<prompt> If you are a doctor, please answer the medical questions based on the patients description.I take a combined birth control pill- Levlen ED. I missed taking one active pill one night last month however took it the next day around lunchtime as I was away had to get a new prescription. I took that days pill as per normal the last in that packet then skipped the sugar pills started on the active pills in a new packet as the medication info said to do that to main contraceptive effectiveness. 15 days after the missed pill I started getting some spotting breakthrough bleeding which has continued for about a week to varying degrees. Its been very minimal but enough to notice stain underwear. My partner I dont normally use a condom when having sex the only time we had been intimate without a condom around when I missed the one pill was 5 days prior 8 days after so I had taken 8 active pills straight after the missed on before having sex again. We have had sex together without using any other protection a few times since as well thoughQuestions- is the BTB spotting a result of the missedlate pill andor continuous use of the active pill skipping sugar pills??? And could the contraceptive effectiveness of my pill have failed or been compromised due to the missed pill andor the spottingBTB? Another words should I be concerned about falling pregnant? My next period is due in 5-6 days so time will tell I guess Im praying my pill has covered me!...  <response>: Hello and welcome to Chat Doctor, The break through bleeding does not indicate pregnancy. In order to confirm or rule out pregnancy, get pregnancy test done. The schedule of oral contraceptive pills OCP is as follows:1. The OCP should be taken each day at the same time of the day.2. If you miss the pill once, take the pill immediately as soon as you remember and continue the Chat Doctor. 3. If you miss the pill for more than one day, discontinue the cycle for that month. Continue the cycle from next month. Use some other method of contraceptive for the left days for the month.4. Follow the instructions mentioned on the pack which differ from manufacturer to manufacturer.5. If you taking antibiotic especially amoxicillin, ampicillin, etc. you need to take some other contraceptive for next 14 days. 6. Break through bleeding is normally seen with OCP use. Get a pregnancy test done for confirming or ruling out pregnancy. Thanks and take care 