allay my pregnancy paranoia!

March 12, 2009 3:35 PM

Can I use the birth control pill without a condom?

I feel silly asking this question, but I want to make sure. I'm not new to taking the pill, but I'm new to sex and I'm nervous! (I'm 20.)

I'm currently taking the Yasmin birth control pill (used to take Ortho Tri Cyclen Lo, just switched to Yasmin a month and a half ago) but we've also been using condoms. I'm very good about remembering to take my pill daily, but the time of day I take it usually varies (usually not by more than 2 hours, but occasionally there are larger/lesser gaps).

Last night the condom broke, but I'm not really worried about it because I'm protected by the pill (which I am, right?!?!) and this brought up the question - do we really need the condom? I know and trust my partner, and even though he's okay with continuing to use one, personally I would much much much prefer to lose the condom (and so would he). I'm just hesitant because my pill use is very good but not absolutely *perfect.* So would we be okay without a condom? Reading other threads and internet statistics is making me nervous and I'm not sure if I'm overthinking this.

After that I'm finding myself looking into getting an IUD but since I've never been pregnant i'm not convinced I'll be able to get one easily plus I'm concerned about cost. But could I even forgo a condom with an IUD, assuming I know/trust my partner, got tested, etc? Are they that much more effective than the pill?
Help me allay my pregnancy paranoia!!

posted by sarahj to health & fitness (39 comments total)

Of course you can take the pill without condoms. The pill doesn't protect you from any STDs, but if you've been on the pill for more than a few days, you are pretty damn well protected from pregnancy.
posted by roomthreeseventeen at 3:39 PM on March 12

memailed you
posted by silkygreenbelly at 3:40 PM on March 12

As long as you take the pill like the package insert tells you to, you ought to be fine, pregnancy-wise. However, sans condom, standard know-the-penis warnings apply.
posted by phunniemee at 3:41 PM on March 12

Two things you probably already know: the pill won't prevent STDs, and no form of contraception is 100% effective.
posted by box at 3:41 PM on March 12

Depending on the pill, the stated efficacy is around 98%. So generally speaking it is pretty effective...except for that 2%. Which, when you consider the millions upon millions of people having sex with nothing but the pill for protection, is actually a quite terrifying statistic.

If you absolutely must lose the condom, I would encourage you to use spermicidal lubricant and a diaphragm.
posted by turgid dahlia at 3:42 PM on March 12

Skipping a day can make a difference. Skipping a few hours? Not so much. You aren't that explosively fertile, even at 20, particularly if you've been on the pill for more than a few months.

That being said, any time you have sex, even with hormonal contraception and a condom, there is always a statistically significant chance that you're going to get pregnant. Condoms break. Doses are forgotten. The body does, in fact, have rhythms designed to make babies. That chance may be vanishingly small, but it's always real. The only way you can be 100% completely sure you won't get pregnant is if you don't have sex.

That being said, if you properly use hormonal contraceptives, i.e. don't miss a day, your chance of getting pregnant is less than 1%. You're being careful. That's good. I don't think you ought to be having sex unless you're married, but I also don't think that if you are going to have sex that you need to be paranoid about it. Proper use of contraceptives--and you can do that without using a condom--very rarely leads to pregnancy.

Be religious about taking your pill and quit worrying.
posted by valkyryn at 3:43 PM on March 12 [1 favorite has favorites]

For something as important as this, hedging your best seems like a no-brainer. Advise you stick with both. I say this as someone whose good friends and neighbors conceived a third child while on the pill.
posted by davejay at 3:50 PM on March 12 [1 favorite has favorites]

hedging your BETS, that is.
posted by davejay at 3:51 PM on March 12

The only way you can be 100% completely sure you won't get pregnant is if you don't have sex.

