Off Label BCP Usage - Pregnancy Risks
December 18, 2016 11:50 AM Subscribe
Yes, I'm going to ask my doctor this when I'm in in about three weeks, YANMD, etc. Just wondering what other people's experiences are here with taking birth control pills off-label.
I take monophasic BCP off-label to skip periods in order to control my anemia, and to experience the miracle of clear skin. Fortunately since I am not relying on them to protect against pregnancy (I use barrier methods) I can take them a bit sloppily; I have found that I can take a pill every other day to maintain these benefits to my health and my appearance, which have never been better.
What I'm wondering is, since I am not taking these pills in a way which prevents pregnancy but rather for other reasons, what's the likelihood that if I stopped using a barrier method (or experienced one-time user error with barrier method) that I'd get knocked up? Is taking the pills not-as-intended as worthless as not taking them at all? It seems like in terms of pregnancy prevention, either you're taking them perfectly or you may as well not take them at all. I see the stats out there for pregnancy risk with "imperfect use" and it's unclear what that even means. Does that mean skipping a pill but otherwise taking them responsibly every day at the same time, or does that mean slipshod like I am?
Note that I am not trying to get pregnant at this time, this is more of a hypothetical question. Just wondering what my future might look like if I ever wanted to, because stopping taking the pills would result in extreme anemia and pizzaface which I'd like to avoid forever if possible.
I take monophasic BCP off-label to skip periods in order to control my anemia, and to experience the miracle of clear skin. Fortunately since I am not relying on them to protect against pregnancy (I use barrier methods) I can take them a bit sloppily; I have found that I can take a pill every other day to maintain these benefits to my health and my appearance, which have never been better.
What I'm wondering is, since I am not taking these pills in a way which prevents pregnancy but rather for other reasons, what's the likelihood that if I stopped using a barrier method (or experienced one-time user error with barrier method) that I'd get knocked up? Is taking the pills not-as-intended as worthless as not taking them at all? It seems like in terms of pregnancy prevention, either you're taking them perfectly or you may as well not take them at all. I see the stats out there for pregnancy risk with "imperfect use" and it's unclear what that even means. Does that mean skipping a pill but otherwise taking them responsibly every day at the same time, or does that mean slipshod like I am?
Note that I am not trying to get pregnant at this time, this is more of a hypothetical question. Just wondering what my future might look like if I ever wanted to, because stopping taking the pills would result in extreme anemia and pizzaface which I'd like to avoid forever if possible.
I'm really surprised you're not getting spotting. Everbody is different, but if I miss even one pill I get spotting. my understanding is this is even more common when you take it for longer than three weeks in a row.
To answer your question, though, since the package insert says to take the pill within three hours of the usual time, I imagine you are at risk of ovulating by taking it 24 hours late every time. You're probably still at pretty low risk of pregnancy since your barrier method would have to fail at the same time as you happened to ovulate.
posted by Waiting for Pierce Inverarity at 12:28 PM on December 18, 2016
To answer your question, though, since the package insert says to take the pill within three hours of the usual time, I imagine you are at risk of ovulating by taking it 24 hours late every time. You're probably still at pretty low risk of pregnancy since your barrier method would have to fail at the same time as you happened to ovulate.
posted by Waiting for Pierce Inverarity at 12:28 PM on December 18, 2016
As I understand it you're taking only the active pills and you're taking them only every other day?
There's no way I'd depend on this for birth control, because of the latter. You're still protected if you're taking continuous birth control, but there's a reason you're supposed to take them every day. They have not been tested in the way you are taking them.
It is getting harder and more expensive to get an abortion these days. If you don't want to be pregnant, use a backup method of birth control.
posted by fiercecupcake at 4:04 PM on December 18, 2016
There's no way I'd depend on this for birth control, because of the latter. You're still protected if you're taking continuous birth control, but there's a reason you're supposed to take them every day. They have not been tested in the way you are taking them.
It is getting harder and more expensive to get an abortion these days. If you don't want to be pregnant, use a backup method of birth control.
posted by fiercecupcake at 4:04 PM on December 18, 2016
Best answer: FWIW, I interpreted the question the opposite way: "do I have to stop taking the Pill on alternate days when I am trying to get pregnant?"
posted by instamatic at 5:24 PM on December 18, 2016
Note that I am not trying to get pregnant at this time, this is more of a hypothetical question. Just wondering what my future might look like if I ever wanted to, because stopping taking the pills would result in extreme anemia and pizzaface which I'd like to avoid forever if possible.I don't actually know the answer to this, mostly because all the want-to-get-pregnant people I have known were either "not trying not to" or were hard core taking charge of your fertility and temp every morning types. But if that's indeed what the question is trying to ask, maybe that will help someone who knows more than I do answer. All I know is that the Pill is not supposed to be harmful if you keep taking it in between getting pregnant and discovering your pregnancy, but IANADoctor. I guess you can find out the "not trying very hard not to conceive" way, if you're not on a tight timeline when you do decide to start trying.
posted by instamatic at 5:24 PM on December 18, 2016
You are not protected from pregnancy by taking the pills every second day.
