It is common to miss a daily birth control pill, but a clear plan of action can maintain contraceptive protection. The necessary steps depend entirely on the specific type of oral contraceptive you use and the number of doses you have forgotten. Birth control pills fall into two main categories: combined hormonal pills and progestin-only pills, each with different mechanisms and rules for missed doses. Always consult the patient information leaflet and contact a healthcare provider if you are unsure of the correct procedure.
Instructions for Combined Hormonal Pills
Combined oral contraceptives (COCs) contain both estrogen and progestin. They offer a greater margin of error for missed doses because the hormones suppress ovulation. The instructions vary depending on how many active pills were missed and where in the cycle the mistake occurred.
If you miss a single active pill (less than 48 hours late), take it as soon as you remember, even if that means taking two pills on the same day. Continue the rest of the pack at your usual time. Backup contraception is not usually required.
If you miss two or more active pills (more than 48 hours late), take only the most recently missed pill as soon as possible, discarding any others. Continue the rest of the pack at your regular time. You must use a backup method, such as condoms, or abstain from sexual activity until you have taken seven consecutive days of active pills.
If the missed pills occurred during the first week (Days 1–7) and you had unprotected sex in the five days before the missed dose, consider emergency contraception. If the missed pills were in the third week (Days 15–21), skip the inactive (placebo) pills and start a new pack of active pills immediately after finishing the current active pills. This ensures the hormone-free interval remains short enough to prevent ovulation.
Instructions for Progestin-Only Pills
Progestin-only pills (POPs) function primarily by thickening cervical mucus to block sperm. They contain a lower dose of hormone than COCs and must be taken precisely, making them highly time-sensitive. For many POPs, taking the pill more than three hours past your usual time is considered a missed dose, which rapidly compromises contraceptive protection.
If you miss a POP dose by more than three hours, take the missed pill immediately and continue the remaining pills at your regular time, even if it means taking two pills in one day. Because the mechanism of action is lost quickly, you must use a backup barrier method, such as a condom, or abstain from sex for the next 48 hours. This period allows the cervical mucus to thicken again.
If you have missed a dose and had unprotected sex, consider emergency contraception. Always check the specific instructions for your pill, as newer POPs (e.g., those containing drospirenone) may offer a longer window, sometimes up to 12 or 24 hours, before a pill is considered missed.
When to Consider Emergency Contraception
If you have missed pills and had unprotected sexual intercourse, consider emergency contraception (EC) to prevent pregnancy. The highest risk occurs when pills are missed during vulnerable times, such as the first week of a combined pill pack or anytime a progestin-only pill is taken late. If unprotected sex occurred in the five days before or after the pill mistake, EC is often recommended to bridge the period of lost protection.
Emergency contraceptive pills are available in two main forms: levonorgestrel (the morning-after pill) and ulipristal acetate. Levonorgestrel is most effective when taken within 72 hours (three days) of unprotected sex, while ulipristal acetate is effective for up to 120 hours (five days). The sooner either pill is taken, the more effective it will be at preventing pregnancy, primarily by delaying or inhibiting ovulation.
The copper intrauterine device (IUD) is the most effective form of EC, working up to five days after unprotected sex. It can then be left in place for long-term contraception. Ulipristal acetate should not be used if you plan to immediately restart your missed progestin-only or combined pill, as its mechanism may interfere with the hormonal contraception. If you have missed three or more combined pills, or are consistently missing doses, contact a healthcare provider for personalized advice and a potential pregnancy test.