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Should I take pills continuously or with a 7-day hormone-free break? #1223/9
Hello! I've been on Diane 35 for the past eight months. I'm on this particularpill because i have cysts in my ovaries and my period was irregular. I started my eight pack and had unprotected sex on the 6th day and I forgot to take my pill the 8th day. So the 9th day, I took 2 pills and applied the "7-day rule". Today is the 7th day and I've taken 16 pills from this pack.

Should I start the second pack as soon as I finish this one or take the 7-day break like always? What are my chances of getting pregnant?

Thank you so much for your time!

You are so welcome for my time.  I love doing this.

 

Your risk of pregnancy is not increased by forgetting that pill on the 8th day.

You can take your usual 7-day break when you come to the end of the end of the current cycle.  However, taking your pills continuously with no hormone-free break could possibly lead to greater protection against ovarian cysts.

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.  Developing a pattern of taking pills is wise but not essential in terms of pill effectiveness. 

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 (nonhormonal) pills

  • She should discard the missed inactive (nonhormonal) 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

Her reply on 12-19: Hello Dr. Hatcher, I hope you are doing great!  I wanted to thank you for actually answering my question.”

“The fact that it is such a personal question, I did not feel comfortable asking people around me, you may understand.  Besides, you have knowledge in this field and I needed professional guidance.  You are a Professor of Gynecology and Obstetrics after all!”

“Your answer really helped, now I know better.  This will not happen again, because a child is a huge responsibility and it is not my time yet.  Thanks again for everything Dr. Hatcher, you have a wonderful day.”

“I apologize for replying to you.  I’m sure it is not appropriate, but I just really wanted to thank you because I’m sure you are a busy man.” 

 

It is important for me to get the kind of feedback you sent me.  I know there is a human being receiving these answers and I LOVE to know an answer is helpful!

 

 

Key words:  Diane 35 birth control pills, cysts, ovaries, period, irregular, unprotected sex, missed pill, 7-day rule, pregnant, cycle, latitude, World Health Organization, contraception, spotting

 

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2010-01-20


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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