Q. As I’m assuming we all do, I occasionally forget to take my pill of a morning. Is it okay to take it later and how long after having made this error can I have safe unprotected sex?
A. If you are taking the combined contraceptive pill (with both estrogen and progesterone hormones), most of them have a 12 hour safety limit. If you take your pill up to 12 hours after the usual time, then you don’t lose your protection. If you have already taken one week of the active pills, then missing one pill is no big deal. If you miss pills in the first week of the pack, then that is a more dangerous time. For missed pills in the first week, or if you start the pack late, avoid sex or use an extra method such as condoms. If you are more than 12 hours late for a pill, don’t take it - it doesn’t help to double up, and can make you feel sick. If you miss a pill in the last week of the pack, when you are coming up to the sugar pill/period break, the safest option is to miss the sugar pills and go straight on to the hormone pills in the next pack - thereby missing a period that month.
Q. My boyfriend and I had a bit of an accident with a condom and now I’m worried about being pregnant. I was told about the morning after pill and was wondering how it worked and how effective it is. Can you help?
A. The ‘morning after’ pill is best taken within 72 hours of sex, and is looked upon as an emergency contraceptive, not a regular form of birth control. There is a new version of the ‘morning after’ pill on the market called Postinor-2: when taken correctly, it will prevent more than 85 per cent of expected pregnancies. Postinor-2 is a hormone (progesterone) that works in several ways: it may prevent ovulation, alter the function of the fallopian tubes to minimize the chance of fertilization, or change the lining of the uterus to make it unlikely that an egg will be able to implant. Postinor-2 comes as two tablets, which must be taken 12 hours apart, the first AS SOON AS POSSIBLE after unprotected intercourse. Side effects do sometimes occur and include nausea, breast tenderness, vomiting and vaginal bleeding. If you have problems purchasing this medication from your local pharmacy, “Hannah Pharmacy and Family Health Center” in Gatsu Barat usually has a good supply.
Q. I have a concern about my girlfriend getting pregnant. I heard that Asian women tend to have more risk of side effects in using the Pill, so we don’t use it. I would like to know how effective using only a condom is for avoiding pregnancy, and in terms of the Pill, if there are different degrees of side effects depending on race.
A. Condoms are a very effective method for preventing pregnancy if you use them correctly. It is also wise to be aware of your partner’s cycle, and understand that the most fertile time for women is between day 12 and day 17 of her cycle (counting the first day of her period as day 1, and assuming that the cycle is regular). Extra caution should be taken if using condoms in this window period, as any leakage could surely result in pregnancy. The other important point is to make sure that the blister end of the condom remains free of air and that the penis is not pulled right up to the end of the teat as this will encourage rupture of the condom. It is also important that the male withdraws before the erection subsides so that the condom does not slip off during withdrawal. To further prevent the condom slipping off during withdrawal, the man should hold the base of the condom around the base of his penis as he withdraws. Using a water-based lubricant (oil based lubricants may weaken the latex) during intercourse will also minimize risk of the condom breaking. Serious side effects of the Pill are the same for women for all races. However, the risk of such serious conditions as heart attack (which occurs in women who smoke heavily and also take the pill) and blood clots depend very much upon the risk factors for each individual.
Q. I am on the pill, and like the safety of having my period every month, however I occasionally want to change a period if I have an ‘event’ coming up. Is it safe to take the inactive (sugar) pills a week early and swap the active ones for the week of my ‘event’ instead of skipping the inactive (sugar) pills altogether?
It is quite safe to manipulate the pill cycles; after all, the cycles we have on the pill are completely artificial, and the reason we take them for three weeks on and one week off is that most women feel that they should have a “period” every month to be “natural or normal”. Many women who have horrible painful periods even on the pill, very sensibly decide to have fewer periods (every 2 months for example), and some women with conditions such as endometriosis take the active pills without any breaks at all, sometimes for years. You should be cautious if you are on the triphasic pills, where there are three different strengths of hormone pills in the one packet (3 different color pills). It is more difficult to miss periods on these pills. Monophasic pills, which are the same strength on each day (2 colors of pills), are much easier to manipulate - just keep on taking them until you decide you want a break, then stop. For anyone taking the pill for contraceptive reasons, it is important to have no more than a seven day break from active pills.
Q. My daughter is 14 years old and I was horrified to find a packet of contraceptive pills when I was cleaning her bedroom. I am disturbed to think that she is sexually active at her age, and also upset that our doctor would have prescribed them for her?
A. First of all please don’t jump to conclusions about why your daughter is taking the pill. Oral contraceptives are also prescribed for heavy or irregular menstrual cycles (a very common condition in adolescents), as well as to treat some skin conditions such as acne. It seems that it’s about time that you and your daughter had a good talk, and try to establish an honest and open relationship about her development and relationships through her teenage years. If your daughter is sexually active (and this is not uncommon at age 14), then try to give her some guidance on safe sex, and make her aware that while the pill may prevent pregnancy, it will not prevent sexually transmitted disease. As to who prescribed this medication for your daughter, don’t send out the lynching parties just yet! The doctor probably had a very valid reason for prescribing them.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
