These answers are for general informational purposes only and are not a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.
The best birth control if you don’t want to have children are in order from best to least effective:
The birth control implant (Nexplanon ®, Implanon ® works better than tubal ligation! Some women do GREAT on it. Some women have a lot of random breakthrough bleeding (BTB).
The IUD with hormone (Mirena ®, Liletta ®, Kyleena ®, Skyla ®) are very well tolerated because it is low dose and progesterone only. 30% of women who go on Mirena and Liletta have no periods. yay! 70% get lighter periods. Kyleena and Skyla are more likely to continue to have periods.
Then comes, Tubal ligation and then copper IUD in terms of efficacy at preventing pregnancy.
If you like the birth control ring (Nuvaring ® or its generics), now there is a 1 year ring. You could just put it in and leave it in for a year!!
Know that there are 40 different birth control pills with estrogen and progesterone. so if you didn’t like 1 then there are 39 other formulations of the birth control pill you could try.
If you are in a long term heterosexual relationship, it’s better for the one with the testicles to get a vasectomy than you to have your tubes tied. Vasectomy is more effective and less invasive than tubal ligation. Tubal ligation is invasive! they have to poke 3 holes in your abdomen, blow it up with gas. and it’s NOT as effective as the implant/IUD with hormone! and NOT as effective as vasectomy.
If your doctor is an ob/gyn or even if they are not, you can cite the ACOG committee opinion https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Sterilization-of-Women-Ethical-Issues-and-Considerations it says:
“It is ethically permissible to perform a requested sterilization in nulliparous women and young women who do not wish to have children. A request for sterilization in a young woman without children should not automatically trigger a mental health consultation. Although physicians understandably wish to avoid precipitating sterilization regret in women, they should avoid paternalism as well.”
The IUD with hormone fails 1/1000.
Tubal ligation/women’s sterilization fails 5/1000
The implant fails 1/1000.
Vasectomy fails 1.5/1000.
The birth control ring, the birth control patch, and the birth control pill fail 7/100, though the ring and patch, should have a theoretical lower failure rate because you have fewer chances of forgetting/messing up. The ring has 13 chances a year of messing up, the patch 52 times and the pill 365 times.
You can read more about birth control efectviness or what’s the best birth control for you in our resources.
There are 2 hormones in birth control pills:
Norgestimate does not have a higher dose estrogen and it’s known for breakthrough bleeding.
Zovia/Demulen has a 50mcg estrogen version and it has a higher progestin effect so will most likely stop the breakthrough bleeding
Medications such a Vyvanse and other ADHD meds rev up the liver and eat up the estrogen and other hormones in birth control so people on those meds sometimes need higher estrogen.
Yes it’s possible for several reasons: If you don’t take it every day, if you need a higher dose of hormones than you are on. and some people are just really fertile and get pregnant on the birth control pill even if they take it every day. If you think you might be pregnant, you should check a pregnancy test. However, if you take your medicine everyday and there isn’t any unusual spotting, then it’s unlikely that you would get pregnant. The chance of pregnancy on the birth control pill, if you take it right, is like 3/1000 women. And 9/100 in “normal use” meaning with errors.
We recommend and encourage using condoms to protect yourself and your future children from sexually transmitted infections.
If you missed 1 pill, take it as soon as you remember it. If you missed 2 days of pills in a row, take 2 today, and 2 tomorrow.
If you missed 3 days of pills, you’ll probably get your period, you’re are at risk of getting pregnant. Consider taking some emergency contraception (Pandia Health can help you get some – we can call in a prescription to your local pharmacy if you are our telemedicine patient) if you had sex during those 3 days. Use a backup birth control method (condoms) for the next month to be absolutely safe.
Re-start your pills after being off for a total of 5 days (so if you missed your pills for 3 days, stay off for another 2 days and then re-start your pills).
Talk to your doctor/provider if you have ANY questions or our pharmacist/telehealth partner doctor if you are our telemedicine patient.
A partner pharmacy is an existing pharmacy with whom we have established a business relationship to fulfill the medication. We have carefully selected pharmacies in the United States who provide high quality service and believe in our mission.
You will be provided with a USPS tracking number via text or email.
This depends on what your insurance will allow and what your doctor wrote. Pandia Medical Group’s doctors usually write for 1 year’s supply at a time and California law mandates that insurances allow 1 year’s supply at a time. If you have no insurance, we can ship as many months worth of medication as you are willing to pay (up to a year).
We work with a partner pharmacy who sources from a distributor who obtains medications from manufacturers who abide by FDA regulations.
Thank you for your generosity! Pandia enables donations via the Pandia Health Birth Control Fund (sponsored by the Center for Policy Analysis). We welcome all levels of giving.
Yes, we have a referral program for patients, organizations, and campus reps. If you are interested in participating, please contact info@pandiahealth.com.
We currently partner with pro-women, pro-health non-profits in a variety of ways. Donation via referral code tracking is one possibility. For more information, contact info@pandiahealth.com.
Pandia Health was founded by a doctor who understands firsthand the medical office experience. We endeavor to reduce frantic, last-minute birth control refill requests to keep your admin efforts down while also helping your patients stay compliant with their monthly medications. You can e-prescribe to our partner pharmacy and recommend our service to your patients. We are happy to send you marketing materials for your office. Please email info@pandiahealth.com if you are interested.
Our partner pharmacy bills the cost of the medication to your insurance. If you have a copay, we will send you an invoice via email and you can pay online via debit or credit card.
The best birth control if you don’t want to have children are in order from best to least effective:
The birth control implant (Nexplanon ®, Implanon ® works better than tubal ligation! Some women do GREAT on it. Some women have a lot of random breakthrough bleeding (BTB).
The IUD with hormone (Mirena ®, Liletta ®, Kyleena ®, Skyla ®) are very well tolerated because it is low dose and progesterone only. 30% of women who go on Mirena and Liletta have no periods. yay! 70% get lighter periods. Kyleena and Skyla are more likely to continue to have periods.
Then comes, Tubal ligation and then copper IUD in terms of efficacy at preventing pregnancy.
If you like the birth control ring (Nuvaring ® or its generics), now there is a 1 year ring. You could just put it in and leave it in for a year!!
Know that there are 40 different birth control pills with estrogen and progesterone. so if you didn’t like 1 then there are 39 other formulations of the birth control pill you could try.
