Pill: how and when to take it

Everything you need to know about the pill, its correct use and what happens when we forget to take it for one or more days.

The pill, also called oral or hormonal contraceptive, is a contraceptive method to be taken by mouth. It contains an estrogen and a progestin, analogues of female sex hormones.

Its safety in preventing pregnancy is almost absolute, if it is not forgotten or situations do not occur that may interfere with its absorption, for example the simultaneous intake of certain drugs, certain foods or episodes of vomiting or diarrhea.

There are also other contraceptive methods: let’s see what is the percentage of risk of becoming pregnant on a case-by-case basis.

If you want to know more about contraceptives read this sheet.

What they are and how they should (or can) be hired

The majority of pills (there are different types) are designed to mimic the natural 28-day menstrual cycle. 

Each pack contains 21 pills, to be taken one a day for 21 consecutive days followed by a 7-day break during which “pseudo menstruation” (bleeding similar to that of normal menstruation) appears.

Hormonal contraceptives also exist in packs that contain 24 active pills and 4 placebo pills (i.e. that have no effect because they do not contain hormones), and still others with 26 active pills and 2 placebo pills.

In other countries, then, pills are on the market that provide for a longer period of intake without menstruation: the so-called “extended use”.

A method of taking which, under the advice of a doctor, can also be adopted in Italy using, for example, pills that come with 24 active doses + 4 placebos is to take two, three, four or more packs of pills, skipping the placebo ones (the last 4 of the pack) and starting a new pack without taking an interval.

For the future, continuous use pills are foreseen with the number of days of intake regulated by the woman with a kind of minicomputer attached to the package.

Want to test your knowledge about the pill? Take the test How much do you know about contraception.

On a full or empty stomach?

Food, in general, has no influence on the absorption of the pill, so it can be taken either before or after meals: the important thing is to always take it at the same time.

Hiring “very punctual” or is there a little tolerance?

Obviously, taking the pill must be done without a stopwatch. An oscillation of a few hours has no influence on contraceptive safety.

The important thing is not to delay taking it for more than 12 hours: within this limit, the pill can be taken without compromising its contraceptive action.

The interview with gynecologist and sexologist Alessandra Graziottin on the contraceptive pill .

Oversights: here’s what to do, case by case

If the delay in taking a tablet is more than 12 hours, contraceptive protection may be reduced or compromised altogether. In addition, the greater the number of missed tablets, the greater the risk.

1) Forgetting a pill during the first week (day 1-7) carries a high risk of pregnancy. In this case, therefore, it is important to act as follows:

• take the missed pill as soon as possible, even if it means taking two tablets on the same day;
• continue to take the other pills in the usual way;
• have protected intercourse (condoms) for the next 7 days.

If there has been intercourse in the 2-3 days prior to forgetting, or if two or more pills have been forgotten, it may be appropriate to consider using emergency contraception.

2) Forgetting a pill in the second week (day 8-14) does not involve any special risks.

• The missed tablet should be taken as soon as possible, even if this means taking two tablets at the same time. The next pills should be taken as usual.
• It is not necessary to use additional contraceptive precautions which, on the contrary, must in any case be taken for at least 7 days if two or more tablets are forgotten.

3) In case of forgetfulness in the third week (day 15-21) there is a real risk of pregnancy. In this situation the alternatives are:

• The user should take the forgotten tablet as soon as she remembers, even if this means taking two tablets at the same time. The other tablets should be taken at the usual pace. The next pack must be started immediately after finishing the previous one, i.e. without taking the usual interval between the two packs.
• The woman can stop taking the tablets from the current pack, have a pill-free interval of 7 days (including the day the pill was forgotten), and then continue with a new pack.

If more than one tablet has been missed and no pseudo-menstruation occurs in the tablet-free interval, the possibility of a pregnancy should be considered.

The risk of pregnancy

If the pill is taken correctly and there are no dietary, pharmacological or pathological interferences, including vomiting or diarrhea, contraceptive safety is almost absolute.

However, it must be taken into account that each woman may have a greater or lesser ability to use hormones, and this could create rare cases of unexpected pregnancy.

The risk of becoming pregnant after forgetting to take a pill for one or more days varies from person to person, also in relation to the day of the cycle and the number of pills forgotten.

If menstruation does not appear during the interruption period, it is necessary to carefully evaluate whether there have been any forgetfulness in taking, drug interference, vomiting within 3-4 hours of taking it or diarrhea within 4-6 hours.

If there are no suspicions of this type, it is better to start again with the pill after the 7-day break, even if doing a psychological pregnancy test can help.

However, it should be remembered that taking some pills cannot harm a possible pregnancy.

After episodes of vomiting

If vomiting occurs within 3-4 hours of taking the pill, there is a risk that it has not been absorbed adequately. – As soon as the vomiting crisis has ceased, a new pill should therefore be taken. If a new attack of vomiting occurs within 3-4 hours of taking the reserve pill, in addition to taking another pill, if possible, it is advisable to use additional precautions (condom) for the following 7 days.

If vomiting appears 5-6 hours or more after taking the pill, risks of non-absorption can be excluded.

After episodes of diarrhea

If diarrhea (fluid discharge) occurs within 4-6 hours of taking the pill, there may be a risk of non-absorption of the drug.

A new pill should be resumed later, as soon as the diarrhea crisis has ceased. If a new diarrhea crisis reappears within 4-6 hours of taking the reserve pill, in addition to taking another pill if possible, it is advisable to use additional precautions (condom) for the following 7 days.

If the diarrhea appears more than 6 hours after taking the pill, risks of non-absorption can reasonably be excluded.

When unexpected bleeding occurs

Small bleedings are possible in the first months of taking modern low-dose pills.

If this bleeding persists in the following months (beyond the fourth or fifth month), it is necessary to speak to the gynecologist because it may be advisable to change the type of pill.

When suspicion keeps you from sleeping

Obviously the only way to be sure that there is no pregnancy is to take a test, urine or blood, and get a negative result. The validity of the response is already valid after a few days of delay.