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Reproductive Health

What to do if you miss a birth control pill

by DR. CHIMENE ROCHA

Taking your birth control pill (oral contraceptive pill) daily is vital to preventing pregnancy. More than 1 million unintended pregnancies happen in the U.S. because of incorrect birth control pill use. To avoid this, make sure to take your pill every day as prescribed. 

However, sometimes doses get missed. So what should you do if you miss a pill? That depends on the type of birth control pill used, when you were supposed to take your most recent dose, and how many pills you miss. 

The most commonly used birth control pills are referred to as “combination pills” because they contain both estrogens and progestins. Some women use progestin-only pills, also known as the “mini-pill,” that do not contain any estrogen. The two types of pills have somewhat different courses of action following missed doses. The side effect of missing birth control pills, other than possibly getting pregnant, is breakthrough bleeding. 

The Centers for Disease Control and Prevention (CDC) recommend these actions after missing birth control pills: 

Combination pills

  • If you miss one pill (up to 48 hours since you were supposed to take a pill)
  • Take your most recently missed pill as soon as you remember
  • Continue to take your remaining pills at the usual time, even if it means you take two pills in one day.
  • You don’t need to use additional contraception.
  • Emergency contraception is generally not needed unless you have missed other doses this cycle or at the end of the previous pack.
  • If you miss two or more pills (more than 48 hours since you were supposed to take a pill)
  • Take your most recently missed pill as soon as you remember. You can throw the other missed pills away. 
  • Continue to take your remaining pills at the usual time, even if it means you take two pills in one day. 
  • You should either avoid sex or use a backup method of contraception (e.g., condom) until you have taken a pill a day for 7 days consecutively.
  • If the missed pills are in the 3rd week of the pack (days 15-21 for 28-day pill packs) finish taking the pills for that week as scheduled. Skip the hormone-free last week and start a new pack. If you can’t start a new pack right away, either avoid sex or use a backup method of contraception (e.g., condom) until you have taken pills for 7 days consecutively.
  • If the missed pills are in the 1st week of your cycle or within 5 days of unprotected sex, consider emergency contraception.
  • If you miss any of the placebo pills (the ones at the end of the pill pack that do not have any hormones), don’t worry about it. Just take the next one to keep yourself in the habit of taking a pill each day.

Progestin-only pills (“Mini pill”) 

  • If you miss a dose by more than 3 hours
  • Take your most recently missed pill as soon as you remember
  • Continue to take your remaining pills at the usual time, even if it means you take two pills in one day.
  • You should either avoid sex or use a backup method of contraception (e.g., condom) until you have taken a pill a day for 2 days consecutively.
  • Consider emergency contraception if you had unprotected sex.    

Can I still have unprotected sex and avoid pregnancy?

Having unprotected sex after missing birth control pill doses increases your risk of getting pregnant. However, in many cases, you can still avoid pregnancy if you missed your birth control pill and remembered to take it within 48 hours. If you are unsure, it is always better to err on the side of caution and use protection until you are back on track with your pills. 

Chances of pregnancy with missed pills

When birth control methods are studied, two factors are often measured: efficiency and effectiveness. Efficiency refers to how a method of contraception performs in clinical trials in people who use it correctly. Effectiveness is how well it works in the real world with women who may occasionally forget their pills. There is no question that the chance of pregnancy increases with missed pills and the more pills that are missed, the higher the risk of getting pregnant. 

It is estimated that women in the U.S. have unintended pregnancies 0.3% of the time in their first year of using birth control pills, even under perfect use. With typical (not perfect) usage, the rate of unintended pregnancies is more like 9%. You have an increased chance of getting pregnant if you miss the first few hormonal pills in a pill pack; this translates to an extension of the placebo week when you are not exposed to any contraceptive hormones. By extending this hormone-free time frame, you run the risk of ovulation occurring and increasing your chances of getting pregnant. When in doubt, if you miss your birth control pill doses, use a backup method of contraception and get back on track with your pills as soon as possible.

What if I miss pills often?

It cannot be stressed enough that for birth control pills to work, they need to be taken every day. If you find that you are missing pills often use backup methods and consider emergency contraception if you have unprotected sex. Talk to your healthcare provider about alternative methods of hormonal birth control, like a hormonal patch, vaginal ring, injection, implant, or intrauterine device (IUD) that do not rely on you to remember to take them daily.

When should I call my doctor?

If you are ever unsure about what to do after missing one or more birth control pills, talk to your healthcare provider. Alternatively, if birth control pills are not right for you, your provider can help you choose a method that fits your medical and lifestyle needs.