If you are in a long term heterosexual relationship, it’s better for the one with the testicles to get a vasectomy than you to have your tubes tied. Vasectomy is more effective and less invasive than tubal ligation. Tubal ligation is invasive! they have to poke 3 holes in your abdomen, blow it up with gas. and it’s NOT as effective as the implant/IUD with hormone! and NOT as effective as vasectomy.
If your doctor is an ob/gyn or even if they are not, you can cite the ACOG committee opinion https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Sterilization-of-Women-Ethical-Issues-and-Considerations it says:
“It is ethically permissible to perform a requested sterilization in nulliparous women and young women who do not wish to have children. A request for sterilization in a young woman without children should not automatically trigger a mental health consultation. Although physicians understandably wish to avoid precipitating sterilization regret in women, they should avoid paternalism as well.”
The IUD with hormone fails 1/1000.
Tubal ligation/women’s sterilization fails 5/1000
The implant fails 1/1000.
Vasectomy fails 1.5/1000.
The birth control ring, the birth control patch, and the birth control pill fail 7/100, though the ring and patch, should have a theoretical lower failure rate because you have fewer chances of forgetting/messing up. The ring has 13 chances a year of messing up, the patch 52 times and the pill 365 times.
You can read more about birth control efectviness or what’s the best birth control for you in our resources.
There are 2 hormones in birth control pills:
Norgestimate does not have a higher dose estrogen and it’s known for breakthrough bleeding.
Zovia/Demulen has a 50mcg estrogen version and it has a higher progestin effect so will most likely stop the breakthrough bleeding
Medications such a Vyvanse and other ADHD meds rev up the liver and eat up the estrogen and other hormones in birth control so people on those meds sometimes need higher estrogen.
Yes it’s possible for several reasons: If you don’t take it every day, if you need a higher dose of hormones than you are on. and some people are just really fertile and get pregnant on the birth control pill even if they take it every day. If you think you might be pregnant, you should check a pregnancy test. However, if you take your medicine everyday and there isn’t any unusual spotting, then it’s unlikely that you would get pregnant. The chance of pregnancy on the birth control pill, if you take it right, is like 3/1000 women. And 9/100 in “normal use” meaning with errors.
We recommend and encourage using condoms to protect yourself and your future children from sexually transmitted infections.
If you missed 1 pill, take it as soon as you remember it. If you missed 2 days of pills in a row, take 2 today, and 2 tomorrow.
If you missed 3 days of pills, you’ll probably get your period, you’re are at risk of getting pregnant. Consider taking some emergency contraception (Pandia Health can help you get some – we can call in a prescription to your local pharmacy if you are our telemedicine patient) if you had sex during those 3 days. Use a backup birth control method (condoms) for the next month to be absolutely safe.
Re-start your pills after being off for a total of 5 days (so if you missed your pills for 3 days, stay off for another 2 days and then re-start your pills).
Talk to your doctor/provider if you have ANY questions or our pharmacist/telehealth partner doctor if you are our telemedicine patient.
You can go to a local pharmacy/grocery store. You can go to a fire station – they are supposed to be able to take it and say your doctor told you to ask them if they would help. You can also call the last doctor’s office you went to and ask what your blood pressure was at that visit.
Mainly it’s because they missed some pills or they took a medicine that ate up the hormones faster than usual like over the counter cold medicines can do that, St. John’s wort, magnesium. Studies have shown that if you have fewer placebo days, you decrease the chance of pregnancy. So if you are OK skipping the placebo, that should decrease the chance of pregnancy.
We only recommend taking the POP if you have high blood pressure, which requires that you take it at the same time every day, if you are late by 3 hours, then you need emergency contraception and to abstain from sex for the next 5 days.
The new hot thing for birth control is getting more people to consider the LARCs (Long Acting Reversible Contraceptives) but until then, there will be a business for the pill, patch and ring birth control methods.
Always use a condom, unless you both entered this relationship as virgins. Have some emergency contraception around in case the condom breaks. If you really want to prevent pregnancy, the woman should be on some form of hormonal long term birth control or the IUD. Get tested annually for chlamydia and optionally HIV.
Generics are pretty much the same as name brand and thus you can can save money if they go with the generic. Often times, people think they are on “name brand” but they are really on generic! e.g. Chateal is a generic. Generic has the same active ingredients as the brand name equivalents. The difference is that the “name brand” got the original patent. Check out our blog on the Top 5 Reasons to Chose Generic Over Brand Name BC or watch this video: https://www.youtube.com/watch?v=SOG-8GPryfA
The best birth control is vasectomy, but that is a permanent method. The next most effective pregnancy prevention method the IUD with hormone.
The patch works the same as the pill and ring. The only difference is it delivers the medicine through your skin rather than through your mouth or other part… and you only have to think about it once a week. For more info https://www.bedsider.org/methods/the_patch. We don’t recommend it as much because it has a high hormone level compared to pill or ring. but if it’s the only method you like, then it is better than nothing.
Additional Information:
Birth Control pills are really good for those that want/need them. They are FAR more effective than abstinence or condoms for preventing unplanned pregnancies. They can be used to treat acne, anemia, bad cramps, PCOS. They can be used to turn off your periods Did you know that you can skip your periods??? As Dr. Berg pointed out – they can decrease your risk of several cancers.
Yes. Generics, by law, have the same active ingredients as their name-brand versions. Generics may differ on the inactive ingredients.
Based on your answers from the health questionnaire regarding your medical history and previous birth control experience, our doctors will prescribe the safest option with the least side effects.
We carry all brands of birth control (pills, patch, ring). We will notify you if your product is not in stock and discuss alternatives.
Please note that your insurance may not cover the full price of name-brand medications. You are responsible for charges not covered by your insurance. We will contact you to approve the price if that is the case, and you may choose to pay the extra charge for the name-brand or go with a lower priced alternative. Most birth control pills that are widely available today are generic brands.
Yes, we welcome all patients. You can choose to get a prescription via telemedicine and/or opt for automated delivery (once you have an active prescription).
Pandia Medical Group offers all patients the option of a prescription for Emergency Contraception (EC) in addition to regular birth control. We recommend that all women of reproductive age have EC on hand for emergencies.
Using Pandia, you can receive your EC by mail in about a week, or we can also call in or fax the prescription to one of your local pharmacies within 1 business day.
