Ovulation and the pill

[FadedPassion]

Hello! First of all I just wanted to give a shout out to everyone here for helping with my anxiety about taking my pill. I've decided to also buddy up with condoms along with my perfect pill use which has eased my mind a lot.

The other day I was reading a message board and came across a conversation that I wanted some clarity about. This girl was saying how the combo pill only suppresses ovulation 75% of the time. I've never heard of this statistic before and was wondering if it's true? I have heard that you have a higher chance of ovulating on a progestin only method but I've never heard of this about the combo pill. Just to clarify I am aware that there's a small possibility of ovulating on the pill but I thought it was very small and not 25%.

She also said that her specific pill says it's more effective than a standard combo pill. She says her pill pamphlet says hers is 99.9% effective. Everything I've ever read says that all combo pills are 99.7% effective. My pill pamphlet isnt that clear, all it says is "all combination pills are over 99% effective". I was wondering if it's possible that different combo pills can have different effectiveness?

[Heather]

All combined hormonal contraceptives are in that 99.7-99.9% range for one year of perfect use. Which is really not a very useful figure since a) so, so few people will literally never make a single mistake in one full year and b) in one full year, that .2 percent difference is really no real difference at all.

Here's the most comprehensive literature/study review on ovulation incidence and COCs I can find online if you want to dig in: http://srh.bmj.com/content/familyplanni ... 7.full.pdf

I'm not sure, though, why you're glomming on to what this random person on the internet said (and no, I haven't seen that figure before, and can't speak to its accuracy, especially since "random internet girl" isn't a credible source of anything, and it doesn't sound like she showed where she saw this) as a cause for concern. Combined oral contraceptives work in THREE ways: suppressing ovulation is but one of them, and the other two -- thickening cervical mucus to inhibit sperm cell mobility and thinning uterine lining to make implantation unlikely -- are also highly effective, and are there in the event ovulation isn't suppressed.

[FadedPassion]

Thank you I appreciate it! It was more just out of curiosity, it was something I never heard of before so I wanted to educate myself on it. She claims that all of her obgyn's told her this information and that they had pamphlets to back it up, again not sure if I believe it lol. Then she said how her pill is apparently "one of the most effective" according to her pill pamphlet at 99.9% effective which again I never heard of.

Sorry just 1 more question if you don't mind. I know the pill works in those 3 ways like you stated, if 1 or even 2 of those ways happened to fail would the pill still be <99% effective or would it go significantly lower?

[Alice O]

Hi FadedPassion,

There are two parts of my answer.

1. It sounds like you are asking: if someone ovulated, and had a typical amount of cervical mucus, but had a thinner uterine lining, would that person have a 99% chance of not getting pregnant? A thinner uterine lining would make it difficult for a fertilized egg to implant, so it would definitely help prevent pregnancy, but I do not know the exact effectiveness rate of this. As Heather stated, the almost 100% effectiveness of the combined oral contraceptive is due to having 3 methods of preventing pregnancy.

2. As you can tell this question gets us pretty far into the land of math and probability. And the reality is we are humans, not robots, and human medicine is far less simple, and less black-and-white than we may want it to be. An anxious mind can obsess over a question like this forever! Instead, I would encourage you to remind yourself that this is your anxiety/obsessiveness speaking, and re-direct your attention elsewhere. While of course also continuing to work on treatment for your mental health.

We can continue to talk about mental health treatment, but we won't answer any more questions about the effectiveness rate of the combined pill, as we have headed into anxiety-land.

[FadedPassion]

Thank you. Sorry I didn't mean to come across as if I'm going crazy over mental health issues.... I was just curious.

[Alice O]

Don't worry, I'm absolutely not judging you as "crazy"! I just wanted to acknowledge the role that anxiety often plays when we fixate on questions like this.

[FadedPassion]

Oh of course I totally understand
I'm doing very well handling my anxiety over the past few months. I like to learn and educate myself on these types of things so I apologize if my curiosity seemed to come off as overly obsessive or anxious. Thank you for taking the time to answer.

[Jacob]

Hey faded passion,

I don't know where the initial misinformation came from but to me it sounds like somebody misunderstood how the pill works and then spread their misunderstanding.

If using the pill you are 'technically' only receiving additional hormones for three of every 4 weeks, but that's because the contraceptive pill has an affect on your whole cycle, and every 4th week (i.e. 25%), when you aren't fertile, you are on placebo pills. There's no egg to fertalise, because ovulation has already been prevented when it would have occurred earlier in the cycle. I'm guessing that's where they came up with 25% but in this context it means nothing.

Again, technically speaking, you only ovulate once per cycle anyway, so really it only needs to prevent ovulation once a month, the rest of the time it's the things which Heather described. That's both enough, and the maximum possible amount of ovulation prevention.

Please be wary of people putting out bad information online, I hope this helped clear that up!