Something I’ve discovered in my years of stretching condoms over my arm for educational purposes and pleading with the public to get tested is that a sexpert’s work is never really done. When you least expect it, someone will pull you aside or text you or Facebook message you out of the blue with a question they hope you can help with. Always and everywhere, people are wondering about sex.
Case in point: I was recently at the wedding of a pair of dear friends. During the reception, the bride suddenly popped up behind me. “I need you,” she said, laying a hand on my shoulder.
She explained that she had realized that morning that she had forgotten to take her birth control pill the night before. “How worried do I need to be?” she asked, then added, “This isn’t 1956. I am NOT trying to get knocked up on my wedding night.”
Although 99 percent of American women who have ever had sex have used a contraceptive method, most people know very little about the way these drugs and devices actually work to prevent pregnancy. That lack of understanding can cause all sorts of anxiety and complications. As with most other things in life, knowledge is power.
Before I could answer the bride’s question, I had a few questions of my own. First, I needed to know what type of pill in her pack she’d missed. Was it one of the active pills in the first three rows? Or one of the placebos in the fourth row?
In a standard pack of birth control pills, only the first three rows contain active ingredients that prevent pregnancy. The fourth week are just sugar pills intended to keep people in the habit of taking a pill every day so that they don’t forget to re-start their active pills at the right time. If you miss one of those, no biggie. If you miss an active pill, then there’s more to discuss.
She confirmed that she had missed an active pill. Next, I needed to know what specific kind of pill she was taking.
KNOW YOUR PILLS
Although being called “the Pill” can make it seem like there’s only one kind of oral contraceptive, there are actually dozens of formulations. Most people who take contraceptive pills are prescribed some variation of a class of drugs known as combined oral contraceptives. The “combined” part is in reference to the fact that there are two synthetic hormones mushed up into there — chemical mimics of progesterone and estrogen, which naturally occur in the body and work together to regulate aspects of ovulation (the release of eggs) and the menstrual cycle.
Another, less-frequently prescribed class of oral contraceptive are progestin-only pills, sometimes called minipills. More on those in a minute.
The bride told me that she took a combined pill. Next, I needed to know a little more about her habits when it came to taking it. Was she generally good about taking it each day, or had she missed others this month?
Contraceptive pills work to prevent pregnancy through a combination of three actions. Most importantly, they suppress ovulation. If there’s no egg to fertilize, that Eggo can’t get preggo.
They also thicken cervical mucus, making it harder for sperm to swim, and thin out the lining of the uterus, making it a less cozy place for an embryo to implant. These secondary effects can provide additional barriers to pregnancy should ovulation occur despite your best efforts to prevent it, but they’re not as sure a bet as keeping your/your partner’s ovaries chilled out in the first place.
The reason that timing and consistency are so critical when it comes to effective use of the Pill is that in order to work best, the hormones it contains need to reach and maintain particular levels in the body. When pills are missed, those hormone levels fluctuate, which can create an opportunity for your/your partner’s ovaries to get cooking on a shiny new egg — not ideal.
The bride told me that this was the first pill she’d missed all month, and that she was usually good about taking it. That was all the information I needed to tell her she’d be fine, and that she should just take the missed pill as soon as she could, even if it meant doubling up with her next dose.
One missed combined oral contraceptive when a person is generally consistent about taking it generally isn’t cause for alarm. Missing two or more in a row, however, merits extra caution. It’s best to abstain or use a backup method, such as a condom, for at least seven days to give your/your partner’s body a chance to get back on track.
NOT SO FAST
But that’s for combined pills — progestin-only minipills are a bit more finicky. Missing or being more than a few hours late on just one minipill can yield a risk of pregnancy, and experts recommend using a backup method for at least two days afterward, just in case.
More specific questions or concerns about missed pills — including when is an appropriate time to use emergency contraception — are best directed toward a healthcare provider. And if you find yourself regularly getting into a tizzy over missed pills, it might be time to explore other contraceptive options with less room for user error, like the implant or an IUD.
As for the bride, she was relieved to know that she could enjoy the rest of the night without stressing about unplanned pregnancy. If you’ve got pending nuptials yourself, you might want to consider inviting a sex educator — you never know when we’ll come in handy.
I’m still on the lookout for stories and thoughts about pubes! Send ’em to email@example.com for possible anonymous inclusion in a future column.