Missing birth control pills can happen to anyone. Understanding the correct actions is important for maintaining contraceptive effectiveness and preventing unintended pregnancy, as steps vary by pill type.
Immediate Steps for Combination Pills
If two combined oral contraceptive (COC) pills are missed (more than 48 hours since a pill was due), take the last missed pill immediately. Disregard any earlier missed pills. Continue the remaining pills in the current pack at the regular time, even if it means taking two pills on the same day.
The specific actions depend on the week in which the pills were missed. If two active pills are missed during the first week of a pack, take the last missed pill as soon as remembered and continue the pack. If unprotected sexual intercourse occurred in the preceding five days, emergency contraception should be considered.
If two active pills are missed during the second week (days 8-14 of a 28-day pack), take the last missed pill as soon as possible and continue with the rest of the pack.
If two active pills are missed in the third week (days 15-21 of a 28-day pack), finish the active pills in the current pack and immediately start a new pack without taking the hormone-free placebo pills.
Immediate Steps for Progestin-Only Pills
Progestin-only pills have a narrower window for effective dosing. If a progestin-only pill is missed by more than three hours, or if two or more pills are missed, contraceptive protection may be lost. For most progestin-only pills (like norethindrone or norgestrel), if two consecutive pills are missed, take the last missed pill as soon as possible. Continue taking one pill daily at the regular time, even if it means taking two pills on the same day.
For newer progestin-only pills containing drospirenone, if two or more white hormone pills are missed, take the most recent missed pill immediately and continue taking one pill a day until the pack is finished. Any older missed pills should be left in the pack.
When to Use Backup Contraception
After missing two birth control pills, use backup contraception, such as condoms, to prevent pregnancy. For combination pills, use backup contraception for seven consecutive days after resuming consistent pill-taking, regardless of the week missed.
With progestin-only pills, if two or more pills are missed, condoms should be used until hormonal pills have been taken correctly for at least two consecutive days, or for seven consecutive days for drospirenone-containing pills.
Considering Emergency Contraception
Emergency contraception (EC) may be considered if two birth control pills are missed, especially after unprotected sexual intercourse. EC can be used to prevent pregnancy after unprotected sex or if there was a failure of regular contraception. EC is most effective when taken as soon as possible after unprotected intercourse, typically within 72 hours, though some forms can be effective up to five days later.
If two or more active combination pills were missed during the first week of a pack and unprotected sex occurred in the preceding five days, EC is recommended.
If two or more progestin-only pills were missed and unprotected intercourse happened in the previous five days, EC should be considered. It is important to note that ulipristal acetate (Ella), a type of EC, may counteract the progestin in oral contraceptives and might not be suitable in all situations.
Next Steps and Seeking Medical Advice
After taking immediate steps, continue the remaining pills in your current pack as scheduled. Breakthrough bleeding may occur, a common side effect when pills are missed or taken inconsistently. This bleeding is not a cause for concern but indicates a disruption in hormone levels.
If confused about specific instructions, if you frequently miss pills, or have concerns about potential pregnancy, consult a healthcare provider or pharmacist. They can provide personalized guidance and discuss alternative contraceptive methods if consistent pill-taking is challenging. Reviewing the patient information leaflet included with your pill pack also offers detailed instructions.