room for "user error" would help with these anxieties. Some folks do prefer the pill for a variety of reasons, and that is totally ok. I just wanted to make sure it's the best method that's available to you.

I also wanted to mention that the resources that were shared with you in the thread were actually shared with you a few times before other threads. It's ok to ask questions when you have them, but I highly suggest bookmarking or saving these resources and consulting them first to see if the answer is there. If these resources are not accessible in some way and that isn't easy for you to do, we'd love to hear how we can improve that.

[Heather]

Hi there, Julia. I'm popping in to talk about spotting.

Here's the thing: if you have a uterus, and you're somewhere in your life and human condition where you are between puberty and menopause, spotting is a thing that both can and sometimes will happen.

It doesn't stop being a thing that can happen on the pill, because the pill doesn't take away or get rid of your uterus or ovaries and the hormones they produce in reproductive cycles. Instead, it uses synthetic versions of those same hormones to create a different balance and pattern of the hormones you have happening already so that pregnancy is highly unlikely. You do still have some version of a menstrual cycle, because the pill was also designed to mimic those in some ways, just not a fertility cycle.

You also still have a uterine lining, like you would without the pill, but one of the two main ways the pill works is to keep that lining thin (via the progesterone in it) so that even in the event the other way it worked failed, there wouldn't be enough lining for a pregnancy to happen.

Spotting happens when not on the pill due to hormonal changes and fluctutations, sometimes even really subtle ones. Those still happen on the pill because those and other hormones are still in your body, and because the pill is also keeping that lining thin with extra progesterone, spotting can happen on the pill for that reason, too. There are some other more uncommon reasons, like infections or fibroids, for example, but by and large spotting is just about hormone shifts, which can happen in bodies pretty much any time.

Make sense?

[Juliaho90]

Thank you heather! I totally forgot my body makes these hormones too and sometimes naturally it fluctuates because of stress etc. so they make sense now.

As for the contraceptive method, I didn’t consider IUDs though I know they have a higher success rate but I feel like I need a method where I am physically doing something each time to prevent pregnancy. So me taking a pill each day, this action, is supposed to make me feel reassured. And it would need to be something I can track. Hence the pill was thought to be the best option for me.

I think lately I have been under a lot of stress and anxiety. I have been seeing a psychologist for these issues too.

[Heather]

Happy to help clear that up for you.

It sounds to me like the idea of doing something everyday to reassure yourself hasn't been successful. That's not super surprising to me, because sometimes something like this where you have to focus on it every day and where there is room for error can have the opposite effect, and instead of quelling anxiety, increase it.

Since that plan isn't working for you, even when backing up with a condom, what do you think about switching instead to something where there's no question about if you can or have made a mistake, because your method working to its capacity isn't something you have to control in the first place? IUDs and implants are the most effective reversible methods out there and do their job all by themselves.

A middle ground for you might be a Depo-Provera injection, where you do have to do something, but only four times a year, and by showing up to a healthcare provider's office to get your injection.

Lastly, have you talked with your therapist about the anxiety manifesting around this? If so, did they have any suggestions for you about how to manage it?