Missing birth control pills, especially for several days, can be concerning. Understanding the appropriate steps to take when three pills have been forgotten is important for maintaining contraceptive protection. This guide addresses potential pregnancy risk, how to safely resume medication, and specific actions for different pill types.
What to Do Immediately
The immediate actions after missing three birth control pills depend on the type: combined oral contraceptives (COCs) or progestin-only pills (POPs). For COCs, which contain both estrogen and progestin, take the most recently missed pill as soon as remembered, even if it means taking two pills in one day. Any earlier missed pills from the three-day lapse should not be taken. Continue the remaining pills daily until the pack is finished.
If missed pills occurred in the first week of a pack and unprotected sexual intercourse took place within the last five days, emergency contraception should be considered. When three or more COC pills are missed in the first two weeks, or any active pills are missed in the third week, use backup contraception, such as condoms, for at least seven consecutive days of active pill taking. For progestin-only pills, missing a pill by more than three hours, and certainly three pills, significantly reduces their effectiveness. Take the missed pill as soon as remembered and continue with the next pill at the regular time. Use a barrier method, such as a condom, for at least the next 48 hours after missing POPs. Always consult the specific pill’s patient information leaflet for precise instructions.
Assessing Pregnancy Risk
Missing three birth control pills significantly increases the risk of pregnancy because it disrupts the primary mechanisms by which these hormones prevent conception. Combined oral contraceptives (COCs) work by inhibiting ovulation, thickening cervical mucus, and thinning the uterine lining. When multiple active pills are missed, the body’s natural hormonal cycle can resume, potentially leading to the release of an egg from the ovary. This allows for the possibility of fertilization if sperm are present.
Progestin-only pills (POPs) primarily prevent pregnancy by thickening cervical mucus, which blocks sperm from reaching an egg, and by thinning the uterine lining. While some POPs can also suppress ovulation, they are more sensitive to timing, and even slight deviations from the regular schedule can compromise their effectiveness. Missing three POPs can quickly reverse the mucus-thickening effect, making it easier for sperm to pass through the cervix. The risk of pregnancy is further influenced by the week in the cycle when the pills were missed, with missed pills early in the pack generally posing a higher risk.
Considering Emergency Contraception
Emergency contraception (EC) offers an option to prevent pregnancy after unprotected sexual intercourse or when contraceptive methods fail, such as after missing multiple birth control pills. Several types of EC are available, each with a specific window of effectiveness. Levonorgestrel pills, often known as the “morning-after pill,” are most effective when taken within 72 hours (three days) of unprotected sex, though they may offer some reduced effectiveness up to five days. This type of EC works primarily by delaying or preventing ovulation, thus stopping the release of an egg.
Another oral EC option is ulipristal acetate, which can be effective for up to 120 hours (five days) after unprotected intercourse. Ulipristal acetate also primarily functions by delaying or inhibiting ovulation. The most effective form of emergency contraception is the copper intrauterine device (IUD), which can be inserted up to five days after unprotected sex. The copper IUD works by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization and implantation. Timely administration is crucial for the maximum effectiveness of any emergency contraceptive method.
Restarting Your Pills and Future Protection
After addressing the immediate situation of missed pills and considering emergency contraception if necessary, it is important to understand how to safely resume regular birth control and ensure future protection. Individuals should continue taking their birth control pills daily, one pill at the usual time, starting from the day they remember. This helps re-establish consistent hormone levels.
Full contraceptive protection typically does not return immediately after restarting pills, especially after missing three active pills. For combined oral contraceptives, backup contraception, such as condoms, should be used for at least seven consecutive days of active pill taking following the missed pills. For progestin-only pills, backup contraception is generally recommended for at least 48 hours after resuming daily pills, due to their more sensitive timing requirements. Some individuals may experience temporary side effects when restarting, such as irregular bleeding or spotting, as their body adjusts.