One mth off and three on. no period. unprotective sex.

Patient: I have been on birth control for over a year, I have the birth control that gives you 4 periods a year. one mth I wasn’t able too take it, after that mth I started back on it. been on it for 3 mths and I was suppost to haves period and I haven’t. I’ve had unprotective sex with my bf for the last 2 mths. along with my birth control we have just pulled out a few times, most times he didn’t pull out. lately I have been very tired, sick when I wake up with headaches . also have been moody and I dont feel like myself. should I be worried I migth be pregnant or because I missed a mth this could be why?

Doctor: