Category: Sexual Health

Categories
Birth Control Emergency Contraception Health Sexual Health

Missed Birth Control Pills: What To Do If You Forget Your Pills?

Credit: Illustration by Siena Health

Realising you missed your birth control pills can be a scary and stressful experience, and we know that. So here’s a step-by-step guide on what you can do to ease your worries! 

Perhaps you were running late and in a moment of panic, you couldn’t afford to indulge in your regular morning routine. Or you didn’t purchase your refills in time and realised it was way too late. 

Whichever’s the case, missing your birth control pills can most definitely leave you in a flurry, especially when you have devoted yourself to it. But alas, it happens so don’t beat yourself up about it! Thankfully, there are ways to manage this (mini) crisis. 

If you missed your pills, your next line of action should take into consideration:

  • Number of pills you have missed 
  • When you missed the pill (how far in are you with your pack)
  • Type of birth control pill you’re on (combined contraceptive pill or the progestogen-only pill)

The information leaflet that comes with your contraceptive pills should also have stated specific instructions on the steps you should take regarding the specific brand of birth control you are on. 

Symptoms you may notice if you missed your pills 

If you aren’t 100% sure, there are several symptoms that are pretty clear indicators you missed taking your birth control pills. The most common side effect is light bleeding or starting your period. You may experience menstrual cramps and nausea associated with it. 

Typically, there’s nothing to worry about and everything should return to normal once you’re back on the contraceptive pills regularly!

Combined contraceptive pill

The combined contraceptive pill contains both estrogen and progestin. There is a great variety of combined contraceptive pills you can choose from but some of the common combination pill brand names include Yaz, Yasmin, Microgynon 30, Liza, Mercilon and Drospera. A combination pill is considered “missed” if you don’t take it for 24 hours or more after you were supposed to. 

If you are late (less than 24 hours) or missed (24 to 48 hours) an active pill

You’re still protected against pregnancy if you missed 1 pill anywhere in the pack or started a new pack 1 day (24 hours) late. 

Follow these steps:

  1. Take the late or missed pill immediately
  2. Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day)
  3. Take the 7-day pill-free break as prescribed or if you’re on an everyday pill, take the inactive pills 
  4. Emergency contraception is not usually needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle
  5. No additional contraceptive protection (e.g. condoms) needed

If you missed two or more active pills (48 hours or more)

When this happens, it greatly increases your chances of ovulation. In this case, when you missed 2 or more active pills anywhere in the pack or started a new pack only after 2 days (48 hours) or more, you may not be protected against pregnancy. 

What you should do:

  1. Take the last pill that you missed immediately even if it means taking 2 pills a day 
  2. Discard any earlier missed pills 
  3. If the missed pill is within: 
    • Week 1 (pills 1 to 7) or Week 2 (pills 8 to 14) of the pack:
      • Continue to take the active pills in your current pack daily
      • Take the inactive (sugar) pills or a 7-day break
      • Begin a new pack the next day
    • Week 3 of the pack (pills 15 to 21): 
      • Continue to take the active pills in your current pack daily
      • When you have finished taking all the active pills, discard the pack
      • Don’t take the inactive (sugar) pills or a 7-day break, begin a new pack the next day
  4. Consider taking emergency contraception if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days
  5. Use extra contraception (i.e. condoms) or abstain from sex for the next 7 days 

If you missed inactive pills 

If you miss 1 or more inactive (sugar) pills, simply throw away the missed pills and take the next pill at the usual time. Remember, you also have to stay on track with your active pills as there should be no more than 7 consecutive active pill-free days between packs.  

Missed birth control pills: a brief overview

ScenarioRecommended ActionsEmergency ContraceptionBack-up Birth Control
Late or missed 1 active pill– Take the late or missed pill immediately
– Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day).		Consider only if you missed the pill earlier in the pack or in the last week of your previous packNot required
Missed 2 or more active pills– Take the last pill that you missed immediately even if it means taking 2 pills a day
– Discard any earlier missed pills 

If you missed the pill within week 1 – 2 of the pack (pills 1 to 14):
– Continue to take the active pills in your current pack daily
– Take the inactive (sugar) pills or a 7-day break, begin a new pack the next day

If you missed the pill within week 3 of the pack (pills 15 to 21):
– Continue to take the active pills in your current pack daily
– Skip the inactive (sugar) pills or 7-day break, begin a new pack the next day		Consider only if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days.Use extra contraception or abstain from sex for the next 7 days 
Missed 1 or more inactive pills– Discard missed pills and take the next pill at the usual timeNot requiredNot required

Progestogen-only pill or mini pill 

Unlike the combined contraceptive pill, progestogen-only pills (aka mini pills) contain progestin and not estrogen. They are taken continuously without any hormone-free breaks. 

