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Do I need backup contraception for pills?

Q: I am a mother of a 13 months old baby and I am not planning for the next one for another 2 years at least. I have been on Femilon for the past 7 months. My queries are: Should I go in for IUD - Mirena? I missed a tab in the first weekend and took it 24 hours later with the next one; what should I do? Should we use condoms too for a week? Should we give a gap of not being on femilon for a month every 3-4 months and if so what contraception is most effective?

A:Mirena is a very safe IUD in my experience. If you want to get away from the hassle of taking birth control pills, it is a good alternative. Some patients will experience excessive bleeding/cramping with it. In general, if you miss one pill, it is okay to take two the next day. If you miss more than one day it is very important to start using a back up/barrier method for contraception (in addition to continuing the pills). It is not a good idea to skip pills every few months. Especially if you do not want a surprise pregnancy. Any time you start pills after a break, it takes one whole cycle before you are protected. We usually recommend a back up method with the first month of pills. If you are looking for a contraceptive option where you will not have to take something every day, Depoprovera injection is another option. You get one injection every 12 weeks and you are protected from the day of the injection. This method does cause irregular bleeding.

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