Re-Taking Birth Control Pills If You Have Diarrhea

Emma asked

Last Sunday, I had my pill at usual, 8:30 PM is my normal time. I then had unprotected sex. However, that following Monday evening, I went to the toilet and had diarrhea. I woke up at 5 AM Tuesday and had 4 more bouts of diarrhea. I was sick. I decided to take another pill at midday as a precaution for fear of an unplanned pregnancy. I then waited until midday Wednesday to take my next pill as things seemed to be improving but my diarrhea came back. So as a precaution I doubled up on the pill again. And doubled up today too. My question is, given the circumstances, should I be concerned about an unplanned pregnancy?

Answer

Taking oral contraceptive (i.e. birth control) pills consistently is necessary for optimal effectiveness. With consistent and perfect use, they are over 99% effective in preventing pregnancy.

However, it can be extremely difficult to not make a mistake somewhere down the line, and therefore, the effectiveness of "the pill" is often listed around 90-91%, which is based on typical use.

In fact, it has been reported that nearly 40% of unintended pregnancies are due to inconsistent or imperfect contraceptive use.

Does Having Diarrhea Count As A Missed Dose?

Most birth control pill products have specific directions regarding what you should do if you miss doses or are late taking a pill. However, what is less clear, is whether or not having diarrhea or other GI issues counts as missing a dose.

Even the prescribing information for birth control pill products often don't offer specific advice. The following is from the prescribing information for Yasmin, a popular combined hormone (i.e. contains progestin and estrogen) birth control pill:

"In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures should be taken."

While the above states you may need to take additional contraceptive measures, there is no specific directive on what to do.

Similarly, another birth control product (Seasonique) has the following statement in the prescribing information for the product:

"If you have vomiting or diarrhea, your birth control pills may not work as well. Use another birth control method, like condoms or a spermicide, until you check with your healthcare provider."

Diarrhea - Birth Control Pill Recommendations

While individual birth control products often don't give a specific recommendation regarding whether or not having diarrhea necessitates re-dosing, the CDC (Centers for Disease Control) has published guidelines:

To summarize the CDC guidelines:

• If you have vomiting or severe diarrhea for less than 48 hours (2 days) after taking a dose, you generally don't need to repeat the dose but should continue taking your pills daily at the usual time. No additional contraception is needed.
• If vomiting or severe diarrhea continues for 48 hours or longer, continue taking pills daily at the usual time. However, backup contraception is needed until the birth control pills have been taken for seven consecutive days after the vomiting or diarrhea has resolved. You may also be recommended to start a new pack depending on which week you are on.

The above chart corresponds to combined hormone birth control pills. If you are taking progestin-only pills, it is recommended to use backup contraception for at least 48 hours after the vomiting or diarrhea has resolved.

Final Words

It is important to note that anytime you are having vomiting or diarrhea that affects how you take your medication, you should reach out to your doctor for specific advice as every individual's situation is unique.

If you are ever concerned that you are in a situation where your birth control pills may not be as effective, it's not a bad idea to use back-up contraception to be safe. Alternatively, you can consider using an emergency oral contraceptive such as Plan-B or ella.

As a final note, there, unfortunately, is no way to definitively say whether or not your pills are less effective in situations like these.

We can only make assumptions based on the data and guidelines available. It is therefore prudent to discuss your options with your doctor, be it taking additional pills or using emergency contraceptives.