If you missed a pill within the 3-hour (mini pills) or 12-hour window period (desogestrel pill)

You will still be protected against pregnancy if you are: 

  • Less than 3 hours late in taking a progestogen-only pill
  • Less than 12 hours late in taking a desogestrel pill

What you should do: 

  1. Take your missed pill as soon as you remember 
  2. Take your next pill at the usual time 
  3. There’s no need for an additional form of contraception or emergency contraception even if you’ve had unprotected sex

If you missed a pill for more than 3 hours (mini pills) or 12 hours (desogestrel pill)

Heads-up, according to the National Health Service, you’re likely unprotected against pregnancy! 

What you should do: 

  1. Take 1 pill as soon as you remember even if you have missed more than 1 pill
  2. Take your next pill at the usual time – this may mean taking 2 pills in a day (1 when you remember and the other at the usual time) which is totally okay to do so 
  3. Continue taking your remaining pills daily at the same time 
  4. You may need emergency contraception if you’ve had unprotected sex in the last 5 days
  5. Use back-up contraceptives for the next 2 days (48 hours) after taking the missed pills or simply refrain from having sex 

Useful tips to help you remember to take your pills on time

Whether or not you’re trying out a new routine to remind yourself to take the pill or ensuring you’re way more well-equipped after your first “missed birth control pill” scare, the following list of tips we’ve compiled will definitely help you.  

  • Opt for another birth control method such as the patch as it only needs to be changed once a week 
  • Set a recurring alarm or reminder on your phone 
  • Use a birth control pill reminder application 
  • Incorporate it into your daily routine 
  • Place the pills in an easily noticeable spot (e.g. bedside table, beside your toothbrush)
  • Get your partner to remind you

Seek help if you need to

We totally get that it can be real confusing knowing you missed your pill and the follow-up steps taken vary depending on what type of birth control pill you’re on. But hopefully, this condensed guide can be your saving grace in times of need (and that you won’t be referencing it anytime soon!).

Feel free to reach out to Siena’s doctors, if you are unsure which instructions pertain to your oral contraceptive pills or to discuss any other concerns you may have with your birth control method. 

References:

Categories
Birth Control Sexual Health

Birth Control Patch: 7 Facts You Should Know

Credit: Illustration by Siena Health

Don’t shy away from the birth control patch! Simple and convenient, it’s a seamless integration into your everyday routine and here are the reasons why.

With a variety of birth control to choose from, you may or may not have overlooked the birth control patch as another great alternative for your contraception needs. Or perhaps you’re unfamiliar with how the patch works and would rather stick to methods you’re used to. Nevertheless, the birth control patch is meant to be just as effective as birth control pills and may even be easier to use. 

A quick survey of the local landscape surrounding birth control based on a 2016 survey study: Singaporean women have low awareness and knowledge of hormonal intrauterine devices (IUD), the patch and the vaginal ring. This was the first survey study that assessed Singaporean women’s awareness and knowledge of contraception in Singapore. Thus, there were only a sparse few who actually used the patch. (Source: Singapore Medical Journal) 

Even though the patch may not be as popular as condoms or the pills, it works just the same in helping you prevent pregnancy. Especially if you dislike popping pills or if you’re afraid of going through with bigger commitments such as the implants and IUD, the patch is a perfect midway option. 

Read on as we cover how the birth control patch works, its benefits, and more!

1. The patch works by delivering hormones through your skin and into your bloodstream

Similar to birth control pills, the birth control patch contains two hormones estrogen and progesterone, which work together to prevent pregnancy by suppressing ovulation. When you wear the patch, it releases these hormones which your body subsequently absorbs through the skin.

The patch is able to stop ovulation while the hormones in the patch also thicken the cervical mucus, preventing sperm from entering the uterus. The hormones also thin the uterine lining which makes the implantation of a fertilised egg difficult.

Similar to birth control pills, the birth control patch is 99 percent effective in preventing pregnancy with perfect usage. But in real-life conditions, such as incorrect application or forgetting to replace the patch, they become about 91 percent effective. In comparison to the pill, however, the patch is a great alternative if you find daily pill-popping a hassle.

