A recurring point of contention between my husband and me is my inability to remember to take my birth control pill. It's the same conversation each time. "It's so simple!" he insists. "It's just one pill you have to take every single day. Set an alarm! Put it on your nightstand!" I then provide him with several logistically sound reasons there's still room for error (maybe I'm not home and forgot to pack it, maybe my alarm goes off at an inopportune time) and conclude with, "Men should have to take the pill!" Then there are mutterings about the patriarchy, and we repeat the same conversation the next month when I inevitably forget—just some light talking points in the Malhado household.
I forget so frequently, though, that it makes me wonder how it's affecting my body. Will there be any long-term repercussions? Is it impacting my fertility? I know outright that it causes me to have two periods a month or become especially bloated, but what else is happening internally that I need to know about, aside from the obvious (possible pregnancy)? After talking with a group of friends and colleagues, it's clear that missing pills is a common and frequent issue, so I consulted Paula C. Brady, MD, assistant professor of obstetrics and gynecology at the Columbia University Irving Medical Center and reproductive endocrinologist at the Columbia University Fertility Center, to find out if being delinquent with contraception causes any harm to the body.
How bad is it for your body to miss a hormonal birth control pill? Does the same apply to a nonhormonal pill?
Turns out the answer isn't so cut-and-dry, since women take birth control for a number of different reasons. "If the woman is taking a hormonal birth control to suppress pelvic pain or other physical symptoms related to her menstrual cycle, she may have pain or symptoms of the condition," says Brady. "In general, if a woman is taking the birth control pill to prevent pregnancy, there's no harm done by missing one combined birth control pill (containing estrogen and progesterone)."
However, Brady does note that missing one progestin-only pill (also known as the mini pill) can expose you to the risk of unintended pregnancy, so it's important to use backup birth control (e.g., condoms) until you've taken seven days of active pills. If you've missed a placebo (nonhormonal pill found at the end of a pill pack), you're in the clear. These are essentially sugar pills. "Just remember to start your next pack of pills right on time!" warns Brady.
What exactly is happening inside your body when you miss a pill?
"The combined birth control pill (with estrogen and progesterone, as opposed to the progesterone-only mini pill, which works differently) prevents the ovaries from preparing an egg to ovulate," says Brady. When you miss one combined birth control pill, you might experience a fluctuation in estrogen or progesterone, but the ovaries are still suppressed.
If you miss two or more pills, the ovaries may start an ovulation cycle, which requires the use of another birth control method, like condoms, to prevent pregnancy. Since the mini pill works by thickening the mucus in the cervix to prevent the sperm from fertilizing, when you skip the pill, there are changes in the mucus, which make it easier for the sperm to reach the egg.
If you do experience two periods in one month, does this pose any danger?
"Breakthrough bleeding after missing a pill is bothersome but not dangerous," explains Brady. "Just continue taking your pill as usual, and call your doctor if the bleeding is heavy or prolonged (more than a few days)."
Does skipping a pill impact your fertility?
According to Brady, your fertility is not impacted by stop-and-go birth control use—music to my ears: "A woman is born with all the eggs she'll have in her lifetime, which decrease in number each month regardless of whether she's using birth control pills. Missing a pill (depending on the type of pill) may reduce the protection against pregnancy but will not affect overall fertility or the number of eggs a woman has."
If you didn't take a pill ASAP on the day after you forgot, what should you do?
If you only missed one combined birth control pill, Brady advises taking it as soon as you remember, even if that means taking two pills at once. "If only one combined birth control pill is missed, the pill is still effective contraception, and you don't need a backup method like condoms," she explains. When I asked Brady if there is any risk in taking two pills at once, she explains that the only side effect is nausea, which can be curbed by taking them with food or before bed.
As mentioned previously, if you missed multiple combined birth control pills (two or more), Brady says you'll need to use backup contraception for seven days. "If you missed two or more pills in the first week of your pills and had unprotected intercourse during that week, consider emergency contraception to prevent unplanned pregnancy," she advises. "If you missed multiple pills in the last (third) week of active pills, just throw the pack out and start a new one, in addition to using backup birth control for one week."
Women who miss progestin-only pills should use condoms until they have been taking the mini pill again for seven days and should consider emergency contraception if they had unprotected intercourse around the time of the missed pill. In both cases, remember to speak with your physician first to ensure this is safe for you.
Speaking of emergency contraception, here are a few things you should know about taking Plan B.