Oral contraceptive question

[Juliaho90]

Hi, I am only occasionally sexually active. My partner and I don’t really have a chance to be intimate with each other because we don’t stay together and only have a chance to do so when we go on a trip together, which rarely happens because of busy work schedules etc.

So this December, we are planning a trip and I know with my anxiety and OCD, I tend to get very paranoid about being pregnant even though we do not have penetrative vaginal sex at all. Sometimes we shower together, or lay on top of each other when we kiss so there may be genital contact there, although no penetration or ejaculation.

I am thinking of getting oral contraceptive pills, just for the purpose of the upcoming trip so that I will not get paranoid and scared. I have read through the information available on the website but I have more questions. I haven never taken any oral contraceptive pills before and know nothing much about it so please bear with me:

1. Are oral contraceptive pills safe in general? Since you are actually taking in synthetic hormones, does it cause cancer if I take the pills?

2. Is it ok (in terms of health and safety wise) for me to take the pills just for the December month/cycle so that I push back my period for December (so I won’t have it during the trip) and discontinue use after since we will not be intimate and therefore no need for the pills?

3. I know the pills do not take effect immediately.. but my next period isn’t due until mid of Nov. Can I start taking the oral contraceptives when my next cycle starts (within days 1-5), and ensure that those pills will have the full effect to prevent pregnancy in December when I am on the trip?

I have anxiety and OCD, so I definitely prefer to be in control. My partner is cool to put on a condom when necessary so it isn’t about that.

[Sam W]

Hi Juliaho,

For your second question, those are all things to talk with your healthcare provider about. Honestly, we don't recommend people plan to start and stop the pill over such a short time, if for no other reason than it can cause some irregularity in your cycle as your body adjusts (which, if you're prone to pregnancy scares, may increase your anxiety). And yes, if you started in November, did one pack, and then started a second pack in December, you should have full protection during that December pack.

For your first question, it may help to know that the pill is actually one of the most studied medications out there. Resistance (mostly of the political or religious variety) to it when it first was in development resulted in more rigorous testing and study than we've seen with nearly any other medication, so we can be very sure it is safe overall, surer than we can for many other medications out there. That being said, it's still important to talk with a healthcare provider to see if you have risk factors in your own health that make the pill a higher risk option.

I just want to check, are you receiving mental health support, like counseling or medication, for your anxiety and OCD?

[Juliaho90]

Hi Sam. Thank you for the quick response.

1. I understand that it doesn’t make sense to start and stop so quickly and usually people go on the pill for longer. But in term of health and safety wise, is that ok for me to do so if I only need it for that trip? Will my period go back to normal cycle when I stop taking the pill?

2. When do you think I should see the doctor regarding oral contraceptives? My period is not due until 17 November so I have a bit of time until the next cycle..

3. Also, if I am on the pill, and I decide that I don’t want to take it anymore. Can I just stop taking the pill and the “withdrawal bleed” will start? I am a little confused about the withdrawal bleed too, I mean I understand that it is not really a period since there is no ovulation, so where does the blood come from? Is withdrawal bleeding safe?

4. If I end up getting pregnant while on the pill, will I still have “withdrawal bleed”?

And to answer your last question, yes I am seeing a psychologist every other month.

[Sam W]

You're welcome! And glad to hear you're getting support for your mental health.

Your cycle will eventually go back to normal once you stop the pull. And I would suggest talking with your healthcare provider about starting the pill sooner rather than later, so you're not scrambling to get it done before your trip. They can also figure out any risks based on your health history, and help you figure out the timing of starting and stopping the pill.

If you stop the pill in the middle of the pack, you will likely get your withdrawal bleed. Withdrawal bleeding is safe, and it's the result of the hormone cycle that happens while you're on the pill causing your uterus to shed its lining (so its a mix of things like that tissue, blood, and vaginal discharge). As far as pregnancy goes, you should treat your withdrawal bleed like a period; if you get it, it means you're not pregnant.

