Thank you for your question – it seems to me that your question has two parts – one is about how well birth control pills work, and the other is about Plan B. I have a lot of information about Plan B HERE. And I have talked about missed pills HERE. But your question reminds me that I am long overdue for a good summary of how birth control pills work, how well they prevent pregnancy, why you still need to use condoms, other things birth control pills can be used for other than pregnancy prevention, and more.
So, let’s get started.
What exactly are birth control pills and how do they work?
Birth control pills usually contain a combination of two hormones – progesterone and estrogen. These work together to prevent pregnancy by preventing ovulation (the release of the egg) each month, by making the lining of the uterus thinner to prevent implantation, and in other ways. Some pills contain only progesterone, but most have both.
Are there different kinds?
There are a lot of different types of pills, each with slightly different hormone amounts and ratios. Some pills have the same combination of estrogen and progesterone each day, and others change the amounts of estrogen / progesterone week to week. No one pill is better than another, though each woman may have different experiences with different pills (meaning that if one doesn’t agree with you another formulation might be a better fit for you.) Most pills come in monthly packs, where you take 21 days of active pills, and then 7 days of placebo (sugar pills) – during those 7 days, you get your period. There are some brands which you can take active pills for 84 days and then a week with no pills so you get a period every 3 months – you need to check with your Dr about how to do that exactly. Don’t try it on your own!
How well do they work?
The average Pill failure rate is about 10% per year. Meaning that over a year, 1 in 10 users may get pregnant. This is almost always because of missed pills or not taking the pill perfectly. If used perfectly, the failure rate is very, very low. If remembering to take a pill every day isn’t for you, then you might want to consider another birth control option – there are a lot out there!
How do I start the pill?
First you will take a pregnancy test – if it is negative, and after your Doctor or nurse prescribes the Pill for you, you can start it one of two ways:
- Start the first Sunday after your next period starts. This gets the hormones most in line with your natural cycle so there is less spotting at the beginning and weird period adjustments. It also makes the Pill effective sooner. Just in case you can overlap with backup contraception for a week if you want.
- Or, start the pill the same day – for this method you might have some spotting for the first few cycles while everything gets lined up, hormonally. And you definitely need a backup birth control method for the first week of the pill, no matter what.
What do I do if I missed a pill?
Missed pills are the reason for pregnancy occurrence in women taking the Pill, almost always. What to do:
- If you missed one pill in a cycle, take it as soon as you remember and keep on going with what the regular schedule is. This means you will take 2 pills on the same day, maybe at the exact same time if you don’t realize it until you open your pack and see yesterday’s pill sitting there staring at you.
- Do this every time you miss a pill. But if you miss 2 pills in a cycle, you need a backup method for the rest of that pack.
- If you miss 2 pills in a row, double up when you remember and keep taking the rest of the pack with backup protection.
What about if you took an extra pill by accident?
Not a problem – just keep taking the pills in the rest of the pack one a day – you will finish the pack a day earlier, but that is OK. If you aren’t sure what to do, call your Dr or nurse! There are other situations where they may make other recommendations. And when in doubt, use a backup!
Always, for STD prevention. The only exception? Both partners are tested at the same time and all STD screens come back negative. And you both are monogamous.
Most women have very few side effects, especially now that hormone doses in pills are lower than in the past. The first few months you might have some breast tenderness, a bit of bloating and maybe nausea (taking the Pill at bedtime can help with that). You may have read that Pill cause blood clots – they can. But actually the risk of blood clots with pregnancy is HIGHER than on the Pill. If you have family members who have had blood clots, you will want to mention that to your Dr when you go in to ask about birth control. What do they NOT cause? AKA side effect urban legends: They do not cause weight gain, birth defects, or infertility.
Other things birth control pills are used for.
Some young women can benefit from birth control pills for reasons not related to preventing pregnancy. The Pill can make you periods lighter so you lose less blood (and iron!) each month. It also can decrease cramps and PMS. And, acne – they can lessen acne. And if you get migraines related to your periods, there are some pills that might be able to help with those too (though this is something you should discuss specifically with your Dr).
So, back to your question, you are wise to use both the Pill and condoms for the reasons we talked about above. You have double protection, and STD protection and it sounds like you are very serious about taking the Pill properly and every day. This is the perfect way to use the Pill to prevent pregnancy. In a scenario like this, it is very unlikely that pregnancy can occur (again, if every single day the Pill was taken properly). For information about Plan B specifically, read more HERE. You might be interested to know that for women on the Pill who have an issue where they think they might have an accidental fertilization, there is a way that regular birth control pills can be used in an emergency (like a Plan B) – for that situation, I always encourage teens to call their Dr for more information so that they know what to do in advance of needing to do it.
I hope this helps clear up some questions. Remember, Real Talk with Dr Offutt answers questions for everyone – we are not a replacement for asking your own regular Dr or NP for medical guidance and we cannot respond ot urgent medical situations. What we are all about is sharing as much useful medical information with teens like you out there in the e-world, and your questions help us know what worries teens about their health.