Pregnancy fear: on birth control, used condom and pull out, but brown discharge before period?

Patient : I am a 21 year old female who has been on birth control for about 5 years now. I have been on Jolessa for at least 3 of those years. I take it to near perfection (within an hour of the same time every single day without fail), but a few weeks ago, I went to take it and the pill was already gone. I had been drinking that night and think I just took it a bit early (I tend to do that automatically without thinking). Anyways, this occurred 3 days after I had sex 3 times. The guy used a condom every time before any sexual contact as well as pulling out every time. I know I took my birth control perfectly (at 10pm on the dot) the entire week leading up to that night, as well as the 3 days afterwards. I am supposed to go on placebo pills Sunday of this week, and I usually get my period by Wednesday. However, I have had some brown spotting since last Wednesday or Tuesday or Thursday, not really sure. I've had some issue with breakthrough bleeding in the past. But I'm afraid of implantation bleeding. So I have a few questions: 1) what is the likelihood I'm pregnant if I use my birth control pretty perfectly (I even think I took the pill that one night that I can't remember, considering I don't know what I would've done with the pill besides take it), and if my sexual partner always uses a condom and pulls out? 2) is brown discharge before a period on birth control normal? 3) if I get my period Wednesday like normal, can I stop worrying about this? Or does that not mean anything (just withdrawal bleeding?) like I've read somewhere? Thank you!
Symptoms:  Breakthrough bleeding, brown discharge, cramping
Doctor :   You seem to be quite diligent about taking the pills and I would describe that as a near perfect use of the pills. With perfect pill usage the failure rate is 0.3 percent. This means that if taken correctly the combined oral contraceptive pill is more than 99% effective in preventing pregnancy (this means that only 1 woman out of a 100 will get pregnant each year). However in typical use (that is when one makes mistakes in taking the pill), the failure rate is 9%. Specifically in you case, even if you did forget to take the pill on that particular night, I do not think you could be pregnant since you were on the pills for a week before the intercourse and also for atleast 3 days after. Missing a pill day entirely also usually does not result in a failure due to the cummulative contraceptive effect provided by the previous pills. To compound that with the fact that condoms were used during each of the acts the chances that you could be pregnant are almost nil. What you are experiencing is unlikely to be implantation bleeding and is more likely to be a breakthrough bleeding. Implantation bleeding is a light pinkish or dark red coloured bleeding that generally lasts for a day or two and is seen 6 - 12 days after the fruitful intercourse. Breakthrough bleeding is rather common on oral contraceptive pills. If you find that bothersome, I suggest you should discuss this with your doctor and get another formulation prescribed to you that might better suit your body. Nevertheless as I mentioned above failure is possible even with perfect usage for various reasons that cannot be fully described here. So I would suggest that rather than stressing yourself about the possibility of a pregnancy, you could just take a home pregnancy test and reassure yourself. The best time to do so would be on the coming Wednesday (i.e your expected day of periods). The test is 99 percent reliable if done correctly so there would be no reason to doubt the results if the come negative in your case (which is what I expect). Alternatively, if you get a period on Wednesday, you really could just stop worrying about the pregnancy as it seems very very unlikely that you could be pregnant.

Comments / Follow Ups

Patient: Also want to add that I just moved back to college (like right around the day the spotting started) and have sort of been stressed out by that, and started an intensive exercise program yesterday - exercised again today and today was the first time I've gotten the cramping feeling too, post workout. I could be dehydrated I guess. I just need to not have this hanging over my head the first week of classes so mostly I'm just wondering- if I get my period Wednesday, am I safe? Or do I need to go through the awkwardness of buying a pregnancy test?
Patient: Thank you so much for your thorough answer and explanation. I feel relieved after reading that, but as suggested, I bought a set of pregnancy tests online just to reassure myself. Hopefully they arrive by Wednesday but if not, I will take them as close to Wednesday as possible. Thank you again so sincerely for responding!

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