Our doctors write prescriptions for Ulipristal Acetate (Ella) which are typically covered by most insurance plans. When you take Ulipristal Acetate, make sure you STOP your regular birth control pill for 5 days (use a backup method for those days or don’t have sex) and then restart your regular birth control pill on day 6.
We can prescribe birth control pills, patch, and ring as well as Emergency Contraception pills.
In CA, if you want to keep birth control prescriptions and care confidential from your parents and you are on your parent’s insurance, you can have the right to do it! You will need to read and fill up this form , call your parents insurance and tell them you want to submit Confidential Communications Request Form. You will need to send it by fax or email and wait 7 business days before you do anything that you want kept confidential. Your medical records should always be confidential regarding birth control, sex etc even without doing this form. But for insurance/billing/medications, you need to fill out this form and speak with the insurance in order to submit it.
To find the contact info for your health plan, you can select “find your health plan” on this page or we can help you.
In general, “the holder of the insurance” doesn’t find out about prescriptions filled on the insurance. Our telemedicine visit is out of pocket (you pay by PayPal or credit card), NOT billed to insurance – so “the holder of the insurance” would never find out about that.
Yes, your birth control should be covered under your insurance. Under the Affordable Care Act, all FDA approved birth control must be covered by insurance. If you have any problems getting it covered, contact the National Women’s Law Center 1-866-745-5487 or email coverer@nwlc.org or go to coverher.org
Unfortunately, with pharmacist prescribed birth control, they still require that you have to go into the pharmacy. With Pandia Health, you can enjoy the privacy, confidentiality, and convenience of an only Doctor consultation. Pandia’s Health Doctor group can prescribe you birth control within 24 hours and get your meds FREE delivered to your door – all done from the comfort of your home or wherever you and your phone currently are.
If you don’t have insurance or your insurance does not want to cover your medication, check out this post to find out how you can get free birth control.
Yes, in the state of California, you can get birth control without your parents knowing. Minors have the right to get treatment for the prevention of pregnancy without requiring their parent’s permission. However, you will have to pay for the treatment or have to sign up for special insurance to cover it or they have to contact the insurance and tell the insurance company that they want “privacy.”
To pay for the treatment, you just need a credit card. (We don’t accept Venmo or other payment yet)
To sign up for special insurance, go to http://www.familypact.org/Get%20Covered/what-does-family-pact-cover and go to the top R and fill in your zip code, and it will give you a list of clinics you can go to sign up for Family PACT insurance which covers birth control confidentially.
You can also tell your insurance company that you want your birth control treatment confidential. Find out how here.
We encourage minors to talk to their parents, but if they can’t then we want to help young people prevent unplanned pregnancies. It is also important to prevent sexually transmitted infections by using condoms in order to have a healthy sexual life.
Cold medicines rarely affect birth control. Unless you are on Pseudoephedrine, which revs up your system and chews up the birth control pills’ hormones faster. If you notice spotting when taking your cold meds, then the birth control might not be working. Use a back up method to be safe.
Actually, high Vitamin C does the opposite. It might increase the effect of the estrogen and increase the risk of blood clots. So watch out for headaches, chest pain, leg pain. If you get any of those, go to the emergency room and tell them you are on the birth control pill.
Multivitamins won’t affect birth control pills. Only if you are on a supplement with high dose magnesium, such as a specific antiacid not just a multivitamin.
It’s safe to take it with birth control pills. However, the topamax may make the birth control NOT work. so best to consider the shot, the implant or the IUD with hormone. she can check out bedsider.org for options and for those options she has to go in and see a provider. For providers she can go to familypact.org (if you are in CA).
It doesn’t matter WHAT time you take the pill with relations to SEX. It just has to be taken at the SAME time every day. And if you are LATE by 3 hrs, then you need Emergency Contraception and/or abstain/condoms.
Yes. the 1 week placebo was originally established with much higher dose pills specifically 100mcg of estrogen component and now we are at 35 mcg and 20mcg. So, we have seen escape ovulation at day 6 or 7 of placebo in some patients. Thus, to be safer, you could consider decreasing the placebo week to just 4 days or 5 days.
In fact, I suggest skipping the placebo week altogether. There is no need for that week. Read John Rock’s Error
Theoretically, you are covered if you start within 5 days of the 1st day of your period. But to be safe, we recommend using a back up for 1 month. People engaging in sex should always consider using a condom to protect against sexually transmitted diseases. And for women, it’s cleaner to use a condom because no leaking of fluid for the next 24 hrs after sex.
Yes. Here are the typical use effectiveness rates vs. perfect use. All are with men ejaculating in the women:
It depends which type of birth control pill, and how soon after the beginning of your period you began the medication.
If you are on the “regular” combination pill, and you start the pills on your period (within 5 days of the start of your period), you are protected theoretically within 24 hrs. If you are on the “regular” combination pill, and you start the pills NOT on your period, you are protected after 7 days on the pill.
If you are on the progesterone only pills, you are protected 48 hrs after starting that pill. However, if you are 3 hrs late taking the progesterone only pill, then you need to use emergency contraception!
To be absolutely safe, waiting a month, would be best. And Dr. Sophia Yen (Pandia Health’s CEO & Co-Founder) always recommends using a condom to prevent Sexually Transmitted Infections and to avoid leaking sperm for the next 24 hrs. Ew!
Warm pack. Warm bath/shower. But we suggest skipping your periods, that’s the best way to avoid that badness. Or at least going on the birth control pill, patch, ring, shot, implant, or IUD with hormone – all of which will make your periods lighter and hopefully less painful.
Yes. the treatment options for PCOS are: birth control pill/patch or ring or Metformin. Additionally, weight loss (if you are overweight) can help. You can read more here.
1/10 women have or will develop PCOS, when they come OFF the pill, they will have difficulty getting pregnant (though ironically the first month off the pill is the most fertile for them) but it will NOT be due to the pill but their underlying PCOS.
Also, the pill, patch, vag ring, etc do NOT protect against STDs (sexually transmitted diseases) so if you get Chlamydia and don’t know it, then that would affect your future fertility and again it wouldn’t be the pill causing the issue. So always use a condom.
Often when people start birth control, it synchronizes when the hair falls out and it seems like you are losing more than usual because it all comes out at once versus slowly over the month, However, your hair will be the same over the entire month. The main factor affecting hair loss is the progesterone and the progesterone.
It does NOT decrease cervical cancer. It DOES decrease endometrial and ovarian cancer though for the latter not as much as ring/patch/pill. Endometrial cancer by stopping the monthly ebb and flow of the endometrial lining. Less growth/shedding, less risk of cancer. Ovarian cancer b/c it does block ovulation but not as 100% as the ring/patch/pill. again, less frequent damage to the ovary (ovulation) less risk of CA.
b/c people don’t use them correctly (re-use! or old condom, or put it on the wrong side, flip it [but the wrong side already has pre-ejaculate which can have s14% rate of failure with condoms, why?perm] and possibly breakage.
Some pills may be better than others. Very-low-estrogen pills that contain drospirenone, desogestrol or norgestimate seem to have the greatest negative impact on libido and vaginal dryness, so if you’re taking one of these, talk to your doctor about whether it’s contributing to any symptoms you might have. Use a silicone lubricant, and ask your doctor for a prescription for hormonal creams to apply to the opening of the vagina. And know that you are not crazy.
Dr. Goldstein discovered that about 5% of women have a genetic variant that results in a defective or inefficient testosterone receptor. These women require much more testosterone to keep the vulvar and vaginal tissue healthy and for their glands to function normally. The effects are not obvious until testosterone levels become lower than normal, but that happens to every woman who takes the pill.
So, in women with this genetic variant, the problem is threefold:
Researchers looked at 33 years of studies that included more than 8,400 women taking birth control pills. Of those women, 22% reported a rise in their libido, 15% said they felt less desire, and 63% reported no change at all.
So maybe birth control makes sex better. Less stress from worrying about getting pregnant may = more drive?
Well if it’s not the pill, then what is it?
Could be your health, age, feelings about your relationship, are you physically active, do you drink too much, and how much stress is in your life.
“Regular” birth control pills, and the patch, and ring have 2 types of hormones in them: estrogen and progesterone. The amount of each hormone and type of progesterone varies by the pill. Each woman responds differently to the hormones.
One way the pill, patch, ring works is by blocking ovulation and many women notice a slight increase in libido with ovulation.
If you notice a change, talk to your provider. S/he can check to see if medical conditions or another medication might be causing your mojo to go down. S/he can help you decide whether to change medications. S/he might recommend you see a therapist or other medical experts if something turns up on the tests.
Do a check in with yourself: how is the relationship going? What stressors are going on? Are you eating too little/too much? These are all things that can put you out of the mood.
The natural state of a female animal is pregnant and birth control pills, patch, ring mimic pregnancy. But it’s also about risk/benefits. The benefits are – decreased ovarian cancer, endometrial cancer, decreased anemia, better quality of life with less blood or no blood, The risks – are blood clots but we screen for that but it’s a higher risk if you are 35 or older and smoke.
The Birth control pills actually DECREASE your chance of endometrial and ovarian cancer. and are the only way to decrease you chance of ovarian cancer (that we know of) other than taking out your ovaries.
If you personally have breast cancer or liver cancer, the pills can make it worse.
There is an association of birth control pills and breast cancer – but that is not certain if that is causation. i.e. Women who delay having kids until they are older increase their chance of breast cancer. Women who are the pill delay having kids. We do know that delaying having kids causes breast cancer, so we think that is most likely what is going with birth control pills and breast cancer.
Absolutely not, birth control pill, patches, ring, implant, IUD with hormone, do NOT cause infertility in the future. I think the confusion arises in that 1 out of 10 women will have PCOS. PCOS causes irregular periods and those women will have difficulty getting pregnant later. The treatment for PCOS is birth control pills. So we put these women on birth control pills and when they come off, they don’t remember they had PCOS or they weren’t diagnosed with it BEFORE they were put on the birth control pills, so when then try to get pregnant, they blame the pill. When really it was the PCOS that caused the difficulty getting pregnant.
Also, ironically enough, women with PCOS are MOST fertile the moment they get off the pill because that is when their hormones are most normal. Their hormones get more abnormal (more PCOS-y) the more days they are off the pill.
Read more about PCOS here https://www.pandiahealth.com/polycystic-ovary-syndrome-what-is-it-and-how-do-you-treat-pcos/
The dose is soooo small that she should be ok. Dr Yen is lactose intolerant and has no problems. A quick internet search shows no one has had problems. If she has problems she can try taking the pill intravaginally because lactose intolerance is not an allergy but a lack of enzyme to digest it. Without the enzyme then the lactose in the gut causes side effects bc bacteria then digest it causing gas diarrhea etc. If she has milk allergy, she should be fine with medical grade lactose bc the allergy is to a protein and not the lactose.
No. In research where they put 50 women on the pill and 50 women not on the pill. The women on the pill LOST on average 1 pound. NOT a pound a week, NOT a pound a month, just 1 pound. I think this is b/c the women NOT on the pill have menses and they bloat up and bloat down and weigh 1 pound more b/c of bloat.
Some women experience the munchies with the pill and others do not. Each individual is different. If you think your pill is making you gain weight, then try a different formulation. There are like 7 different progesterones you can try and it might be the dose of estrogen, which can be lowered.
The best way to avoid nausea is to take it right before you go to bed. or with DINNER. try that. and if that doesn’t work, then you might need to go to lower dose estrogen pill.
Most people do fine. Some people have nausea but that is only if they take it first thing in the AM on an empty stomach. Some people have irregular periods – but that’s b/c they don’t take it at the same time everyday. Some women notice an enlargement of their breasts like a cup size. most side effects get better/go away by 3 months on the pill.
A partner pharmacy is an existing pharmacy with whom we have established a business relationship to fulfill the medication. We have carefully selected pharmacies in the United States who provide high quality service and believe in our mission.
You will be provided with a USPS tracking number via text or email.
This depends on what your insurance will allow and what your doctor wrote. Pandia Medical Group’s doctors usually write for 1 year’s supply at a time and California law mandates that insurances allow 1 year’s supply at a time. If you have no insurance, we can ship as many months worth of medication as you are willing to pay (up to a year).
We work with a partner pharmacy who sources from a distributor who obtains medications from manufacturers who abide by FDA regulations.
ECP is for emergencies. It does NOT work as well as regular birth control – pill, patch, ring, shot, implant, IUD. That’s why it is “Plan B” and not Plan A. It is very jarring to the woman’s body and messes up her periods.