2. The patch is designed to be fun-sized and discreet 

Image credit: Siena Health

The birth control patch looks like a plaster, as it is a small and sticky square patch that is usually thin and beige in colour.

Worried about them being too obvious? You can apply them to the skin on your upper outer arm, abdomen, buttocks or upper torso. Take note: do not apply the birth control patch to your breasts or somewhere easily irritated by clothing.

3. You only need to think of the patch once a week

Application

The following steps are really important to ensure you use the patch accurately and effectively. 

Firstly, open the pouch containing the patch and remove the protective film. Apply the sticky side of the patch onto your skin by exerting slight pressure for at least 10 seconds to ensure it is properly attached before smoothing out any wrinkles. 

Thereafter, you can change your birth control patch each week over a period of three weeks and go without the patch during the fourth week. Similar to getting your period, you’ll experience withdrawal bleeding. After the fourth week has ended, start your next cycle with a new patch.

For first-time users of the patch 

Once the birth control patch has been prescribed to you, apply the first patch during the first 24 hours of your period. It becomes effective immediately after application within the first five days of your period. And yes, now you don’t have to worry about relying on any other back-up contraceptive methods! 

Alternatively, if you decide to use the first patch on the first Sunday after your period has started or you apply your first patch more than five days after your period started, the patch will not take effect immediately. Meanwhile, you should use an additional form of contraception (i.e. condoms) for the next seven days.  

Mark your calendars — note down the first day you apply the birth control patch and designate it as your next “patch-change” day! 

Each patch lasts for seven days so you’ll have to keep it on throughout and replace the patch exactly one week from the date you first applied it.

Extra tips:

  • Apply the patch on completely clean and dry skin
  • Avoid using lotion, oil, powder and makeup on the area you plan to apply the patch to
  • Try to store your unused birth control patches in a dry and room-temperature environment away from direct sunlight
  • Do not remove the patch from the pouch if you don’t intend to use it yet

4. Fuss-free removal process

Image credit: wikiHow

To remove the birth control patch, all you need to do is peel off the old one and replace it with a new one. It’s best to fold the adhesive sides of the old patch together before disposal so that it is not exposed. Do not flush the patch in the toilet as this may contaminate the water supply with hormones.

5. Do daily checks on your patch

This is an unlikely scenario as the birth control patch is designed to be firmly attached to your skin. You can safely shower, exercise and even swim with the patch. 

But in the event the patch does come loose or fall off, there are ways to get back on track! 

Prone to bad memory and sticking to a schedule? Don’t freak out because even if you really do forget to change your patch and it’s been less than two days (48 hours), just reapply a patch immediately and subsequently change your patch on the same day as the previous patch. If it’s only come loose, you can stick it back on and continue using it. 

However, if the patch has come off for more than two days or you’re unsure how long it has been since the patch fell off, reapply a new patch immediately and use another birth control method for at least a week. You’ll also have to begin a new four-week cycle and take note of the day you applied the replacement patch. The day on which you apply the new patch will be the new “first day” of the new application cycle. 

It’s uncommon for the birth control patch to fall off if you’ve followed the instructions closely. To prevent it from happening, try to cultivate a habit of checking your patch daily to ensure it’s still firmly attached to your skin. If the patch does not completely stick to your skin, immediately replace it with a new patch.

There is also a handy tool available online if you ever lose track of your birth control schedule and require help ASAP! 

6. The patch has other non-contraceptive benefits 

Similar to the benefits of other forms of hormonal birth control, the hormones in the patch can also help to lighten and regulate your periods while alleviating symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It can even lower the risks of developing cysts in your breasts and ovaries. (Source: Planned Parenthood)

7. You can use your birth control patch to skip your period

A long-awaited holiday trip coming up? Attending a pool party in a couple of weeks? Or simply longing to head to the beach? With the birth control patch, you can be sure to leave all your period worries behind during times like these!

If you’d like to skip your period altogether, use the patch every week. This means starting a new pack of patches every three weeks without any break in between (i.e. continue using the patch during the fourth week). By doing this, the constant stream of hormones in your bloodstream eliminates your monthly withdrawal bleed.

What are you waiting for? 

Surely by now, you’re more familiar with the various upsides of the birth control patch and why it’s so convenient and easily reversible! Using the patch is definitely an effortless and painless process since it only needs to be applied once a week.