Or if you get sterilized: all the sex you want and no pregnancy scares! (Of course, this isn't an option if you might want to make use of your reproductive system at some future point.)
posted by korpios at 3:51 PM on March 12

My son was concieved while on the pill. There's a list of things that could make the pill less effective, and some of them make the pill much less effective. My wife was on ortho tricyclen when she took anti-biotics for an infection, so Yaz (poor Allison Moyet!) might react differently, or not at all. She has an IUD now and seems happy with it.
posted by boo_radley at 3:55 PM on March 12 [1 favorite has favorites]

Keep in mind that if you start any other medications, they can interfere with your birth control. I wish I didn't know this because of someone close to me getting pregnant while religiously taking the pill, but I do.
posted by hermitosis at 3:55 PM on March 12

If you absolutely cannot deal with an unplanned pregnancy and the choices it brings, don't ditch the condoms. Condoms and HBC are very effective.
posted by DarlingBri at 3:57 PM on March 12 [1 favorite has favorites]

And you can get an IUD even if you've never been pregnant. Mine was $35 (covered by insurance), but if you don't have insurance, you could try a place like Planned Parenthood, where costs depend on what you can pay (sliding scale).
posted by amarynth at 3:59 PM on March 12

I have been on the pill for a decade (up until a few months ago), and for the most part didn't use condoms. I too did not have perfect usage, as I would take it before going to bed at night, which could be anywhere between 10 pm and 4am, and have not ever really had a scare (other than that based on paranoia alone).
posted by greta simone at 4:05 PM on March 12

It depends on what you consider to be an acceptable risk.

Typical use percent chance of failure during first year of use:

The Pill: 8%
Latex Condom: 15%

When used together, multiply probabilities of failure, assuming condoms and hormonal birth control are independent mechanisms:

Combined: 1.2%


Source: Comparison of birth control methods


(assuming the Pill is basically the same as Drospirenone, the active ingredient of Yasmin)
posted by qxntpqbbbqxl at 4:07 PM on March 12 [2 favorites has favorites]

If you're in a mutually monogamous relationship and neither of you have STIs, then you don't need to use condoms.

Yasmin is a combined pill, so provided that you take it within a 12-hour window, it's not late. Do try to take it at close to the exact time every day, though.

If you absolutely must lose the condom, I would encourage you to use spermicidal lubricant and a diaphragm.

Spermicide isn't exactly good for you, and you and/or your partner may have sensitivities to it.

About IUDs: doctors are increasingly willing to give IUDs to women without children, especially if you're in a stable relationship/not involved in high-risk sexual behaviour. The progestin-releasing IUD (Mirena) is more effective than the pill (see here), and almost always ends up being more cost effective over the life of the IUD (5 years) than using the pill. The IUD Divas Livejournal community is a great resource for all things IUD-related.
posted by thisjax at 4:08 PM on March 12

I'm all about the two types of birth control, as davejay said hedging your bets is never a bad idea. But then, I'm pretty serious about not getting pregnant and tend to be a bit on the anxious side. Tons of people use just hormonal birth control, that's what it's designed for.
If you really hate condoms and really trust your boyfriend (and both get tested GET TESTED GET TESTED) then sure, ditch them. If you'd like backup, consider some kind of diaphram or an IUD in addition to hormonal birth control, just don't pick a hormonal IUD.
Oh, and if you're worried about taking the pill at different times of day, consider switching to the totally awesome NuvaRing - just make sure you *do* use backup while you're switching over.
posted by you're a kitty! at 4:12 PM on March 12

I stuck with both when I was younger, and at a time where pregnancy would be a much bigger life problem than it would be now (was in school, no money, etc.). Not saying you NEED to, but if you want to be extra, extra sure, it's not a bad idea.
posted by fructose at 4:16 PM on March 12

YMMV, and take this FWIW, but I have been on Yaz for two years, and I have been having regular sex without condoms since then.

I do not have perfect use. I forget every once in a while, and I do not take it at a constant time each day.

I have never been pregnant.
posted by derogatorysphinx at 4:19 PM on March 12

You might want to consider fertility awareness (awareness of your natural fertility cycles) as a second method.
posted by kch at 4:20 PM on March 12

Fertility awareness is great, kch, but all bets are off when you're on the pill... which eliminates the cycle part of your cycle. In other words, there's nothing to be aware of when you're not ovulating.

Double methods = good if you can't accept the possibility of pregnancy.
posted by charmcityblues at 4:37 PM on March 12

You might want to consider fertility awareness (awareness of your natural fertility cycles) as a second method.

