Faith Carlin, M.D. OB/GYN Medical Practice

Frequently Asked Questions

All questions are welcome; no question is considered "dumb" or out of place in this office. Many people have the same questions, so we have compiled this listing. Dr. Faith Carlin has written all the answers, so they should be deemed reliable, however, if you are not a patient of ours, you should check with your own physician before taking this "advice."

Missed pills: if you miss one pill, take the missed pill as soon as you remember and take the pill that is due also. You have a low risk of getting pregnant, but may begin bleeding.

• if you miss two pills in a row, take two pills as soon as you remember and take two pills the next day and you should be caught up. Use a condom or other method the rest of the cycle to protect against pregnancy. You will probably spot until the next period.
• if you miss three or more pills in a row stop taking the pills in your current pack. Wait for your period to start and then start a new pack on the Sunday closest to the start of your period. Use another method of birth control from the day you stopped the pills until you have completed 2 full weeks of the new pack.

Irregular bleeding or no bleeding (missed period): it is not uncommon to have irregular bleeding (known as break-through bleeding) on BCP, especially in the first one to three cycles. You should continue to take your BCP as if nothing is wrong. Try and take your pills at the same time each day, it may help this problem and it will definitely help you to remember them. If you have taken all your pills and do not get a period, don’t panic.

You are probably not pregnant, but you could check by doing a home test. If it’s negative, start your next pack of pills as if nothing out of the ordinary has happened. You did not bleed because there is not enough tissue in the uterus to bleed off. This is the result of the low-dose pills currently popular on the market. Some women love this problem, others hate it. If you want to have a period, your pills will probably need to be changed, but it is not necessary to have a period if you are on BCP.

What day do I start my first pill pack? This applies to new users only, as current users already know the day of the week to start as it is always the same day once you get started. You may start the first pack on the same day as your period starts or the 5th day after your period starts or on the Sunday closest to the start of your period. The Sunday start is designed to give you your subsequent periods during the week, not on the weekends. Whichever you or your doctor chooses, use another method of birth control until you have completed the first pack to really avoid an accidental pregnancy. Remember, BCP only protect against pregnancy, not diseases.

How long should I be off BCP before attempting pregnancy? I recommend stopping the BCP 1-2 months before getting pregnant. When you stop the BCP, start taking a prenatal vitamin. The folic acid in the vitamin taken BEFORE conception decreases your risk of birth defects. Use a condom or other method for the 1-2 months before conception. Of course if you conceive immediately after stopping the BCP, or even while taking them, the pregnancy may continue. There have been no reported birth defects due to use of BCP in pregnancy.

What are common side-effects of BCP? All drugs have a risk-benefit ratio to consider. BCP give you 99% protection from pregnancy as well as decrease your risk of uterine and ovarian cancer. However, they may cause nausea, headaches, breast tenderness and growth, moodiness and weight gain (3-5 lbs. at best, more is not the pills fault!). Try taking the BCP at bedtime instead of daytime. Try to live with the effects for 1-2 cycles before giving up, as most are temporary. Keep a log of exactly the symptoms you don’t like, it may help the doctor decide which BCP to try next.

Frequency of dosing: The injections protect you from pregnancy for 12 weeks. However, it may take up to 18 months before you could become pregnant. Therefore this method is not intended for short-term use. You do have a 2 week "grace" period in which to get your next injection (i.e. 14 weeks from previous injection will still be protected), but this increases your chance of irregular bleeding.

Irregular bleeding: This is probably the most common side-effect of the drug. However, the more injections you take, the better the chance you have of having no periods at all--most women love this! The Depo-Provera user must seriously consider the potential side-effects of the drug before it is given, as there is no way to get it out of the body once injected, it has to wear off over time (3 months).

Again, these are commonly asked , but consult your own OB or CNM during your prenatal care. Write your questions down before an upcoming appointment, so you won’t forget.

What medications are safe for use in pregnancy?

• Tylenol--NOT aspirin, Advil, Aleve, Nuprin, etc.
• Kaopectate
• Sudafed--NOT if you have high blood pressure
• Antacids--Rolaids, Tums, Mylanta, Maalox, etc. Too much causes diarrhea.
• Robitussin cough syrup
• Preparation H
• Metamucil, Fibercon, Citrucel and other bulk fiber products
• Gyne-Lotrimin cream (OTC yeast infection medication)
• Cough drops and Chloraseptic spray
• Benadryl

How soon after I am pregnant, will a home test be positive? Most home tests are accurate enough to predict pregnancy when done on the day you expected your period. If the test is negative, and you are pretty sure you are not pregnant, wait a week before testing again, then call your doctor. If you think you are pregnant but the test is negative, repeat it in 3-4 days, or call your doctor to see if a blood test is indicated. Using the first mornings urine works best because the pregnancy hormone is most concentrated then.

How long should it take to get pregnant? Assuming there are no known problems, a couple where the woman is under the age of 35 should conceive within 12 months, with 50% conceiving within the first six of those months. Therefore, infertility evaluations are generally not started until one year has gone by. However, once the woman is over the age of 35, her fertility declines and I like to start the evaluation at 3 months, even though that really is very little time for nature to have taken its course.

What is it? A very high dose of birth control pills given within 72 hours of unprotected intercourse that can decrease your risk of pregnancy by 85%

What if I take it and it fails? If you decide to continue the pregnancy, there are no birth defects associated with it.

What are the most common side-effects? Significant nausea and vomiting. If you throw-up the pills you will not be protected. Anti-nausea medications are sometimes given to prevent this.

What is normal discharge? Generally it is white or clear in color, not irritating to the skin and does not have a foul odor.

What is a yeast infection? Generally excessive white itchy discharge that may occur with clumps, like in cottage cheese. There are many good over the counter medications to use, however you should not treat yourself if you have never had one diagnosed before. If you have recurring or frequent yeast infections, you should see your doctor.

What is the most frequent type of infection? A bacterial infection that is associated with a fishy odor and thin milky discharge. This requires a prescription medication to eradicate, if your own body’s defenses do not.