Forgetting a birth control pill is common. While daily use is recommended for protection, knowing what to do after a missed dose can help maintain effectiveness. This guide explains the effects of missing a pill and outlines actions for different pill types.
Immediate Consequences of Missing a Pill
Missing a birth control pill can disrupt ovulation, increasing pregnancy risk. Pills deliver hormones that prevent egg release. A missed dose causes hormone levels to drop, potentially allowing an egg to be released.
Hormonal fluctuations from a missed pill can also trigger breakthrough bleeding or spotting. This unexpected bleeding happens because the uterine lining, which is kept stable by consistent hormone levels, may begin to shed when those levels decrease. While often not a cause for alarm, persistent or heavy breakthrough bleeding should prompt a discussion with a healthcare provider.
What to Do After Missing a Pill
Actions after missing a birth control pill depend on the pill type and number of doses missed. Combination pills contain estrogen and progestin, while progestin-only pills (mini-pills) contain only progestin.
Missing One Combination Pill
If you miss one combination pill, take it as soon as you remember, even if it means taking two pills in one day. Continue the pack as usual. Generally, additional protection is not needed, especially if within 24 hours.
Missing Two or More Combination Pills
If you miss two or more combination pills, take the most recently missed pill immediately, even if it means taking two at once, and discard earlier missed pills. Continue daily pills and use backup birth control, like condoms, for seven days. If missed pills were in the third week of a 28-day pack, finish active pills, skip placebo pills, and start a new pack immediately.
For progestin-only pills, timing is more precise; missing a pill by over three hours is a missed dose. If you miss one, take it as soon as you remember, even if it means taking two in one day. Continue daily pills at your usual time. Use a backup method, like condoms, for at least the next two days, as it can take about two days for cervical mucus to re-thicken and provide protection.
When to Consider Additional Protection
Backup contraception, such as condoms, is recommended in specific situations after missing birth control pills to reduce the risk of unintended pregnancy. For combination pills, if you have missed two or more active pills or started a pack two or more days late, use condoms or avoid sex until you have taken active pills for seven consecutive days. For progestin-only pills, if a dose is missed by more than three hours, backup contraception should be used for at least two days.
Emergency contraception (EC) may be necessary if unprotected sex occurred around the time of missed pills. This is especially relevant if combination pills were missed during the first week of a pack and unprotected sex occurred in the five days prior to missing the pills. EC is most effective when taken as soon as possible after unprotected sex, ideally within 24 hours, but can be effective for up to three to five days depending on the type. If you are unsure about whether to use EC or have concerns about your specific situation, contacting a healthcare provider for personalized guidance is advisable.