posted by chiquitita at 7:29 PM on December 18, 2016
posted by chiquitita at 7:29 PM on December 18, 2016
Total speculation to your hypothetical question: BCP formulas vary. Just looking over the wiki list, if you're taking, say, Nordiol (50ug ethinyl estradiol/250ug levonorgestrel) every other day, you'd still be taking in more hormones than if you were taking Alesse (20ug estradiol/100ug levonorgestrel) every day. The amount isn't everything, another recent AskMe got into how long it takes for the hormones to kick in and clear out of your system, but that's still a fair amount of variation in what's an effective dose and every body processes things differently. It seems to me that if whatever you're taking every other day is sufficient to really stop your periods entirely, it's quite possible that the hormone levels are staying high enough to stop ovulation too.
The other thought is that heavy periods will only be an issue until you get pregnant, and the hormone changes during pregnancy will be an unknown factor on your skin anyhow, so it's not 100% guaranteed anemia/pizzaface if you decide to have children.
The other other thought is good lord BCP brand names are dumb. Now I want to start reading up on the pharmaceutical branding/marketing process...
posted by yeahlikethat at 7:30 PM on December 18, 2016
The other thought is that heavy periods will only be an issue until you get pregnant, and the hormone changes during pregnancy will be an unknown factor on your skin anyhow, so it's not 100% guaranteed anemia/pizzaface if you decide to have children.
The other other thought is good lord BCP brand names are dumb. Now I want to start reading up on the pharmaceutical branding/marketing process...
posted by yeahlikethat at 7:30 PM on December 18, 2016
Best answer: What's the likelihood that if I stopped using a barrier method (or experienced one-time user error with barrier method) that I'd get knocked up?
If you have normal fertility then the likelihood of getting pregnant if you are not taking the pill every day is high.* (relatively)
Is taking the pills not-as-intended as worthless as not taking them at all?
No, but for the most part it is. The main mechanism of the pill is maintaining a level of hormones in your body that fool it into thinking that it is already pregnant so that you don't ovulate. If you don't maintain that level, you will most likely ovulate so the main mechanism is not going to work for you. However, another effect is that your body makes less hospitable cervical mucus, and you don't need to maintain a consistent daily level of the hormones for that, although theoretically the degree of hospitability might be a little higher.
* Then again, a lot of people think that if they have unprotected sex and have normal fertility, they'll pretty much get pregnant immediately, but the monthly likelihood of pregnancy with no birth control use is only about 25%. So assuming that your unfriendly cervical mucus reduces that number somewhat, if you want to continue taking the pill every other day while trying to conceive, the odds are that it's going to take you at least several months of trying (though honestly those are really the odds already).
Of course, once you do get pregnant, you'll have to stop the OCPs, but keep in mind that pregnancy will then provide you natural protection against hormonal acne (effect on anemia will be less predictable but will be monitored). And at least from my anecdotal experience as a woman with hormonal acne (PCOS), after my second pregnancy and breastfeeding for about a year, my hormonal acne was actually gone for the pregnancy plus 18 months of my baby's life... sadly it came back at the end of this summer when I started a strenuous workout regimen.
posted by treehorn+bunny at 5:43 PM on December 21, 2016
If you have normal fertility then the likelihood of getting pregnant if you are not taking the pill every day is high.* (relatively)
Is taking the pills not-as-intended as worthless as not taking them at all?
No, but for the most part it is. The main mechanism of the pill is maintaining a level of hormones in your body that fool it into thinking that it is already pregnant so that you don't ovulate. If you don't maintain that level, you will most likely ovulate so the main mechanism is not going to work for you. However, another effect is that your body makes less hospitable cervical mucus, and you don't need to maintain a consistent daily level of the hormones for that, although theoretically the degree of hospitability might be a little higher.
* Then again, a lot of people think that if they have unprotected sex and have normal fertility, they'll pretty much get pregnant immediately, but the monthly likelihood of pregnancy with no birth control use is only about 25%. So assuming that your unfriendly cervical mucus reduces that number somewhat, if you want to continue taking the pill every other day while trying to conceive, the odds are that it's going to take you at least several months of trying (though honestly those are really the odds already).
Of course, once you do get pregnant, you'll have to stop the OCPs, but keep in mind that pregnancy will then provide you natural protection against hormonal acne (effect on anemia will be less predictable but will be monitored). And at least from my anecdotal experience as a woman with hormonal acne (PCOS), after my second pregnancy and breastfeeding for about a year, my hormonal acne was actually gone for the pregnancy plus 18 months of my baby's life... sadly it came back at the end of this summer when I started a strenuous workout regimen.
posted by treehorn+bunny at 5:43 PM on December 21, 2016
You also might be interested to know that spironolactone is a medication that can be used to treat hormonal acne that is not a contraceptive (although it is pregnancy category C). Could be an option to consider if you ever want or need to get off the hormones for other reasons.
posted by treehorn+bunny at 5:48 PM on December 21, 2016
posted by treehorn+bunny at 5:48 PM on December 21, 2016
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