By definition, the hormonal birth control disrupts a woman's natural cycles, so fertility awareness is impossible on the pill.
posted by scody at 4:38 PM on March 12 [2 favorites has favorites]

thanks for the clarification!
posted by kch at 4:39 PM on March 12

If both you and your partner get a full STI screen, I'd say it's reasonable to stop with the condoms.
posted by teraspawn at 4:52 PM on March 12 [2 favorites has favorites]

If your big concern is maximizing the effectiveness of your hormonal birth control (or, minimizing the human error factor), you should really consider the Nuvaring. You only have to remember it once a month (well, twice--one day to put it in and one to take it out), not every day.
posted by Meg_Murry at 5:00 PM on March 12

If both you and your partner get a full STI screen...

Yes. If you haven't, do this before ditching condoms. If you're pretty sure that you don't have any STDs, get screened before ditching condoms. If you just know that there's no way you or your partner could have any STDs...then go ahead and get screened before ditching condoms.

As others have said, hedging your bets isn't a bad idea. That said, for what it's worth, my wife and I generally only use the pill for birth control, and we're pregnancy-free for ~5 years. If she ever misses a day, we switch to both the pill and condoms for the remainder of her cycle.
posted by Brak at 5:17 PM on March 12

I was on the pill for about five years and only used condoms when I wasn't in an LTR. I always took it at the same time of day (right before leaving for work), and I also knew better than to have sex without a condom while I was on antibiotics.

My beautiful baby boy is fast asleep in my lap right now. I don't know if I'm super-fertile or if I was one of the 2%, but I'm getting the paraguard next month because a) no way am I trusting the pill again and b) I know better than to flood my body with hormones (I do mean *my* body, that wasn't a dig against the pill itself. I don't react well to it).

I don't know about the IUD for people who haven't had a child, but I do know that if you're not taking the pill exactly as it says on the insert (and even if you are), you can get pregnant.
posted by Lullen at 5:22 PM on March 12

If you don't want to deal with pill timing, consider the patch, the implant, or the IUD as alternatives.
posted by Electrius at 5:28 PM on March 12

Don't lose the condoms.

From my understanding, if you're concerned about the possibility of having HIV, you should get tested right after, at 6 weeks and at 6 months. Can you honestly claim that you and your partner have been monogamous and completely faithful for 6 months?

Furthermore, even if you are sure that you can trust the guy you're with, can you trust the women he's been with? Maybe the last woman he's been with cheated on him. He could be infected and not know. And not just with HIV, but with anything.

Don't lose the condoms unless you're 100% positive. This is your life you're talking about here.
posted by cali59 at 5:35 PM on March 12

I developed a little rule of thumb back in the day:

-Pill
-Pullout
-Condom

Pick 2 of the 3.

The rule has an addendum: if the opposing party is suspect, make sure the condom is 1 of the 2.

In general, my rule leaves some room for variety, at that never hurts, right?
posted by milqman at 5:48 PM on March 12 [2 favorites has favorites]

Do get STI testing done first, both of you.

After that, discuss the risks together. The risk of becoming pregnant on the pill with consistent use (as in, missing a dose by a few hours - not a big deal. Missing a DAY - big deal) is minimal. If the two of you can handle that risk, then ditch the condoms. DO use condoms for the rest of your cycle if you miss a whole day of the pill. DO use condoms if you take any antibiotics.

Beyond that, if you can handle the risks from the use of the pill, ditch the condoms. Nothing is perfect except abstinence, but that doesn't mean you're doomed to get pregnant if you only use *one* form of birth control. Sure, it happens, but it also happens that many fertile people who *try* to get pregnant *don't.* It's luck and timing.

