Do you really need to take the combined Pill at the exact same time every day?

May 7, 2015

Video by Mamamia

Every woman who’s used the Pill knows you’re recommended to take it at the same time every day. But unless you’re a real-life Femmebot, chances are you haven’t always succeeded in doing this.

Life just gets in the way sometimes. You might accidentally sleep in and bypass Pill o’clock by a few hours. You might hop on an international flight and cross time zones, throwing your hourly schedule into disarray. It’s also possible to just forget.

Regardless of the cause, we’ve all felt that panicky stomach-drop on realising what’s happened. Because if we don’t take the Pill at precisely the same time, obviously it won’t work and we’ll be pregnant in no time… right?

“You actually don’t really need to take the Pill at the exact same time every single day, except for the mini pill,” explains Dr Ginni Mansberg, a Sydney GP with more than 20 years of experience.

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“The reason why we [doctors] say to take it at the same time every day is because if you’re a bit of a space cadet, and you only do things if you’re in a routine, the knowledge that you can take it any time, any place means you won’t take it very effectively. It’s more for your convenience, and so you don’t forget, than anything else.”

Before we go any further, there’s an important distinction to make here: the quote above pertains to the combined Pill. However, women who use the mini pill do need to take it at the same time, within a two-hour window, every day. This is because it works differently.

“The mini pill’s only got progesterone in it, it doesn’t have any oestrogen in it. So it won’t suppress your ovulation at all, but it’ll just thicken up the mucus in the cervix and make it more difficult for the sperm to get up there,” Dr Mansberg says. So, if you take it outside of the specified window, there’s a chance it won’t work as effectively.

This narrow two-hour window doesn't apply as strictly to the combined Pill. "How you know this is because we give you seven Pill-free days with the vast majority of Pills, and guess what? You don't ovulate," Dr Mansberg says.

"That artificial 'period' we give you isn't really a period, it's just a withdrawal bleed from oestrogen. You don't ovulate in that time. As long as you get back on the pill after those seven Pill-free days, you're not going to get pregnant. And yet people freak out about missing one pill."

It is a good idea to aim to take your pill at roughly the same time every day, so you get in the habit of taking it daily. Keeping your packet in a visible spot, or setting yourself an alarm, will help you remember. However, if you're crawling into bed at 10.30pm and suddenly realise you forgot to take your tablet at lunchtime as you usually do, don't write it off altogether. Just keep calm and take it as soon as you realise within 12 hours.
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Popular forms of birth control

Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.

Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.

DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.

Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.

condom attacks HIV — CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.

The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.

Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.

Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled

The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.

SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

"If you get home at night and realise your Wednesday pill is still in the packet, just take it then. It's fine. If you work out the next morning there are two pills there when there should only be one, eg. it's Thursday and you've got the Thursday and Wednesday pills there, just take both of them," Dr Mansberg says.

If you miss more than two pills, you'll probably start experiencing breakthrough bleeding, even if you try to continue taking your pills as usual.

"That's why we say if you've missed more than two pills, forget it — write that month off, call it a period, throw that pill packet out and start again," Dr Mansberg says.

Dr Mansberg says this need to start over isn't about having a Surprise Baby. It's because having ongoing breakthrough bleeding for the rest of the month isn't going to pleasant for you.

Forgot to take the Pill? It's OK, take two today.

"It takes quite a long time for your body to ovulate after not being on the pill," Dr Mansberg says.

"Of course, there have been exceptions. But for 99.9 per cent of women, if you take your [active] pills and you miss seven [by taking sugar pills] to have a period, you won't get pregnant. Most pill 'failures' are from people not taking it properly."

It's also important to know that if you are a bit of a space cadet and you really struggle to remember to pop your pill every day, there are other birth control options that don't require your daily attention. There's the intra-uterine device (IUD), for instance, which lasts for five years; or the NuvaRing, which you take out and replace every three weeks. The best part? The company will send you a text reminding you to do this.

As always, if you have concerns or you want more information, have a chat to your GP or call Family Planning Australia.

What kind of birth control do you use?