[Juliaho90]

Thank you Sam. While I have you online, just a few more questions..

1. Is it possible to be on the pill, but not get the withdrawal bleeding even though I am not pregnant? In that case, can I still use a pregnancy test kit to check for pregnancy? I suppose the pill doesn’t interfere with the pregnancy test results?

2. Is it possible for the withdrawal bleeding to happen after I finish the placebo pills? Go example the withdrawal bleed comes after the last pill in the 28 day pack? In that case, do I continue to take the active pills despite having the withdrawal bleed?

[Sam W]

When you're first on the pill, because your body is still adjusting, your withdrawal bleed may not come when you expect it to. And some people do get a withdrawal bleed that starts later than the placebo pills do. When that happens, you keep taking the pills as directed, even if that means starting the next active pack while still on your withdrawal bleed.

Just like periods, withdrawal can be missed or late for reasons that aren't pregnancy, and you can read about those here: M.I.A or, Dude, Where's My Period?. But, if you know you've engaged in sex that poses a pregnancy risk and your withdrawal bleed doesn't come, you can take a pregnancy test just to be safe. And you're correct, being on the pill won't interfere with the results of the test.

[Juliaho90]

Thanks Sam for the response.

Is there a reason why you wouldn’t recommend start and stopping oral contraceptives within a short period of time? Other than causing irregularities in the cycle? I guess safety wise it’s ok?

Also, once I stop taking the pills, how long does it take for my cycle to go back to normal? I know different people have different cycles but in average?

Also, can I be on the pill and taking emergency contraceptive at the same time? (if I am really paranoid and worried?)

[Siân]

The main reason not to take the pill for just short periods of time is that it takes time for your body to adjust both to starting it and to coming off it. It could make your cycle very irregular, and you won't be giving it time for all the side effects to settle down before stopping again. It's not a safety concern.

I don't have any data on how long it takes for the average cycle to go back to normal after the pill. There will be a huge variation between people - a few months is a reasonable assumption.

You can take emergency contraception whilst using the pill. I wouldn't recommend it unless you've had a genuine pregnancy risk though, as the side effects may be stronger doubling up on hormones from both the pill and the emergency contraception.

I think it's worth putting that risk in perspective for a moment here. From what you've said:
1. You are not having the kinds of sex that lead to pregnancy
2. Your partner wears a condom for any genital contact
3. You are planning to be on the pill.

Any one of those would be good protection against pregnancy. A combination of any two would take the risk to pretty negligible. The three together take the probabilities of pregnancy well into range of unthinkably small. I know that anxiety and OCD make it really challenging not to keep thinking about these tiny risks, but I wonder how much these questions are helping you manage your worries, and how much they are feeding them?

[Juliaho90]

He doesn’t wear a condom for genital contact - e.g when we hug in a shower, we are obviously both naked and so while hugging our genitals (his penis erect) would come into contact. Or when we are in bed, not having sex but making out naked (no genital rubbing) and he lies on top of me sometimes, we have genital contact then. I am not sure if that counts as a pregnancy risk.

That’s my reason for concern. Sometimes in the heat of the moment, you can’t control these things.

I am planning to go on the pill for 3 months and then stop. What do you think? There isn’t a need to go on the pill for a longer time because like I said, we don’t really get intimate unless we go on a trip together. And I don’t want to be on the pill long term.

[Juliaho90]

Also, I am planning to see a doctor to ask questions in the next couple of days.. but I am kind of scared though. This is my first time asking for oral contraceptives, I am worried and I don’t know how to start a conversation with the doctor about this.. most doctors aren’t really empathetic.. so that scares me a little

[Sam W]

Hi Juliaho,

A quick hug while you're both naked is unlikely to realistically pose a pregnancy risk. With the making out while naked, unless you're both holding perfectly still you're basically engaging in frottage, which does pose some pregnancy risk (and STI risks as well).

I do want to point out that, even in the heat of the moment, people are able to stop and adjust. So, for instance, if you're naked and about to make out, one or both of you could say, "hey, can we put our underwear back on to do this?"

