Birth control pills prevent pregnancy by releasing hormones. These hormones, typically estrogen and progestin in combination pills or progestin only in mini-pills, primarily stop ovulation, thicken cervical mucus to block sperm, and thin the uterine lining to prevent implantation. Consistent daily intake is important for these mechanisms to be effective.
What to Do If You Miss One Pill
If you miss one combination birth control pill (24 to 48 hours late), take it as soon as you remember. Take your next scheduled pill at its usual time, even if this means taking two pills on the same day. No additional contraceptive protection is needed, and emergency contraception is not required unless other pills were missed earlier in the cycle or in the last week of the previous cycle.
For progestin-only pills, also known as mini-pills, timing is more sensitive because their hormonal effect wears off faster. If you miss a progestin-only pill by more than three hours, take it as soon as you remember. Continue taking your subsequent pills at your usual time, even if it results in taking two pills on the same day. After missing a progestin-only pill by more than three hours, use a backup method of contraception, such as condoms, for the next two days.
What to Do If You Miss Multiple Pills
When two or more consecutive combination birth control pills are missed (more than 48 hours since the last pill was taken), the risk of pregnancy increases. Take the most recent missed pill as soon as you remember, discarding any other previously missed pills. Continue to take your remaining pills at your regular time, even if it means taking two pills on the same day.
After missing two or more combination pills, use a backup method of contraception, such as condoms, or abstain from sexual intercourse until you have taken hormonal pills for seven consecutive days. If the missed pills occurred in the last week of hormonal pills, omit the hormone-free interval and immediately start a new pack after finishing the current one. If pills were missed during the first week of a pack and unprotected sexual intercourse occurred in the preceding five days, emergency contraception should be considered.
If you miss two or more progestin-only pills, take the most recent missed pill as soon as possible, and continue taking one pill daily until the pack is finished. Use a backup method of birth control, like condoms, or avoid sexual intercourse until you have taken hormonal pills for seven consecutive days. Emergency contraception should be considered if pills were missed during the first week and unprotected sexual intercourse occurred within the previous five days.
Important Considerations After Missing Pills
After missing any birth control pills, especially multiple doses, using a backup birth control method is advised to reduce the risk of unintended pregnancy. Condoms are a recommended option for backup contraception. The duration for which backup contraception is needed varies depending on the type and number of pills missed, often ranging from two to seven days of consistent pill taking.
Emergency contraception (EC) is an option if unprotected sexual intercourse occurred after pills were missed. EC pills, such as those containing levonorgestrel (e.g., Plan B One-Step), are most effective when taken as soon as possible, ideally within 72 hours, but can be effective for up to five days after unprotected sex. Another EC option, ulipristal acetate (Ella), requires a prescription and can be taken up to five days after unprotected sex. EC should not be used as a regular form of birth control. If you are unsure about what steps to take or have concerns about pregnancy, contacting a healthcare provider for personalized guidance is recommended.