Feel free to check in with any of Siena’s female doctors before trying out or switching to a new birth control method. We’re most happy to help you find your most suitable, discreet and favoured birth control!

References:

Categories
Birth Control Sexual Health

Birth Control Before The Pill: How Women Prevented Pregnancy Throughout History

Discover a brief history of contraception before the invention of the birth control pill. You’ll be surprised to know about various bizarre and ancient methods!

Birth control options are now more than ever readily accessible in both physical and online spaces. But have you ever wondered how it was like for women in the past when technology wasn’t a thing yet? Read on and I imagine you will count yourselves lucky to be living in the 21st century. Now, you can even get your birth control online and delivered right to your doorstep.

Ancient birth control methods, no thanks!

Commonly used traditional methods comprise largely home-made techniques, some of which may (or may not) surprise you. In the ancient era, women relied on disturbing ingredients like crocodile dung, and bizarre concoctions of edibles such as honey and acacia. Condoms were made from animal membranes and there was a common practice of washing and soaking one’s genitals with ingredients like lemon and olive oil. Lastly, a deadly-sounding method even includes ingesting lead and mercury. Otherwise, before the discovery of chemical and hormonal contraception, the traditional withdrawal (pull-out) method was just as common back then. 

British artist William Blake’s depiction of King Minos. Image credit: National Gallery of Victoria

What about the trusty “wetsuit”? The first known documentation of the use of condoms was by King Minos of Crete in about 3000 B.C. Apparently, his semen contained “serpents and scorpions” which killed his mistresses after intercourse. Back then, condoms were subjected to primitive ideals and definitely did not come in the clean, rubber form we are now accustomed to. Thus, as a form of protection, a goat’s bladder was inserted in the vagina of King Minos’ wife to act as a sheath. Essentially, animal bladders were primarily employed to prevent the contraction of venereal diseases rather than to prevent pregnancy. Resourceful or downright nasty? You decide. 

Finally (and thankfully), rubber was introduced in the manufacturing of condoms which brought about real technological advances. By the 1860s, there was a rise in the large-scale production and popular use of latex condoms, altogether replacing skin condoms made from animal intestines or bladder. 

The battle for birth control

Despite being normally associated with family planning, birth control faced resistance in the 1800s. Many perceived contraception as immoral and akin to encouraging prostitution. (Source: Stanford Medicine)

In fact, under the Comstock Act of 1873 in the United States, even medically prescribed writings or materials regarding contraception and abortion were made illegal as they were seen as obscene and indecent. As a result, the enforcement of the sale and distribution of materials concerning birth control eventually prompted social reformers to advocate the repealing of the federal law. Before the birth control movement became closely tied to the feminist movement, worry-free and safe sex were pretty out of reach for women in those days.

From the 1940s to 1950s, activists Margaret Sanger and Katharine McCormick embarked on a vigorous scientific research in search for the pill that could potentially control fertility. Oh boy did this cause a shift in the previously uneven level playing field for women to take charge of their sexual health. The first invented pill was both effective and simple to use, thus attracting millions of women to partake the first of oral contraceptives. (Source: Planned Parenthood Federation of America) 

Implants such as the intrauterine device (IUD) also made their mark in history since 1909. IUDs were first experimented using a ring made of silkworm gut with two protruding ends of the cervical os. Subsequently, other physicians such as Ernest Graefenberg (FYI: the G-spot was named after him), developed similar versions that proved more effective with the use of a mixture of metals including copper. Ultimately, it was only in the 1980s did the FDA-approved Copper-T gain more significant traction as one of the most effective and safest forms of contraception. 

Revolutionary effects

Needless to say, birth control has improved drastically and we should all be grateful for today’s plethora of reliable birth control methods to choose from. Beyond mere access to birth control pills, other forms of birth control such as patches and emergency contraception have likewise allowed women all around the world to be empowered, educated and take charge of their own health.

