Oral birth control pills provide an effective method of contraception when used consistently each day. Forgetting to take a pill, however, is a common occurrence that can affect the pill’s effectiveness. Understanding the correct steps to take after a missed dose is important for maintaining protection against pregnancy. Specific guidelines depend on the type of pill and how many doses were missed.
Immediate Steps for a Single Missed Pill
If you miss one active combination birth control pill, take it as soon as you remember. This may mean taking two pills on the same day (the missed pill and your regularly scheduled dose). Continue with the rest of your pack at your usual time. If only one combination pill is missed, additional contraceptive protection is usually not necessary, and your pregnancy risk does not significantly increase.
However, if the missed combination pill occurred during the first week of your pack or was the last active pill before your placebo (inactive) week, use a backup method of contraception, like condoms, for the next seven days. This helps account for any potential reduction in hormone levels that could lead to ovulation. Placebo pills do not contain hormones, so missing one does not impact pregnancy risk; they help maintain a daily routine.
Progestin-only pills, also known as minipills, have a stricter dosing window. If you miss a progestin-only pill by more than three hours from your usual time, your protection against pregnancy may be reduced. Take the missed pill as soon as you remember, even if it means taking two pills in one day. Afterward, use a backup method of contraception or avoid sexual activity for at least 48 hours until your cervical mucus has thickened again, which helps block sperm.
Actions for Missing Multiple Pills
Missing two or more combination birth control pills significantly increases the risk of pregnancy. If you miss two or more active combination pills, take the most recently missed pill as soon as you remember, even if it means taking two pills on the same day, and discard any earlier missed pills. Continue taking your remaining pills at your regular time.
Use a backup method of contraception, such as condoms, or abstain from sexual intercourse for the next seven consecutive days after missing multiple combination pills. If the missed pills occurred during the last week of active pills (e.g., days 15-21 in a 28-day pack), finish the current pack, skip the placebo week, and immediately start a new pack. This maintains hormone levels and prevents ovulation. If you had unprotected sex in the five days preceding the missed doses, consider emergency contraception.
For progestin-only pills, missing even one pill by more than three hours is a missed dose. If two or more progestin-only pills are missed, the risk of pregnancy is high. Take the most recent missed pill immediately and continue taking one pill daily until the pack is finished. Use a backup contraceptive method, like condoms, or avoid sexual activity for at least seven consecutive days. Consulting a healthcare provider is advisable, especially if unprotected sex occurred.
Understanding Pregnancy Risk and Emergency Options
Missing birth control pills increases pregnancy risk because consistent hormone levels, needed to prevent ovulation, thicken cervical mucus, and thin the uterine lining, are disrupted. The degree of risk depends on the number of pills missed, the type of pill (combination versus progestin-only), and the timing of the missed pills within the cycle. For instance, missing pills in the first week of a combination pack, or anytime with a progestin-only pill, carries a higher risk because ovulation can occur more readily.
If unprotected sex has occurred after significant missed doses, emergency contraception (EC) is an option to prevent pregnancy. EC works by delaying or preventing ovulation and does not terminate an existing pregnancy. Common EC pills include levonorgestrel (often available over-the-counter) and ulipristal acetate (which typically requires a prescription). Levonorgestrel is effective if taken within 72 hours (three days) of unprotected sex, though sooner is better. Ulipristal acetate can be effective for up to 120 hours (five days) after unprotected sex.
A copper intrauterine device (IUD) is the most effective form of emergency contraception, inserted by a healthcare provider up to five days after unprotected sex. Contact a healthcare provider if you are unsure about what steps to take, have missed multiple pills, have had unprotected sex, or suspect you might be pregnant. They can provide guidance and discuss the most appropriate emergency contraception for your circumstances.
Preventing Future Missed Doses
Maintaining a consistent routine helps remember to take birth control pills daily. Setting a daily alarm on your phone is a reliable reminder, and many dedicated birth control reminder apps are available to track doses. These apps offer customizable alerts and provide a digital record of pill-taking.
Linking pill-taking to an existing daily habit reinforces consistency. For example, taking your pill at the same time you brush your teeth or before dinner integrates it seamlessly into your routine. Placing your pill pack in a prominent, visible location, such as on your nightstand or by your toothbrush, provides a visual cue each day. Having an extra pill pack available also reduces anxiety if a dose is misplaced or forgotten while away from home.