For Plan B and its generics – it is a progesterone. Progesterone is the hormone of pregnancy. So it tells the body that you are pregnant and thus prevents the body from releasing an egg if it is about to release an egg. And some studies have shown that it blocks the sperm capacitation (getting into the egg). For Ella or ulipristal acetate, it mainly works by blocking the body from releasing an egg. because all of these are one time doses, there are no long term effects. We don’t recommend using these methods as your primary method of birth control because it is a “strong jolt” or “reset” to the normal flow but better this than pregnant. Also, you can use emergency contraception multiple times. We also don’t recommend using these methods b/c they don’t work if you have released your egg or there is lower efficacy. So better to prevent the egg from being released in the first place and that is done with the IUD with hormone, the implant, the shot, the ring, the patch, the pill.
“The morning after pill” is usually levonorgestrel. The way it works is that is “scares your body” with high hormones so it won’t release an egg.
Often with emergency contraception (EC) aka “the morning after pill” it will mess up your period, causing it to come earlier or later. Seems like this is the case here.
See your Doctor if you have any more questions.
Ulipristal acetate may change when the next period comes. If your period is delayed beyond 1 week, you should be checked for pregnancy. Do not use ella if you are breastfeeding. Do not use ella more than once in a menstrual cycle.
Always have some emergency contraception around in case condoms break. It happens to everyone – even MDs, even people who educate other people on how to use condoms… Better safe than sorry.
Key information for AFTER you take ella® (ulipristal acetate)
Some side effects include: headache (18%), stomach pain (12%), nausea (12%), menstrual pain (9%), tiredness (6%), and dizziness (5%).
ella® should not be used if you know or suspected you are pregnant, and ella® should not replace a regular method of birth control.
The 72 hour over the counter emergency contraception pills (ECPs) can actually be used out to 120 hrs per the WHO (World Health Organization). However, they work better if you take them ASAP.
The over the counter ECPs are levonorgestrel which is a progestin. They basically tell the body that you are pregnant so why would you want to ovulate (pop out an egg). Thus, if the woman has already popped out an egg (ovulated), then it won’t work and it’s too late to prevent pregnancy. If a woman is going to ovulate in 5 days, then you have 5 days to throw this high dose progestin to prevent the body from releasing egg.
If you are already pregnant, the progestin will do NOTHING to the existing pregnancy. That is it will not cause the embryo to die nor mutate. It will not cause an abortion.
There are no dangers (as in death, and the side effects have been covered by the other answers) to taking the morning-after pill too often.
EXCEPT that it might not work and you end up getting pregnant. “The Morning After Pill” is not as effective as “regular contraception” e.g. ring, patch, pill, IUD, implant, shot.
Its efficacy depends on where a woman is in her cycle.
So it is NOT recommended to take too often, simply because we hope you would use a more efficacious form of birth control if you really want to avoid pregnancy.
Side effects of the morning after pill include: nausea, vomiting, menstrual irregularities, dizziness, diarrhea, and/or breast tenderness.
If you have had an allergic reaction to levonorgestrel or “the morning after pill” before, do NOT take it.
Yes. As part of our high-quality, evidence-based medicine care, we offer all of our patients the option of a prescription for Emergency Contraception in addition to their regular birth control, so you can have it in case of an emergency (like a fire extinguisher). We can also call in or fax the prescription if you need emergency contraception within 1 business day.
We write prescriptions for Ulipristal Acetate (Ella) because it is more effective than Levonorgestrel Emergency Contraception, especially on days 3-5 after a contraceptive accident/failure, and for women who weigh more than 176 pounds or have a BMI>26.
When you take Ulipristal Acetate, make sure you STOP your regular birth control pill for 5 days (use a backup method for those days or don’t have sex) and then restart your regular birth control pill on day 6.
It depends where a woman is in her cycle. If she has ovulated, then most likely it won’t work.
It also depends WHICH emergency contraceptive pill. If you take the over the counter one which is levonorgestrel 1.5 mg vs the by prescription only ulipristal acetate – the latter is MORE effective on days 3-5 after an accident and more effective in women who are 177 lbs or more.
Regardless of efficacy, if you have a contraceptive failure or are sexually-assaulted and want to avoid pregnancy and are within 5 days of the event, it doesn’t hurt to try to prevent pregnancy by using Emergency Contraception.
All Emergency Contraception(EC) is not 100% effective.
Levonorgestrel EC has a variable efficacy from 75–95% effective depending where you are in your cycle and also if you weigh 75 -79 kg, Levonorgestrel EC has lower efficacy than if you weigh <75kg. If you weigh 80kg or more, we recommend you use ulipristal acetate or copper IUD and NOT the Levonorgestrel EC.
There are several options:
Pandia Health can help you with Options 2 & 3, but you will need to see a practitioner in person for Option 1.
For those without insurance, we offer credit & debit card payment options. The cost for generic birth control pills start as low as $15/pack. Prices will vary depending on medication prescribed. If you have any questions in regards to price, our Patient Care Associates are available on Live Chat or via SMS.
Pandia Medical Group offers all patients the option of a prescription for Emergency Contraception (EC) in addition to regular birth control. We recommend that all women of reproductive age have EC on hand for emergencies.
Using Pandia, you can receive your EC by mail in about a week, or we can also call in or fax the prescription to one of your local pharmacies within 1 business day.
Our doctors write prescriptions for Ulipristal Acetate (Ella) which are typically covered by most insurance plans. When you take Ulipristal Acetate, make sure you STOP your regular birth control pill for 5 days (use a backup method for those days or don’t have sex) and then restart your regular birth control pill on day 6.
We work with a partner pharmacy who sources from a distributor who obtains medications from manufacturers who abide by FDA regulations.
Yes. As long as your prescription is still valid at your local pharmacy, we can initiate a transfer and start mailing you your medication from our partner pharmacy so that you can start enjoying free delivery.
You can get access to birth control at any age in the state of California.
Yes. Pandia offers prescription evaluation services through Pandia Medical Group, staffed by board certified physicians in California. We are able to help customers who are new to birth control or whose prescription has expired and are not able to get a doctor’s visit right away. Pandia Medical Group (PMG) cannot guarantee prescriptions in all instances; some patients may have conditions that require blood tests or an in-person examination before a prescription can be given safely. In these cases, we refer patients to their primary care provider or help them locate one.
If you have an active prescription, Pandia Health provides FREE delivery of your birth control to ALL 50 states.