References:
Armitage, H. (2018). Contraception: An evolution and history. Stanford Medicine. https://scopeblog.stanford.edu/2018/05/16/contraception-evolving-the-options/

Burnette, B.R. (2009). Comstock Act of 1873 (1873). The First Amendment Encyclopedia. https://www.mtsu.edu/first-amendment/article/1038/comstock-act-of-1873#:~:text=%2C%20public%20domain

Khan, F., Mukhtar, S., Sriprasad, S., & Dickinson, I. K. (2013). The story of the condom. Indian Journal of Urology, 29(1), 12-15. https://doi.org/10.4103/0970-1591.109976

Margulies, L. (1975). History of intrauterine devices. Bulletin of the New York Academy of Medicine, 51(5), 662-667. https://pubmed.ncbi.nlm.nih.gov/1093589/

Marhol, A. (2021). Ancient Birth Control Methods: How Did Women Prevent Pregnancy Throughout the Ages? Flo. flo.health/menstrual-cycle/sex/birth-control/ancient-birth-control-methods

Planned Parenthood Federation of America. (2015). Birth Control – History of the Pill. https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf

Categories
Emergency Contraception Sexual Health

What to do if the condom tore, broke or slipped?

In Singapore, the male condom remains one of the most popular contraceptive options, experts say.

Yes, it happens.

Condoms do not break or slip often. In fact, it most commonly only happens when couples do not follow the recommendations on proper condom use. 

Though infrequent, there is a chance that they might occur and being armed with the knowledge is crucial in the event you find yourself in such a situation. 

How can you tell if a condom tears or breaks?

Obvious breakage

Sometimes condoms break in the packaging or while they’re being put in place, so it’s a good idea to quickly inspect the condom before putting it on.

If the breakage happens when you’re in the moment, you’ll probably feel (immediate change in sensation for the one wearing it) or see the damage when you or your partner pull away.

However, many people don’t notice that a condom broke until after they’re done having sex. That’s why it’s important that you check the condom when you remove it for any obvious holes or leaks.

Microtear

Microtears are tiny tears not usually visible to the naked eye but can also allow viruses and sperm to pass through. This is rare, especially if you’re using and storing the condom correctly.

In some cases, microtears can be a manufacturer defect, though that’s extremely rare. Manufacturers put condoms through a series of tests to monitor for breaks and defects before selling them.

More often, user error causes microtears. Common mistakes that could lead to microtears include:

  • using an expired condom
  • opening condom wrappers with your teeth
  • putting a condom on the wrong way, then flipping it and reusing it
  • using a condom that was stored in an unsafe place, like a wallet
  • using a condom that was exposed to large temperature shifts, moisture, or direct sunlight
  • using a condom without lubrication, which results in friction that could make the condom break
  • using oil-based lubes, such as Vaseline, lotion, or coconut oil, which can break down the material the condom is made of (latex or polyisoprene condoms)

How to prevent pregnancy if a condom is torn, broke or slipped?

If you had sex within the last 5 days, you can take an emergency contraception (morning-after) pill, which delivers a high dose of hormones to delay ovulation and prevent a fertilized egg from implanting in your uterus.

The two common types of morning-after pills in Singapore are:

  • Ulipristal acetate (Ella®)
    • has to be taken within 120 hours (5 days) after unprotected sex
    • lowers your chances of getting pregnant by up to 98% throughout the entire five-day window; and
  • Levonorgestrel (Postinor®-2)
    • works up to 72 hours after unprotected sex but is generally not recommended after 24 hours
    • lowers your chances of getting pregnant by 95% if taken within the first 24 hours after unprotected intercourse but this declines to 85% if taken between 25 – 48 hours and 58% if taken between 48 – 72 hours after unprotected intercourse.

Generally, it’s important to remember that the EC pill works best the sooner you take it!

Where to get emergency contraception (morning-after) pills in Singapore?

In Singapore, emergency contraception is only available with a prescription.

With Siena, you can buy your emergency contraception online!

Consult one of our female doctors via a video call and have your emergency contraception pill delivered to your door.

No waiting time, free 4-hour discreet delivery.

How to prevent HIV if a condom is torn, broke or slipped?

If you believe that you or your partner are at risk of contracting HIV, speak to a doctor immediately to access your situation and suitability for Post Exposure Prophylaxis (PEP) treatment.

PEP is a 28-day course of anti-retroviral medication that can prevent HIV from infecting your body. PEP is only effective within 72 hours after exposure to HIV, but the earlier you begin treatment, the more likely it is to work in full effect.

After which, you will likely need to take HIV tests to ensure the medication has worked.

The bottom line

Condom breakage or slippage can be a stress-inducing accident, but they’re pretty rare, especially if you follow the recommendations on proper condom use.

More often than not, you’ll know if the condom broke — and that means you can quickly take measures to protect yourself.