Missing two birth control pills can disrupt the steady hormone levels that prevent pregnancy, potentially increasing the risk of unintended conception. Understanding the appropriate steps helps restore protection.
How Birth Control Works
Birth control pills primarily prevent pregnancy by delivering synthetic hormones that regulate the reproductive system. Combined oral contraceptives (COCs) contain both estrogen and progestin, which work by preventing the ovaries from releasing an egg (ovulation). These hormones also thicken cervical mucus, making it difficult for sperm to reach an egg, and thin the uterine lining, making it less receptive to a fertilized egg.
Progestin-only pills (POPs), sometimes called mini-pills, contain only progestin. Their primary action involves thickening the cervical mucus to block sperm and thinning the uterine lining. Some POPs can also suppress ovulation, but this is not their main mechanism, making them more sensitive to consistent, on-time dosing compared to COCs.
Immediate Steps for Missed Pills
When two combined oral contraceptive (COC) pills are missed, the specific actions depend on where you are in your pill pack. Generally, take the most recently missed pill as soon as you remember, even if it means taking two pills in one day. Discard any other missed pills from earlier days. You will need to use backup contraception, such as condoms, for the next seven days.
If the two missed COC pills were in the first week of your pack (pills 1-7), the risk of pregnancy is higher because you are coming off a hormone-free interval. In this situation, take the most recently missed pill immediately and continue with the rest of your pack. Emergency contraception should be considered if unprotected sex occurred in the last five days.
If two COC pills were missed in the second week of your pack (pills 8-14), the risk of pregnancy is generally lower, provided you took pills correctly for the seven days before the missed doses. Continue your pack as usual.
For two missed COC pills in the third week of your pack (pills 15-21), the strategy is to ensure continuous hormone exposure to prevent ovulation. Take the most recently missed pill, and finish the active pills in the current pack. Then, instead of taking the placebo pills or having a hormone-free break, immediately start a new pack of active pills the next day.
Progestin-only pills (POPs) are highly time-sensitive; missing a dose by more than three hours is considered a missed pill. If two POPs are missed, take the most recently missed pill as soon as possible and discard the other. Continue taking your remaining pills at your usual time. Use a backup method of contraception, such as condoms, for the next two days (48 hours).
Assessing Pregnancy Risk and Backup Contraception
Missing two birth control pills can increase the risk of pregnancy, with the exact risk depending on the pill type and when the doses were missed in the cycle. Combined oral contraceptives (COCs) carry a higher risk if pills are missed during the first or third week of the pack, due to the proximity to hormone-free intervals that could allow ovulation. Progestin-only pills (POPs) have a narrower window of effectiveness, making them more susceptible to pregnancy risk with any missed dose.
Emergency contraception (EC) should be considered if unprotected sex occurred before or after missing the pills. EC is most effective when taken as soon as possible after unprotected sex, with some forms being effective up to five days later. Consulting a healthcare provider can help determine the most appropriate type of EC, such as levonorgestrel or ulipristal acetate, based on the timing and specific circumstances.
What to Expect and When to Seek Advice
After missing two birth control pills, you might experience some common side effects as your body adjusts to the fluctuating hormone levels. Breakthrough bleeding or spotting is frequently reported, occurring because the temporary drop in hormones can trigger light bleeding similar to a period. Other potential side effects include cramping, nausea, or breast tenderness. These symptoms are typically temporary and resolve as you resume your pill-taking schedule.
While these side effects are usually not a cause for concern, there are specific situations that warrant seeking advice from a healthcare provider. You should contact a doctor if breakthrough bleeding becomes heavy or lasts for more than seven consecutive days. Persistent or severe abdominal pain, or a fever, are also reasons to seek medical attention. If you experience a missed period after following the instructions for missed pills, or if you suspect you might be pregnant, consult a healthcare professional for guidance and a pregnancy test.