If you need a new prescription, Pandia Health only provides online doctor visits for prescription to those physically in California, Florida, and Texas. We are looking to provide online prescriptions to other states like Hawaii soon (if you are a doctor and have a private practice or want to join our practice, please contact info@pandiahealth.com).
Pandia Health currently offers birth control prescription and delivery to individuals with and without insurance. Based on your needs, Pandia can help with either or both prescription and delivery.
If you need a prescription, select “I need a prescription” and answer questions about your medical history. The doctor will review your answers and contact you if there are any questions or concerns. A prescription is then written and sent to a pharmacy of your choice or to our pharmacy partner. At your request, the doctor can also prescribe Emergency Contraception.
If you currently have an active prescription, you can choose to have Pandia fill your future medication, up to 12 months at a time (depending on your insurance coverage). Just give us the name of your current pharmacy and we will move the prescription to our partner pharmacy or have your doctor send the prescription directly to Pandia’s partner pharmacy.
Delivery is by USPS, which typically delivers 2-3 days from date of shipment. We schedule your refills to arrive a week before your last packet runs out, so you can have peace of mind and can skip the trip to the pharmacy.
The best birth control if you don’t want to have children are in order from best to least effective:
The birth control implant (Nexplanon ®, Implanon ® works better than tubal ligation! Some women do GREAT on it. Some women have a lot of random breakthrough bleeding (BTB).
The IUD with hormone (Mirena ®, Liletta ®, Kyleena ®, Skyla ®) are very well tolerated because it is low dose and progesterone only. 30% of women who go on Mirena and Liletta have no periods. yay! 70% get lighter periods. Kyleena and Skyla are more likely to continue to have periods.
Then comes, Tubal ligation and then copper IUD in terms of efficacy at preventing pregnancy.
If you like the birth control ring (Nuvaring ® or its generics), now there is a 1 year ring. You could just put it in and leave it in for a year!!
Know that there are 40 different birth control pills with estrogen and progesterone. so if you didn’t like 1 then there are 39 other formulations of the birth control pill you could try.
If you are in a long term heterosexual relationship, it’s better for the one with the testicles to get a vasectomy than you to have your tubes tied. Vasectomy is more effective and less invasive than tubal ligation. Tubal ligation is invasive! they have to poke 3 holes in your abdomen, blow it up with gas. and it’s NOT as effective as the implant/IUD with hormone! and NOT as effective as vasectomy.
If your doctor is an ob/gyn or even if they are not, you can cite the ACOG committee opinion https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Sterilization-of-Women-Ethical-Issues-and-Considerations it says:
“It is ethically permissible to perform a requested sterilization in nulliparous women and young women who do not wish to have children. A request for sterilization in a young woman without children should not automatically trigger a mental health consultation. Although physicians understandably wish to avoid precipitating sterilization regret in women, they should avoid paternalism as well.”
The IUD with hormone fails 1/1000.
Tubal ligation/women’s sterilization fails 5/1000
The implant fails 1/1000.
Vasectomy fails 1.5/1000.
The birth control ring, the birth control patch, and the birth control pill fail 7/100, though the ring and patch, should have a theoretical lower failure rate because you have fewer chances of forgetting/messing up. The ring has 13 chances a year of messing up, the patch 52 times and the pill 365 times.
You can read more about birth control efectviness or what’s the best birth control for you in our resources.
It should be free under the Affordable Care Act – both the device and the MD visit to insert it. Insurance should cover IUD insertion without co-pay. If people are being charged, they should go to coverher.org
Hormonal birth control is actually great for women. You can choose to have NO periods and it helps decrease acne. IUDs with hormones also can cause lighter or no periods. IUDs with copper have more blood and more pain but some women like them because they consider them “natural” because there are no hormones.
So, your intuition to go with the IUD is correct. It is the most effective method. The IUD with hormone (Liletta or Mirena) are actually MORE effective than tubal ligation! and they are easily reversible. They last for 5 years.
Prep for IUD:
Depends where you are on your cycle when you start the patch, if you are on your period and start the patch, then AFTER 24 hrs you should be protected. If you are more than 5 days from the FIRST day of your period, then 1 week.
Yes, they do but I would recommend the ring. More information, here. But the patch works as well – the only negative on the patch is that it delivers higher estrogen than other pills and that puts you at risk of blood clots. BUT it is better than nothing. also, if you are NOT good at taking pills by mouth, you can take them intravaginally or you can also stick them in ice cream, yogurt, food, etc. they are really small. You could also consider the implant but 30% of women will continue to ovulate on the implant, so that might not fix all of the dysmenorrhea. But most of the dysmenorrhea comes from amount of blood, and the implant, IUD, patch, shot, ring, pill ALL decrease the amount of blood you lose and thus, less cramping because less blood to get out.
If you’re not happy with the birth control pill that you are taking and the effects they have on you, talk to your health care provider. Don’t just give up and stop taking them. Your provider can give you a prescription for a different type of pill. There are many types, and they affect people differently. Some you’ll like, and some you won’t. You may have to try a few different types before you find the one that works best for you. There are also lots of other methods to prevent pregnancy, so you can talk to your doctor about other options.
What you should do:
If you have unprotected sex during the two days after you miss your pill, you may need emergency contraception – get advice from your GP or contraception clinic.
Drosperinone is the progesterone in Loryna. Loryna has BOTH drosperinone (progesterone) and ethinyl estradiol (estrogen). Birth control pills usually contain BOTH an estrogen and a progesterone. And there are lots of different generic birth control with the same active ingredients at the same doses – for example Loryna = Yaz (lower dose estrogen though), Yasmin, Gianvi, Loryna, Ocella, Syeda, Vestura, Zarah.
We don’t recommend it. It increases your risk of cancer and blood clots. But if you are under 35 and you only smoke 1-2 cig a day. It’s ok. But better to cut down/quit!
We prefer Yasmin to Yaz because Yaz only has 20 mcg of estrogen which is not optimal for women’s bone health. Also, we don’t prescribe Yasmin or Yaz unless the woman can commit to drinking at least 8 full glasses of water a day because it has a diuretic component and we don’t want the woman to be dehydrated and have headaches. Also, if there is any history of kidney disease, Yasmin is not a good option.
