Are women still advised to take their pills at the same time very day?

Q:        Do birth control pill instructions still include the phrase “Take a pill every day at the same time?”

A:         

This remains a common instruction.  And like everything else in life there is wisdom and there are potential problems with this advice.

The Good Side of this advice is that it:

  • ·        helps women stay on schedule
  • ·        permits a partner to participate in the daily challenge of taking pills by calling or saying something to his partner or wife at about the same time each day
  • ·        and still another benefit derived from taking pills on schedule is that it helps prevent spotting or breakthrough bleeding

The Unfortunate Side of this advice if it is presented too strongly, is that:

  • ·        it overemphasizes the importance of the phrase “the same time”
  • ·        it may cause her needless concern should she take a pill an hour, 4 hours or a day late
  • ·        she may be induced to double up pills, increasing her risk for nausea
  • ·        and she may be stimulated to go get emergency contraceptive pills, which are not necessary, but which takes time, costs money, and may be embarrassing.  She most likely does not know that she need NOT use emergency contraceptive pills, even when a full day late!

Below is my response to a woman asking about problems she has had taking pills on schedule. They are the all-too-complicated instructions suggestions published by the World Health Organization in 2005 in their Selected practice guidelines for contraceptive use.  They are far too complicated and the Centers for Disease Control (CDC) in Atlanta will be looking at these suggestions and hopefully will simplify then in the not too distant future:

Some additional information that may surprise you

  1. Continue taking all the pills in this cycle on schedule.
  2. Pregnancy risk is not increased by small mistakes in taking pills.  You have so much more latitude in taking pills than you realize as suggested by the following guidance from the World Health Organization developed by contraceptive experts from around the world. 
  3. Developing a pattern of taking pills is wise but not essential in terms of pill effectiveness.
  4. HOWEVER, missing as much as a single pill can lead to spotting so staying on schedule is important.
Regardless of the time-zone you are in, stick with your pattern of taking pills at about the same time (10:00 PM).  Missing a pill for a day is not wise, but is also not likely to lead to a pregnancy.  Starting a new package of pills a day late is definitely not wise, but also does not increase your risk of pregnancy much.

There is a lot more flexibility taking pills than most women and most clinicians realize.

You have more wiggle room than you may have thought you have.  See the following guidance from the World Health Organization:

 

MISSING PILLS

What can a woman do if she misses combined oral contraceptives (COCs)?

For 30-35 µg ethinylestradiol pills:

Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late

  • She should take an active (hormonal) pill as soon as possible * and then continue taking pills daily, 1 each day.
  • She does not need any additional contraceptive protection.

Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late

  • She should take an active (hormonal) pill as soon as possible* and then continue taking pills daily, 1 each day.
  • She should also use condoms or abstain from sex until she has taken active (hormonal) pills for 7 days in a row.
  • If she missed the pills in the third week, she should finish the active (hormonal) pills in her current pack and start a new pack the next day.  She should not take the 7 inactive pills.
  • If she missed the pills in the first week and had unprotected sex, she may wish to consider the use of emergency contraception.

For 20 µg or less ethinylestradiol pills:

  • If the woman misses 1 active (hormonal) pill or starts a pack 1 day late, she should follow the guidance above for “Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late.”
  • If the woman misses 2 or more active (hormonal) pills or if she starts a pack 2 or more days late, she should follow the guidance above for “Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late.”

For both 30-35 µg and 20 µg or less ethinylestradiol pills:

Missed any inactive (non-hormonal) pills

  • She should discard the missed inactive (non-hormonal) pill(s) and then continue taking pills daily, 1 each day.

*    If a woman misses more than 1 active (hormonal) pill, she can take the first missed pill and then either continue taking the rest of the missed pills or discard them to stay on schedule.

From the World Health Organization’s Selected Practice guidelines – 2005

You DO NOT NEED TO take emergency contraceptive pills if you are late for one or several pills or if you miss one pill in the future.  

Good luck!

To learn more about the advantages and disadvantages of birth control pills, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?