Ok – we made it to the final post of this series. I think this one is fun. Let’s jump straight in.
Does it really matter when I take the pill?
For SPOTTING: I can’t stress enough how important it is to be consistent on timing from a Taharas HaMishpacha standpoint. The #1 thing you can do with any pill to prevent breakthrough bleeding is to take the pill at the same time every day. This is especially true with a Progesterone-only pill, where variations of more than 15-30 minutes can really truly lead to spotting in some women. (Remember, this is because progesterone alone can’t maintain a strong “grip” on the uterine lining ). With a combined oral contraceptive pill, most women won’t need to be quite as careful, but they should try to stay within an hour or so of their set time, and missing a pill here and there can absolutely lead to problems.
For CONTRACEPTION (to prevent pregnancy)
Progesterone only – Each dose of the minipill does its job in the body for around 24 hrs (though it’s actually the most effective as a contraceptive between hours 4 and 22). First of all – that makes it very unforgiving of errors. If a woman is 3 or more hours late taking the minipill, she will need to use a backup method of contraception (see below). It’s a good idea to set a clock sometime in the morning or around noon to remind you to take the pill at your scheduled time. (1. This also puts the evening hours comfortably within the 4-22 hr range for the best odds of contraception, 2. This leaves time to remember a delayed pill instead of accidentaly falling asleep!)
Slynd (US) and Cerazette (Israel) both have more wiggle room when it comes to timing – they will remain effective as contraception even if a dose is delayed for up to 12 hrs (and Slynd actually advertises contraception for up to 24).
Combination – You’ve got a lot of flex here for contraception. Any time of day or night works to schedule your combination pill, pick a time you will be most consistent. Again, spotting/Taharas HaMishpacha concerns are separate from pregnancy prevention.
What do I do if I miss the pill?
First of all, check your package insert. There will be specific instructions for the medication you’re taking and how many pills/for how long you’ve missed. Generally speaking you take the progesterone-only pill as soon as you remember, and still take your next dose as scheduled. If you miss only one day of a combination pill, you would do the same. (After that you’ll need to refer to specific instructions depending on what week of the pack you’re in, etc.)
If you miss taking a progesterone only pill, you’ll need to use a backup method (generally spermicide for frum women, though some may have a heter to use a diaphragm) for 48 hrs. If you miss more than two days of combination pills, you will need to use a backup method for 7 days.
If prescribed a medication that interferes with birth control (such as some antibiotics) or after vomiting soon after taking a pill, you may see more spotting and should use a backup method as well.
*Remember it takes 48 hrs for a progesterone only pill and 7 days for a combination pill to take effect!*
(If a woman starts the combination pill within 5 days of the beginning of her period, she won’t need a backup method – even if she forgets on two days within those first 5 days. But because of the 7 Nekiim, this doesn’t have a lot of practical relevance, so I’m skipping past it.)
How long do I wait in between packs?
Why did I include this question? Because you should NEVER wait more than 7 days between packs. This is true even if it takes a few days to start bleeding after the last active pill of your last pack. This is true even if the bleeding isn’t finished. This is true even if you’ve connected multiple packs. Generally speaking, the 7 Nekiim week will protect a woman who stretches the break in her combination pill a little too far – as long as she has 7 days of pills along with those 7 days of bedikahs, she’s reestablished contraception. BUT if she only starts the pills after she does her hefsek, and that hefsek happens after a 7+ day pill break or she starts the pill for the first time later than 5 days into her cycle, she may not be protected the night she goes to the mikvah. (Was that too tricky to follow? I excuse you from doing the math if you’re not interested!)
If a woman is taking the minipill, she should go straight from pack to pack without a break at all in order to maintain contraception and avoid spotting. If she takes time between she’ll need to follow the rules for missing a pill.
It is possible to “link” birth control packs in order to change the timing of a break/period, or avoid it altogether, but that’s really for another post! Just want to point out that when using Slynd (which has a break built in), you can link like you would with a combination pack.
Let’s end with that ball rolling down the hill analogy again…
Ovulation doesn’t just *POP* occur in the middle of a cycle. There is this complicated interplay between ovaries and brain that progress to ovulation at just the right time. If a woman starts her pill too late, the process leading to ovulation is already in action – the ball has begun rolling down the hill, the egg has started “rolling” out of the ovary. Starting a pill midcycle won’t stop that from happening, but using a backup method for 7 days will ensure that either a) you’ve moved past the “danger” window, or b) another aspect of contraceptive has you covered.
P'nima Wellness 