With your doctor, being matter of fact and direct about what you want is a helpful approach. Similarly, it can help to remember that your doctor is there to help you, and part of that means they're there to answer questions you have about your health or medications. You may also find the tips in this article useful: Dealing With Doctors: Taking Control of Your Health Care Destiny

[Juliaho90]

Hi Sam,

Thank you. I think right now I am on the fence.. I really want to get started on oral contraceptives so that I can enjoy the intimacy without being so paranoid.

But yet I am very afraid that once I start taking the pills and decide to stop eventually, I will not be able to get my periods back and this causes another set of problems. Is it hard to get your normal period back after you stop taking the pills? I know the body does take time to adjust but I am so scared that my body will stop producing hormones for period all together and I will be stuck with no period at all.. is that possible?

[Sam W]

Hi Juliaho,

No, it's not really possible for being on the pill and then coming off it to make your periods go away forever. Think about how, for birth control pills to work properly, you have to take one everyday. That's because the contents of each individual pill only hang around a little while in your body. If the pill was strong enough to stop a period forever, you wouldn't have to keep taking them each day. Does that make sense?

[Juliaho90]

Thank you, I understand now.

If I decide to go on the pill now, and go on my trip on 20 Dec, can I assume that the pill will already have full effectiveness?

I know that no contraceptive is 100%, but I wonder what is the effectiveness if I just take the pill alone without using condoms? I do not have vaginal intercourse or any penetrative sexual acts with my partner, but as mentioned, sometimes we do get involved in frottage naked (him not wearing a condom) and I wonder if that happens when I am on the pill, is that still safe because I am protected by the pill? Just kind of confused because it is said that the pill is actually more effective than a condom, because condom tears sometimes right, although it’s rare.

[Sam W]

You're quite welcome.

As long as you get all the way through your first pack before the 20th, you can assume you'll have full protection.

So, using a condom plus the pill gives you an even higher level of protection, because you're combining two effective methods (and the condom is protecting against STIs as well). That's why we recommend people use a back-up method of birth control if they're looking to be as safe as possible: The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method[/. It all depends on what level of risk you're comfortable with.

It may also help to know that, while the pill has a higher effectiveness rate than condoms, for both those methods the decreases in effectiveness often come from user error. With condoms, that means people do things that make them more likely to break or come off. With the pill, people can forget to take it when they're supposed to and end up decreasing the effectiveness that way.

[Juliaho90]

Thank you.. but I am slightly comfused again. I’m sorry but I have a question.

So if I am on the birth control pill and have genital contact with no condom, do I need to take emergency contraceptive pill (plan b/Ella) to further reduce my risk of pregnancy? Since the pill is not 100%?

I feel like I don’t have confidence with the birth control pills and with condoms. I am still scared that I could get pregnancy because no method is 100%.

[Juliaho90]

Is it safe to take emergency contraceptives together with the regular combined contraceptive pills to be taken everyday?

[Sam W]

Again, that all depends on how much risk you're comfortable with, and there's no danger in taking emergency contraception while on the pill. However, unless you have reason to think your pill had been compromised (like you'd forgotten to take one entirely), there's not really a reason to take emergency contraception, because it's meant to be used if a birth control method fails.

Too, if you're starting to realize you're not comfortable with any amount of risk, no matter how small, that may be a sign that you need to steer clear of any activities that involve direct contact between naked genitals.

[Juliaho90]

Thank you Sam.
I get where you are coming from regarding staying clear of intimacy with the naked genital.
So if I am on the birth control and have contact with naked genitals, can I say there isn’t a real need for me to take emergency contraceptive because if the birth control pill was taken as directed, the birth control pill would have done it’s thing protected me from pregnancy right?

[Sam W]

That's right. You can, of course, keep some emergency contraception on hand just in case it would make you feel more comfortable to have around.

Too, you may want to talk with your partner (if you haven't already) about what risks, or level of risk, you're each comfortable with so you can make sure you're on the same page.

