Pregnancy Test Accuracy - Fourth Day Before Expected Period

Reported accuracy rates vary and are based on a variety of factors.

Question

As per our conversation, I missed one combined hormone. It was the second one in the pack. I did a pregnancy test today (4 days before the expected period). I had a negative result. Would this be accurate? Or should I still be worried?

Asked by Lou On Nov 28, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Nov 30, 2018

Answer

As discussed in our previous answer, while missing one dose of your birth control pills in the first week isn't ideal, it likely won't decrease their effectiveness that much.

In fact, most sources, such as the Centers for Disease Control, state that emergency contraception generally isn't needed after one missed dose. They simply recommend to:

  • Take your missed dose as soon as you remember.
  • Take the next pill at your regular time. This means you may take two pills in one day.
  • You do not need to use a back-up birth control method if you have sex. 

Having said all that, it's never a bad idea to take a pregnancy test after a month in which there may have been a problem taking your pills. Pregnancy isn't likely in your situation but ruling it out can certainly bring peace of mind.

Data varies widely in regard to how accurate a pregnancy test is 4 days prior to your period. Some studies indicate an accuracy rate around 50% while some products claim nearly 96% accuracy. This is discussed more below.

Section Summary

Missing one dose of birth control pills in the first week won't significantly reduce their efficacy. Nevertheless, taking a pregnancy test is never a bad idea if you didn't take your pills consistently over the month or you have missed your period. Pregnancy test accuracy rates on the fourth day prior to your expected period date vary greatly (depending on source you refer to).

Pregnancy Test Accuracy

A key factor in the accuracy of pregnancy tests is the particular product you are using to test, since they all have different sensitivities for hCG (human chorionic gonadotropin), the hormone present in urine after an egg is fertilized.

The accuracy of pregnancy tests increases as you get closer to the date of your expected period. The more days before your expected period you test, the less accurate the test becomes.

For example, testing on the day of your expected period will be far more accurate than testing 5 days before your expected period.

There have been some studies discussing how accurate pregnancy tests are in regard to when the test was taken. One found the following results:

  • 52% accurate three days before a missed period.
  • 69% accurate two days before a missed period.
  • 86% accurate one day before a missed period.
  • Over 95% accurate on the day or missed period or after.

As mentioned above, over the counter pregnancy tests have different sensitivity levels for hCG, which of course alters how soon they can detect pregnancy.

Additionally, some products test for different forms of hCG, such as hCG-h and beta-hCG. They may be able to produce a positive results more than 3 days before a missed period.

One such product is the First Response Early Result test. They give the following numbers on their website:

In laboratory testing, FIRST RESPONSE™ detected the pregnancy hormone levels in 76% of pregnant women, 5 days before their expected period; in 96% of pregnant women, 4 days before their expected period; in >99% of pregnant women, 3 days before their expected period; in >99% of pregnant women, 2 days before their expected period; in >99% of pregnant women, 1 day before their expected period; and in >99% of pregnant women, on the day of their expected period."

While these are pretty strong numbers, it is important to note that there is significant variability among individuals that could affect these results.

Some pregnant women may not have detectable amounts of hormones in the urine when they test, even on the day of their expected period.

In fact, one study found almost 10% of women don't produce enough hCG to be detected until a week or so after a missed period.

Lastly, there are many studies which are dubious of the claimed detection times for many over the counter home pregnancy tests. One study concluded the following:

"Universal claims for OTC-PTs [Over The Counter pregnancy tests] of more than 99% laboratory accuracy and use as early as the first day of missed period, while cleared for use by the U.S. Food and Drug Administration, are ambiguous and inappropriate for many products, according to these data. The majority of products tested were found to detect only a small percentage of pregnancies on the first day of a missed menstrual period. Until more data become available on the actual clinical sensitivity of these products, pharmacists should advise consumers to be cautious in interpreting test results."

So, to answer your question specifically regarding testing four days prior to your expected period, a home pregnancy may be able to detect levels of hormone indicating pregnancy that early, but testing closer to, or after, your expected period will be far more accurate.


Going to your doctor for a pregnancy test is the best way to know for sure.

Section Summary

The closer you are to your expected period date, the more accurate the test will be. Reported accuracy rates in determining pregnancy four days before your expected period day range from as low as 50% to close to 96%, but figures that high are doubted by many studies. For best results, take a test on or around the day of your expected period or see your doctor for the most accurate results.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor Of Pharmacy degree in 2010. He has been featured in several publications including the Huffington Post as well as a variety of health and pharmacy related blogs. Please feel free to reach out to him directly if you have any questions or want to connect! [email protected]; Office: 716-389-3076

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