Missing birth control doses is common and can raise questions about effectiveness and pregnancy risk. Understanding the appropriate steps to take after missing doses is important for maintaining protection. The specific actions depend on the type of birth control used and the timing of the missed doses.
Guidance for Missed Birth Control Pills
Combined Hormonal Pills (Week 1 or 2)
For individuals using combined hormonal pills, which contain both estrogen and progestin, if two active pills are missed in Week 1 or Week 2 of the pack, take the most recently missed pill as soon as it is remembered, even if this means taking two pills in one day. Disregard any earlier missed pills from that period. Use a backup method of contraception, such as condoms, or avoid sexual intercourse for the next seven days to ensure continued protection.
Combined Hormonal Pills (Week 3)
When two active pills are missed in Week 3 of a combined hormonal pill pack, take the most recently missed pill immediately, and any other missed pills can be ignored. Finish the remaining active pills in the current pack, then skip the placebo pills entirely, starting a new pack immediately. A backup contraception method is necessary for seven days after the missed pills. If unprotected sex occurred during the days the pills were missed, emergency contraception might be considered, especially if the missed pills were in the first week of a new pack.
Progestin-Only Pills
For progestin-only pills, if a pill is missed by more than three hours, it is considered a missed dose. If two days of progestin-only pills are missed, take the last missed pill as soon as it is remembered, even if it means taking two pills on the same day. Take subsequent pills at the regular time. Use a backup method of contraception, like condoms, or abstain from sexual activity for at least the next two days, as it takes time for cervical mucus to thicken and provide protection.
Actions for Missed Patches or Rings
Hormonal Patches
Missing two days with a hormonal patch requires specific steps to re-establish contraceptive protection. If the patch has been off for more than 48 hours (two days) during the middle of your patch cycle (weeks 1, 2, or 3), you may be at risk of pregnancy. Apply a new patch immediately, and this day becomes the new “patch change day” for the rest of the cycle. Use backup contraception, such as condoms, for the next seven days. If the patch was missed at the beginning of a new cycle (after the patch-free week), apply a new patch as soon as possible, and use backup contraception for seven days.
Vaginal Rings
For those using a vaginal ring, if it has been out of the vagina for more than 48 hours (two days) during the weeks it is meant to be worn, pregnancy protection may be compromised. Re-insert the ring immediately. Use a backup method of contraception, like condoms, for the next seven days to prevent pregnancy. If the ring was left out for more than seven days after the ring-free week, insert a new ring as soon as possible, and use backup contraception for seven days.
Understanding Pregnancy Risk and Emergency Contraception
Pregnancy Risk
Missing doses of hormonal birth control can reduce their effectiveness and increase the risk of ovulation. When contraception is not used consistently, the body’s natural reproductive cycle can resume, potentially leading to an unintended pregnancy. The risk of pregnancy increases with the number of missed doses and the timing within the menstrual cycle.
Emergency Contraception (EC)
Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Two primary types of EC pills are levonorgestrel (effective within three days) and ulipristal acetate (effective for up to five days). An intrauterine device (IUD) is also highly effective as EC if inserted within five days. Consider EC if unprotected sex occurred after missed birth control doses, especially when ovulation risk is higher. Take a pregnancy test if a period does not occur within three weeks.
Preventing Future Misses and Consulting a Professional
Preventing Future Misses
Establishing routines helps prevent future missed birth control doses. Set daily alarms or use reminder apps. Keep birth control in a visible, accessible location, like next to a toothbrush. Integrating the daily dose into an existing routine, such as brushing teeth or eating breakfast, can also help.
Alternative Birth Control Methods
For those who frequently miss doses, exploring alternative birth control methods may be beneficial. Longer-acting reversible contraception (LARC) methods, such as IUDs or contraceptive implants, offer highly effective options that do not require daily attention. These methods are a suitable choice to minimize daily dose management.
Consulting a Professional
Consulting a healthcare provider is recommended if uncertain about steps after missing doses. A medical professional can offer personalized advice based on your health history and birth control type. They can also address concerns about side effects, emergency contraception, or other birth control options that suit your lifestyle.