[Heather]

Just sticking my nose in to say that being able to manipulate your periods the way you want so soon after starting the pill is pretty iffy. It might do that for you, but it’s more likely to take a few months and in those first months you’re likely to have unpredictable bleeding and spotting.

I also want to add that the pill does not stop your body from producing the hormones that are the why (one reason why, anyway) of periods. Rather, it just changes the schedule of those hormones, with the help of extra synthetic hormones.

[SpaceCowboy]

Hey,

Just popping in because I, myself, have OCD, and I can COMPLETELY relate to being obsessed with the idea of needing to prevent pregnancy and so feeling compelled to engage in what one might call an excessive amount of risk management. We engage in our compulsions to help alleviate the anxiety caused by our obsessions, but it ultimately does not really help with reducing our overall level of anxiety and stress.

Reading your post, I do wonder if some of what is causing this obsession with the possibility of pregnancy is some underlying discomfort or anxiety related to sexual intimacy (whether in general or with this particular partner). My obsessions are often a kind of warped overdrive of what is making me anxious in my life. Does your partner know about your feelings of pregnancy anxiety? Talking with them about how anxious you feel about this possibility (and any other anxieties around sexual intimacy you might be having) may help you to sort through your feelings and decide how to move forward.

[Juliaho90]

Hello! I just wanted to share that I went to the doctor today and felt really good about getting the pills. The conversation was not awkward at all. She prescribed me Yasmin and told me I didn’t have to worry about the side effects since I was healthy and have no previous medical conditions.

I then went online (drugs.com) to look at Yasmin’s reviews and the comments shocked me! I mean there were a lot of people suffering from severe side effects after taking yasmin, and they said to beware of the particular brand of pill. My doctor say nothing and told me that Yasmin is a popular choice of brand for most people.

Now I am stuck... should I take the pill? I am planning to start on the first day of my period, which would come in the next week or so. I know different people react differently, I am just shocked to see how bad people find the pill.

[Juliaho90]

Hey,

Just popping in because I, myself, have OCD, and I can COMPLETELY relate to being obsessed with the idea of needing to prevent pregnancy and so feeling compelled to engage in what one might call an excessive amount of risk management. We engage in our compulsions to help alleviate the anxiety caused by our obsessions, but it ultimately does not really help with reducing our overall level of anxiety and stress.

Reading your post, I do wonder if some of what is causing this obsession with the possibility of pregnancy is some underlying discomfort or anxiety related to sexual intimacy (whether in general or with this particular partner). My obsessions are often a kind of warped overdrive of what is making me anxious in my life. Does your partner know about your feelings of pregnancy anxiety? Talking with them about how anxious you feel about this possibility (and any other anxieties around sexual intimacy you might be having) may help you to sort through your feelings and decide how to move forward.

Thanks for the note! I am just struggling generally with anxiety for a really long time and have been seeing my therapist for about a year now. I just really cannot ever afford to be pregnant. Hence all the anxiety with the intimacy. I hope you are also taking care of your anxiety

[Juliaho90]

Hello... sorry I am not sure if I can kept posting in the same thread since it’s still with regards to the birth control pill.

With yasmin, I was given the 21 days pack. So I read from your site that it is about 91% effective in typical use and almost 99% in perfect use. Can someone tell me the definition of typical vs perfect?

If I take the pill everyday, at almost the same time, never skipping a pill, is that typical or perfect? I know the pill needs to be taken at the same time everyday, but sometimes if I am at work I can’t take it on the dot at the exact same time. So for example, if I take it at 10.30am everyday, but sometimes I take it at 12noon at lunch or sometimes 6am before work. Does it mean I am a perfect user or typical user?

When is it considered a missed pill? Does it matter if I take it a few minutes or few hours early/late sometimes? Is there a flexible range I can play with? My doctor didn’t advise me on that.

I am trying to make my pill as effective as possible.. so if anyone can help that will be great.