First think about it for yourself: if you absolutely 100% would NOT be able to deal with a pregnancy, keep using the condoms no further discussion needed. If you could handle an extremely unlikely total fluke pregnancy (either carrying to term, aborting, adoption, whatever "handling it" means to you), talk to your partner. Remember that this is EXTREMELY UNLIKELY. If he can also handle that, ditch the condoms. If he can't, keep 'em.

turgid dahlia recommended spermicide, which would help alleviate pregnancy risk. I'd just like to weigh in from personal experience that spermicidal lubricant has given me not one, not two, but THREE urinary tract infections and I had to finally convince my partner to stop using it or face not having penetrative sex. Some women aren't sensitive to it, and if you're using spermicidally lubricated condoms, you should know if it bothers you or not. Some women are, and if you are, it can be EXTREMELY unpleasant.
posted by grapefruitmoon at 5:57 PM on March 12 [2 favorites has favorites]

In addition to the patch, the pill, IUD, and hormonal implants.. there's also Depo-Provera (shot) and NuvaRing. Plenty of options if you'd like to be condom free, several of which are less forgetting-prone than pills. (Although I think all hormonal methods can be disrupted by other medicines, namely certain varieties of antibiotic.)
posted by nat at 7:30 PM on March 12

Seconding that spermicide is potentially problematic. I don't know any women who don't have an itchy, irritated reaction to it at best.

Regarding testing, even if neither of you have had a partner other than each other for awhile, it's still a good idea to get tested. It is possible to carry something asymptomatically from MONTHS ago.

(Of course there's risk of pregnancy, there always is, but the scenario you propose is within the bounds of reasonable risk. In your position, I wouldn't use condoms if I didn't want to.)
posted by desuetude at 8:06 PM on March 12

YMMV, and take this FWIW, but I have been on Yaz for two years, and I have been having regular sex without condoms since then.

I do not have perfect use. I forget every once in a while, and I do not take it at a constant time each day.

I have never been pregnant.

This has been roughly my experience, although my pill of choice is currently Seasonique.

OP, I agree with the commenter who recommending getting fully tested (both of you!) before dropping the condoms, but after that you should be ok.

Be very careful with any herbal supplements you might take to make sure they don't interfere with the pill's effectiveness. And anytime you go on antibiotics, break out the condoms again--ask your doctor for how long.
posted by peanut_mcgillicuty at 6:44 AM on March 13

Keep the condom or pick up a diaphragm unless you wouldn't mind getting pregnant! Why wouldn't you? 98% is not 100%.

There is also the sponge, but that can get kind of expensive.

Also, you could not have sex on your most fertile days.

You probably wouldn't get pregnant while on the pill, but it it worries you, then I think the right thing to do is to use some back-up, that way you won't worry.
posted by Penelope at 11:05 AM on March 13

Also, you could not have sex on your most fertile days.

I was pretty sure about this, but I looked it up anyway: there are no "most fertile" days on the pill, as opposed to normal menstrual cycle because the pill works by blocking ovulation. Cite.

Truly, if you want to be extra super careful, the back-up condom is your best bet. It's up to you and your partner if 98% effectiveness is enough or if you want to keep going with the failsafe.
posted by grapefruitmoon at 11:15 AM on March 13 [2 favorites has favorites]

If you and your partner have both been tested for STDs, and if you are honestly very good about taking the pill, then you're fine. Be sure to have condoms on hand in the event that you need to take antibiotics or other medication that could lessen the effectiveness of the pill--I was told that you should use condoms for seven non-placebo days after ending a course of antibiotics. If you ever miss a day, likewise use condoms for seven non-placebo days after the missed pill. I'm very religious about taking the pill (I've forgotten twice in seven years of use), and my partner & I combine that with the withdrawal method for non-contraceptive reasons (I'm sensitive to his semen--it makes me itchy!) and I've never had even a scare, although I suspect that pulling out has helped that a bit.
posted by PhoBWanKenobi at 5:01 PM on March 13

Personal data: been on yasmin for 3+ years and no babies. I take my pill on time maybe 85% of the time.

TMI but also important as an FYI: When I switched to the generic (Ocella I believe it is called), I had SO many issues. Basically had my period for 15 days straight, which made me seriously question it's effectiveness. Called the doctor, who said they were getting a lot of similar reports from patients.
posted by smalls at 5:09 PM on March 13

you are protected by the pill as long as you take it at the same time and you are not on antibiotics, however it does NOT protect you from STDs and STIs.
posted by Ekidnagrrl17 at 7:04 PM on March 17