Missing a birth control pill is a common concern for many using contraception. Knowing what steps to take after a missed dose can help reduce anxiety and maintain effectiveness. This guide explains how to proceed based on the type of birth control pill used.
What to Do if You Miss a Combined Pill
Combined oral contraceptives contain both estrogen and progestin. The actions required after a missed pill depend on how many pills were missed and the week of the pill pack. If only one pill is missed and is less than 48 hours late, take it as soon as possible. Continue taking the remaining pills at the regular time, even if it means taking two pills on the same day. No backup contraception is needed.
When two or more combined pills are missed, or if one pill is missed by more than 48 hours, the approach changes based on the week. If the missed pills occurred in Week 1 (pills 1-7), take the most recently missed pill immediately and discard any earlier missed pills. Continue the rest of the pack as usual, and use a backup method of contraception, such as condoms, for the next seven days. If unprotected intercourse occurred during the week before the missed pills, emergency contraception should be considered.
If two or more pills are missed during Week 2 or 3 (pills 8-21), take the most recently missed pill as soon as possible and discard any earlier missed pills. Finish the current pack as usual. If the missed pills were in Week 2, backup contraception is not needed if pills were taken correctly for the seven days before the missed pills. However, if the missed pills were in Week 3, or if fewer than seven pills were taken correctly before the missed pills, skip the hormone-free interval and start a new pack immediately after finishing the current one. Backup contraception is recommended for seven days if the hormone-free interval is not skipped.
What to Do if You Miss a Progestin-Only Pill
Progestin-only pills, often called mini-pills, have a stricter timeframe for effectiveness compared to combined pills. These pills primarily work by thickening cervical mucus and thinning the uterine lining, rather than consistently preventing ovulation. Daily intake timing is more critical.
If a progestin-only pill is missed by more than three hours, its effectiveness may be reduced. Take the missed pill as soon as remembered. Take the next pill at the usual time, even if it means taking two pills in one day.
After missing a progestin-only pill by more than three hours, use a backup method of contraception, such as condoms, for at least the next 48 hours. This prevents pregnancy when the pill’s effects may be compromised. Consistent daily intake is important for reliable contraception with progestin-only pills.
Assessing Pregnancy Risk and Next Steps
Missing a birth control pill, regardless of type, can decrease its effectiveness in preventing pregnancy. The risk of pregnancy increases with the number of pills missed and the timing within the menstrual cycle. For instance, missing pills early in the cycle, especially in the first week, can pose a higher risk because ovulation may not be fully suppressed.
If unprotected sex occurred after a missed pill, particularly in scenarios where effectiveness is compromised (e.g., multiple missed combined pills, or a progestin-only pill missed by more than three hours), emergency contraception (EC) may be an option. EC can include pills containing levonorgestrel, which work best when taken within 72 hours of unprotected sex, or ulipristal acetate, which can be effective up to 120 hours. These options work by delaying or preventing ovulation.
Always use a backup method of contraception, such as condoms, for at least seven days after a missed pill incident, especially if uncertain about the pill’s effectiveness. Taking a pregnancy test about three weeks after the missed pill or unprotected intercourse is a reliable way to determine if pregnancy has occurred. Consistent and correct use of birth control is the most effective way to prevent unintended pregnancy.
When to Seek Professional Guidance
Consult a healthcare provider if confused or uncertain about what actions to take after missing a birth control pill. This is particularly important if multiple pills have been missed, or if unprotected sexual intercourse occurred after the missed doses. A healthcare professional can offer personalized advice based on the specific situation and pill type.
Seek professional guidance if you experience unusual bleeding patterns or new symptoms following a missed pill. If considering emergency contraception but uncertain about its type or appropriateness, a healthcare provider can provide information and prescriptions. Any persistent concerns or questions about their birth control method warrant discussion with a medical professional to ensure comfort and confidence.