You remembered to set your alarm early for a busy day ahead of you, to respond to that email from last week, and even to wish your cousin’s-brother’s-wife a “Happy Birthday” on Facebook. You picked up some milk on the way home, fed your cat, and you even flossed! As you close your eyes to finally catch some zzz’s, it hits you: YOU FORGOT TO TAKE YOUR BIRTH CONTROL PILL.
If this vignette sounds familiar, you are far from alone. To err is human, and human error is so common when it comes to birth control that effectiveness charts include ratings for both “perfect use” and “typical” or “actual” use. When taken perfectly (aka no missed pills), birth control pills are 99% effective at preventing pregnancy, while typical use—or how most of us end up taking our birth control—renders the pill 91% effective. Of course, knowing that most people screw up from time to time is of little comfort after you realize your mistake and a deep sense of panic sets in as questions race through your mind. What the heck are you supposed to do now? Is it safe to take 2 pills and call it a day? I’m pregnant, i’m definitely pregnant…
First and foremost, breathe. If you’re reading this, then you’re already taking the important first step of researching all your options. By the end of this article, you’ll know just what to expect—and most importantly, what to do—when you miss a birth control pill.
WHY YOU DON’T WANT TO MISS YOUR PILL
To understand why missing one tiny pill can cause so much trouble, it’s important to understand just how birth control pills work in the first place. Unlike barrier methods (such as condoms or diaphragms) that physically block sperm from fertilizing an egg, birth control pills use hormones to change your body’s chemistry and make pregnancy unlikely.
Birth control pills fall into one of two main categories depending on the hormones they utilize to get this important job done.
contain synthetic forms of two hormones, estrogen (Ethinyl Estradiol) and progesterone (progestin), which work together to deliver a one-two punch to your chances of pregnancy (2). As the first line of defense, these hormones prevent your ovaries from releasing an egg—otherwise known as ovulation—every month. Without ovulation, it’s physically impossible to become pregnant. Combination pills also make it difficult for sperm to meet the egg by thickening cervical mucus and making the lining of the uterus, known as the endometrium, thinner.
these only contain a low dose of progestin (2). They prevent pregnancy primarily by thickening cervical mucus, creating a physical barrier that prevents sperm from meeting egg, and thinning that uterine lining. Minipills can prevent ovulation as well, though less reliably than combination pills.
So long as hormone levels are maintained by remembering to take each dose, both types of pills do a fantastic job at keeping unintended pregnancies at bay. It is when pills are missed that these hormone levels are put into jeopardy, as is your protection.
Those that use the combination pill have a little more wiggle room when it comes to taking their pills and still staying safe. According to Planned Parenthood, one pill a day is enough to prevent pregnancy, regardless of what time the pill is taken (3). While missing a single pill can lead to some fluctuation in estrogen and progesterone levels, we have good news: there are ways to generally ensure you don’t get pregnant (read on…) However, while a baby may not be one of them, there are still several other potential side effects to missing your combination pill. Spotting, or light bleeding that is not your typical period is an annoying/potentially messy possibility. If you wind up taking 2 pills at once to make up for a missed pill, the rapid increase in hormone levels can make you feel a little nauseous (3). But look on the bright side: This nausea is much shorter-lived than the morning sickness you may experience should you continue to forget your pill!
In terms of flexibility, minipill users are at a disadvantage. For maximum effectiveness, the pill must be taken within the same 3-hour window each day (4). For example, if you take your pill at 12 pm on Monday, Tuesday’s pill needs to be taken between 9 am and 3 pm. Any deviation from this tight schedule puts you at risk of becoming pregnant, even if you take the pill as soon as you remember (which, of course, you should do!). To add insult to injury, much like with the combination pill, the missed dose of hormones also comes with some unpleasant side effects. Doubling up on your pill could lead to breakthrough bleeding, and just like with combination pills, taking 2 pills at once can also leave you feeling a little queasy for a short period of time. This is completely normal and will quickly pass, we promise.
Now that you know why missing a pill is kinda-sorta a big deal for your body, it’s important to know exactly what you should do if you find yourself in such a predicament.
WHAT TO DO IF YOU MISS YOUR PILL, STEP BY STEP
Before we get into the deets, please remember we are an educational resource, not a medical provider. So, be sure to check in with your clinical team before doing anything!
First, you need to determine whether you are taking combination pills or the minipill. If you see the words “Ethinyl Estradiol” on the packaging for your birth control, this means your pill has estrogen in it and you’re taking combination pills, regardless of any other medications listed on the package. If Ethinyl Estradiol is not listed on the package but Norethindrone is, you’re taking a minipill. There are exceptions to every rule, however, and scientists love to use different names for the same hormone, so here are links to the most common combination pills and minipills (scroll to the bottom of the page).
When it comes to the combination pill, it’s also important to note when in your pack you missed your pill, as missing a pill at the beginning of your pill schedule is slightly riskier than missing a pill in the middle of the pack.
If you’re taking a combination pill and you missed a single pill during the first week of a new pack:
1.Take your forgotten pill as soon as you remember to, then take another pill at your normal time. This may mean you need to take 2 pills in one day, so be prepared for side effects.
2. Continue taking your birth control as normally scheduled for the rest of the month (one pill per day, every day).
3. There is usually no need for emergency contraception. Though the scientific community disagrees on whether backup birth control methods (such as condoms) should be used for 7 days following a missed pill (5,6), it’s never a bad idea to do so for peace of mind.