Acne should get better on any of the birth control pills but Sprintec and Yasmin are best for clearing up acne. However, we don’t recommend Yasmin unless you have really bad acne and you can drink at least 8 glasses of water a day. Otherwise, you might end up with headaches.
If you are having the withdrawal bleed/placebo week, just switch to the new pill and try to maintain the same week off pills.
For example if you are on the 1st pill & the week before the sugar pills on your old medicine, start on the 2nd pill & the week before the sugar pills. Make sure to wait until you get to the withdrawal week, have the bleed, and start the NEW medications on the last day of the bleed
Essentially, finish your current pack and start the NEW pack after the placebo week on the current pack. If you are skipping the bleed/placebo pills, just switch to the new pill.
Yes. Norgestrel = racemic mixture (L and R version). R version does not do anything and may add side effects you don’t need or want. Levonorgestrel = pure L enantomer = fewer side effects. It is the better version.
There is no reason to be on triphasic pill. Triphasic was made to “mimic” the normal cycling of a woman’s cycle. However, the monophasic makes your life smoother and allows you to skip your periods easier if you want to do that.
POPs should be taken at the same time each day. Make sure to use condoms or abstain from sex for 2 days if POP is taken ≥3 hours late. Contact a doctor immediately if you experience abdominal pain. Take another pill immediately if you are vomiting within 2 hours of taking your pill because you need to make sure the pill gets into your system.
If you take the generic of whatever medication you were on previously that is okay. Generic just means that they were not first to market, but the active ingredient inside is the same. Generics are all interchangeable and you can switch between the pills, as long as you are taking a pill every day, you will be covered.
If you have insurance, birth control medication is likely accessible without your needing to pay a copay and without needing to meet a deductible requirement. If you insist on getting a brand name medication, you may be responsible for the difference in price between what is covered by your insurance and the brand name price. If you don’t have insurance, we have cash rates for birth control starting at $20/pack. Delivery of the medication is free.
The consult fee is charged to your card after you answer the health questionnaire online. Our doctor will not review your questionnaire until you have paid.
Yes. (Pandia currently only offers services in the state of California.)
For those without insurance, we offer credit & debit card payment options. The cost for generic birth control pills start as low as $15/pack. Prices will vary depending on medication prescribed. If you have any questions in regards to price, our Patient Care Associates are available on Live Chat or via SMS.
The cost of the online telemedicine consultation with one of our doctors is $29 if Pandia Health delivers your birth control or $59 if you decide to pick it up at your pharmacy. If our doctors determine it is safe for you based on your health questionnaire, you will then receive a new birth control prescription that is valid for 12 months.
The cost of the medication will vary based on your insurance coverage. If you have insurance, there should be no copay unless you insist on a particular brand. If you want a particular brand, we will verify the price with your insurance company beforehand and confer with you before proceeding.
For those without insurance, typical medication costs will start at $15/month for birth control pills.
If you would like us to share information, we can send a copy of the prescription and medical records upon request.
It depends. In California, one option is to submit this form at least 2 weeks prior to having Pandia process your medication in order to maintain privacy. In general, medications are not listed on Explanation of Benefits (EOB) statements which are sent to the primary insurance holder after any services are rendered. However, if you are concerned, please contact your insurance company to verify.
e only share your information with the minimum number of people possible to do our job according to the HIPAA laws.
All health records are kept private and we employ robust encryption methods to protect your personal information. We adhere to the US government-mandated standards of HIPAA (the Health Insurance Portability and Accountability Act of 1996).
Thank you for your generosity! Pandia enables donations via the Pandia Health Birth Control Fund (sponsored by the Center for Policy Analysis). We welcome all levels of giving.
Yes, we have a referral program for patients, organizations, and campus reps. If you are interested in participating, please contact info@pandiahealth.com.
We currently partner with pro-women, pro-health non-profits in a variety of ways. Donation via referral code tracking is one possibility. For more information, contact info@pandiahealth.com.
Pandia Health was founded by a doctor who understands firsthand the medical office experience. We endeavor to reduce frantic, last-minute birth control refill requests to keep your admin efforts down while also helping your patients stay compliant with their monthly medications. You can e-prescribe to our partner pharmacy and recommend our service to your patients. We are happy to send you marketing materials for your office. Please email info@pandiahealth.com if you are interested.
Yes. It is safe to use. It can be stored at 77 degrees fahrenheit for up to 4 months. It can be stored up to 86 degrees. AVOID >86 degrees and in direct sunlight.
If you are LESS than 48 hrs. late with inserting a new ring and you are sexually active:
If you are MORE than 48 hrs. late with inserting a new ring and you are sexually active:
If you would like us to share information, we can send a copy of the prescription and medical records upon request.
No. We recommend that you have a primary care physician for all your health concerns to provide a continuity of care across medical conditions. The doctors on the Pandia team function primarily to provide birth control. We recommend a pap smear every 3 years starting at age 21. If you are sexually active, we recommend getting tested annually for sexually transmitted diseases.
Our doctors take shifts and work as a team, so you may not always speak with the same doctor. We do our best to accommodate consistency to provide you a streamlined experience.
You won’t need to speak to one of our doctors to transfer an existing prescription. Our doctors only communicate with patients who use our telemedicine service.
We currently have six doctors on staff and will increase as we expand services to other states.
No, skipping your period won’t cause imbalances or lead to diseases. Skipping your period is safe, and science proves it. Regarding PCOS, birth control is actually a treatment for it and it does not give way for PCOS to develop. Read our article on what PCOS is and how it is treated. When on birth control, you have the option to skip your period. You can decide if you want to bleed every month or not.
Skipping your period will not cause you medical problems but you will need to consult your doctor if you have blood clots in your family history or you had them at all. Regarding the weight gain, actually the research shows that women on birth control pills lose weight, about 1 pound on average. Women NOT on the birth control pill bloat up and down. Those on the pill don’t bloat as much. Those skipping the sugar pills, bloat even less. Learn more about why you should skip your period in this video.
Lots of doctors have skipped the sugar pills for 10+ years with no problems at all. If you like bleeding each month, go ahead and take those sugar pills, but there is no need to bleed each month, periods optional!
The length you can prevent your period using a monophasic birth control pill or ring will depend on the person. From my experience, the first time you try monophonic birth control, about 3 months. Then each time it goes farther. But everybody is different. Indefinitely e.g. years! It will NOT affect your future fertility.
