### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, so im about six days late now and feeling really off. I have some pregnancy symptoms such as slight nausea, headaches, boobs are tender, feeling bloated, some cramping and moodiness (i have randomly cried about 3 times this week for no big reason). I have never been late before, if anything Im usually early. I am on birth control but we dont use condoms and I know its supposed to be 99% but Ive heard of others getting pregnant while on birth control.. also today i started getting light brown spotting but only when i go to the bathroom.Just wondering with all this information if theres a chance I could be pregnant?

### output:

Thanks for your question. It is important to realize that if you are sexually active, there is always the chance of pregnancy, even if you are using birth control. Oral contraceptives are, in fact, 99% effective. They are so effective that if 100 women used a birth control pill as directed, only one of them would become pregnant in any given year. However, that is still 1 percent of women pregnant using a birth control pill as directed. Birth control pill doses have gotten much lighter over the past twenty years, so formation of ovarian cysts is still possible. I did a study on this several years ago, showing that women may still form ovarian cysts on lighter dose birth control pills, although they usually do not ovulate. That is the mechanism for prevention of pregnancy. Ovarian cysts can make hormones which may produce symptoms in women that mimic pregnancy. A pregnancy test for you is in order and your gynecologist may also recommend an ultrasound of the pelvis to detect any ovarian cyst formation. Hormone production from the ovary may also produce the light spotting you are experiencing. Remember, however, that any amount of bleeding on a birth control pill may signify a menstrual period. Menstrual periods on birth control pills are Chat Doctor.  I hope this answers your questions. I am available for further consultation if needed.