Friday, February 27, 2009

Does Pill Timing Need To Be Perfect?

Hi Dr. Kate,

I am hoping you can settle a debate between me and my friend. We are both on combination, triphasic birth control - specifically Tri-Sprintec. My friend's gynecologist told her to take her pill at the exact same time, on the hour, every day for it to be effective. My gynecologist told me to make sure I take one pill per day, but that time of day has little to no bearing on the effectiveness of my birth control. My friend sets an alarm to take her pill while I just take mine before I go to bed each night, whenever that may be. How important is it to take the pill at the same time every day? Thank you!

Contraception Clock-watcher

Dear Clock-watcher,

You win the debate. Before doctors knew better--about how long each pill stayed in our system, and how long the pill's effects lasted--they always advised patients to take the pill at the same time each day. But now we know that as long as a pill gets in your body each day, you're safe. In fact, even if you miss one day (and double up the following day), the pill's efficacy is the same.

So why do some doctors still recommend this perfectionist timing? It's a matter more of habit than biology. Women who have been on the pill know how difficult it is to take a pill every day for months or years on end--it's the rare woman who never misses one. Many docs think that patients should make their pill-taking as much a routine as showering or brushing their teeth. There's something to this for many people--but women should know that it's okay if they take it at different times each day (like your floating bedtime).

The only birth control pill that MUST be taken at the same time every day is the progestin-only pill, Micronor. This pill works differently than the typical "combination" pill (that contains estrogen as well), and has a very narrow margin of error. Women using this pill must take their next pill within three hours of the previous dose, or they're at risk of pregnancy. But for everyone else, figure out what pill taking habit works best for you.

How do you take your pill each day? What tricks or habits have you used to not forget to take it?


Farida said...

Does this hold true for the Nuva Ring as well? I started Nuva Ring on a Sunday at around 1:30 PM, can I remove it at a later time - like in the evening before bed, and insert it again the Sunday a week later in the evening?

Dr. Kate said...

Farida, when the ring has been in for at least three weeks, yes, you can remove it that evening. I would try to put it back in, though, as close as you can to the same time (or sooner). One of the ways that birth control fails is when you go more than 7 days without hormonal suppression--your ovaries "wake up" and may ovulate before you begin your birth control again. So while you have some flexibility in when you take it out, I wouldn't mess with the following 7-day window.