A good read is John Rock’s Error by Malcolm Gladwell on how it’s not necessary to have a period while on the pill. The withdrawal bleed was just put there because one of the creators of the pill was a devout Catholic and wanted to use the pill with the rhythm method.
Read more facts and learn how to skip your period here.
No, the lining of your uterus is NOT building up, higher and higher when you don’t have a period on birth control. It’s just at a steady level which is usually smaller than your “regular period.” When you have a period off your birth control pill, it’s because you were building the lining of your uterus to accept an embryo – so you need lots of blood and nutrients.
When you are on the birth control pill, you aren’t trying to accept an embryo, so you don’t need to and you don’t build as much of a lining. and thus there is less lining to shed, when you do shed it.
We always recommend using condoms with the use of another contraceptive such as the hormonal birth control, pill, patch, or ring. However, if you were on the active pills for 3 weeks in a row before the bleeding, you do not need to use back up, we actually strongly recommend skipping your period. Check out our periods optional page to learn how to safely skip your period.
Skip your sugar pills and go right into the next pack. you should be able to make it out to 3 months without a period the 1st time, and then 6 months, then 9months. some people are able to go straight into no periods.
Check out this video of CEO Dr. Sophia Yen discussing how to safely skip your period while on the pill.
Periods are optional! The only reason that we build the lining of our uterus every month and pop out an egg (ovulation) is to make a baby. On average in the US, periods start at 12 years old and women have their first baby at 26 y/o. If we aren’t going to make a baby, then why bother with that? Every time we shed our lining and pop out an egg unnecessarily, that adds to the risk of endometrial and ovarian cancer. That’s 14 years of monthly periods for no good reason. So you can turn those off with the ring or pill or IUD with hormones.
It prevents endometrial and ovarian cancer and anemia. Women and physicians have done it since 1960s. And the natural state of a woman is pregnant or breastfeeding and she has no periods during that time. Refer her to the wings of inspired business podcast for more info.
It depends what method of birth control you are talking about.
You can skip indefinitely. My ob/gyn professor said, “The Natural State of a woman is pregnant. How many periods does a pregnant woman have? None.” For more information, check out our #PeriodsOptional page.
If this is the first time that you started birth control pills, then sometimes it takes 3 months for your body to get used to it. Once you start the birth control pills, then you should take a pill everyday. For the spotting, you can try ibuprofen 600 mg up to 3 times a day for up to 5 days WITH FOOD to see if that helps. It would have been better if you started on the LAST day of your bleeding but it’s ok to start when you started.
When you get spotting, that means your body wants to come off the medication. Come off for 5 days, have a bleed during that time and on day 6 re-start ACTIVE pills whether or not you are still bleeding. Hopefully next time you can get out a longer period before the spotting happens. For many women, they get to 3 months, then 6 months, then “home free.” However, other women just always breakthrough at 3 months.
You can stop the pill or another form of hormonal birth control at any time, just know that your “period” will come and that you will no longer be protected against pregnancy. To find more information click here and if you are stopping birth control because you are planning family check out this link too.
You may start the combination birth control pill at any time. If you start within five days after the first day of your period, you are protected against pregnancy right away. For example, if your period starts on Monday afternoon, you can start the pill up to Friday afternoon to be protected from pregnancy right away. If you are later than 5 days after the FIRST day of your period, you will be protected from pregnancy after seven days of taking the pill every day. Use a back-up method of birth control like a condom, female condom, diaphragm, or sponge — if you have vaginal intercourse during the first week of starting the pill. Also, the pill does NOT protect against STDs, so always use a condom WITH your birth control if you want to avoid getting STDs. To know more about the pill check out this post.
Great questions! Yes, you are protected against unplanned pregnancy on the placebo pills as long as you took 3 weeks of active pills before the placebo. Just remember that you will only be protected for birth control and we always encourage the use of condoms for being a sexually healthy person and avoid STIs. You can read more about the pill here. We highly recommend skipping to placebo week to skip your period, and start a new pack! Check out our Period Optional page.
When you use the birth control pill, patch, ring or shot, implant or IUD with hormone, it keeps the lining of your uterus from growing to the full thickness that it would require to support a pregnancy. This is one of the main mechanisms by which birth control works to prevent pregnancy. If the lining is thin, then there is nothing for the embryo to stick to.
If you usually bleed, 7 days, you can expect it to go down to about 5 days. If you usually use 5 pads, then it might go down to 3 pads, etc. Hormonal birth control pills also give you an option to completely skip your period! Check out our periods optional page for more information.
It is expected and normal for the bleeding to get lighter on the birth control pill, patch, ring, implant, injection, IUD with hormone.
Withdrawal bleeding after stopping hormonal birth control it’s to be expected. Any time you miss 3 pills in a row (be it because you are on the placebo/sugar pills of the pack or if you did so by mistake) the hormones drop, and you should expect a withdrawal bleed. You can now get pregnant if you ovulate and obviously if you stop taking birth control. It’s no big deal unless it is really heavy or goes on longer than 7 days, in that case, visit your MD or closest ER to get professional advice asap. You can read more about how stopping hormonal birth control affects your menstruation here.
Yes, you still need a pap smear every 3 years for birth control pill and if you’re using any other type of birth control (ring, patch, hormonal IUD, IUD copper, condoms). If you are not monogamous, then also STD testing every year.
Yes, you can get an HPV vaccine as long as you are under 26 years old. If you are 26 or older, then you have to pay and it is expensive. And it is likely that you are already infected with HPV (Human Papillomavirus) by 26 years old and there is some cross-immunity, so they have deemed it not cost-effective after age 26.
You don’t need a pap smear to see what birth control you need. Actually, the pap smear has nothing to do with birth control pills. The Pap smear is to check for cervical cancer. In fact, most doctors have 1 pill they prescribe to most patients, if that has bad side effects, then that’s where they change it up. Read more about pap smear and what it consist on here
How long are your periods? on the birth control pill, they should only be like 3–5 days. If your periods are extra long, you should get a blood test for von willebrand’s disease (a bleeding disorder). If Reclipsen is not good for your acne, you can try a birth control pill with norgestimate. However, the one you are on is pretty good.
It may be smart to check your thyroid to make sure there is nothing going on there. Do you take your pill at the same time every day? that is important!
You can skip your periods altogether if you like. Just skip the sugar pills. Usually, you can get to 3 months with no periods and then you get some spotting. Read more about how to skip your period here