If you’re taking a combination pill and you missed a single pill in the middle of your pack (i.e. weeks 2 or 3):
1.Take your forgotten pill as soon as you remember to, then take your normal dose for the day. Once again, this may mean taking 2 pills at or around the same time.
2. Continue to take your birth control pills on time for the rest of the month.
3. No emergency contraception or back-up birth control methods are necessary.
If you’re taking the minipill (aka the progestin-only pill) and you still get menstrual periods:
1.If you’ve missed your dose by more than 3 hours, take your pill as soon as you remember to.
2. Continue to take your pills as normally scheduled, aka within 3 hours of the same time every single day.
3. You should use another birth control method for the next 2 days to prevent pregnancy.
4. If you’ve engaged in any activities that could lead to pregnancy within the past 5 days, consider using emergency contraception (like Plan B, for example) to prevent pregnancy.
5. If you ever become ill and vomit or have diarrhea within 3 hours of taking the minipill, continue to take your pill as scheduled for the remainder of the month. However, you must use a back-up birth control method until you have gone at least 2 days without vomiting after taking your pills (7).
If you missed your minipill, but you are chest feeding and don’t currently menstruate, just take one pill as soon as you remember and then return to your normal pill schedule. If you gave birth within the past 6 months, you’re still protected—simply resume your schedule on the day you realize you missed your pill.
Ok, but what if I miss more than one pill…
If missing one pill can put you at a slight risk of pregnancy, missing multiple pills takes that risk and multiplies it. Things get a little more nuanced in these cases, depending largely on the type of pill you are taking and when you missed your pills.
If you’re taking combination pills and miss 2 pills in a row in either the first or second week of your pill pack (5):
1.Take 2 pills as soon as you realize you missed your pills.
2. Take 2 pills the next day as well. And yes, this also increases your chances of nausea from the increased hormones.
3. Continue to take your pills normally for the rest of the month (one pill per day).
4. Use a back-up birth control method until you begin a new pack of pills. While most sources agree that consistently taking your pills as normally scheduled for 7 days is also enough to ensure protection, if you’re going to be worried about it, stick with the rule that doubles up on protection the longest. Better safe than sorry!
If you’re taking combination pills and miss 2 pills in a row in week 3 OR you miss 3 or more pills at ANY point in your pill pack AND you are a Day 1 starter (aka you started taking your pills on the first day of your period) (8):
1. First, make sure you have another pack of birth control. You’re going to throw out this month’s pack and need to have the next one ready to go immediately.
2. Begin a new pill pack the same day you realize you missed your pills, taking one pill per day as normal.
3. You must use a backup form of birth control until you have taken 7 pills as normally scheduled.
4. You may not have a period this month. If you don’t get your period next month as well, contact your obgyn or midwife.
If you’re taking combination pills and miss 2 pills in a row in week 3 OR you miss 3 or more pills at ANY point in your pill pack AND you are a Sunday starter (aka you started taking your pills on the first Sunday during or immediately following your period):
1. Resume taking one pill per day until the next Sunday.
2. On Sunday, throw the rest of your current birth control pack out. You will start a new pack today, so be sure to have one on-hand.
3. Use a backup form of birth control until you have taken 7 consecutive pills correctly.
4. Your period may not come this month, but as mentioned before, you should speak with your doctor if you miss next month’s period as well.
Finally, if you’re taking minipills and miss more than one, the procedure is the same as when you miss one pill (6).
WHAT TO DO IF YOU MISS A BIPHASIC PILL?
WHAT TO DO IF YOU MISS A TRIPHASIC PILL?
Because nothing can ever be simple, combination pills can be further subdivided into 4 categories: Monophasic, Biphasic, Triphasic, and Quadriphasic (5). These terms describe how many times the level of hormones in your active pills (typically the first 21 or 24 pills in your pack) change over the course of the month. Each subdivision typically follows the following schedule:
Monophasic pills: Every single active pill in your pack has the same dose of hormones.
Biphasic pills: The first 7 or 10 pills in your pack (phase 1) have one dose of hormones, while the next 11 or 14 days (phase 2) have another. They are usually color-coded based on dosage to help make this distinction more clear.
Triphasic: Phase 1 of these pills lasts anywhere from 5-7 days, while Phases 2 and 3 can each last 5, 7, or 9 days. Color coding is your friend here as well.
Quadriphasic: If you thought triphasic birth control was complicated, quadriphasic birth control takes things a step further while also having more active pills to account for. Phase 1 of this form of birth control lasts 2 days. On days 3-7 of your birth control pack, you are in Phase 2, while days 8-24 constitute Phase 3. Quadriphasic pill users also take active pills on days 25 and 26, giving us Phase 4. With all those different doses, color coding is your BEST friend.
Luckily, this is where things get simple again. Regardless of which type of active combination pill (or pills) you missed, the procedure for rectifying the situation is always the same (5). As long as you follow the instructions when it comes to missing one or more pills listed in this article, you should be golden!
DOES ANYTHING CHANGE IF I MISS A PILL DURING DAY FOUR?
If you’re taking combination pills and your pack comes with 28 pills, the last 2-7 pills are usually a completely different color from the rest of the pack and are taken when you get your period. These pills do not contain any hormones and are fittingly known as “inactive” pills. They’re usually just a placebo meant to help you establish and maintain your pill-taking routine, but some brands of birth control, such as LoEstrin FE (5), supplement these pills with iron to help replace the iron your body loses during menstruation.
The good news is that because they contain no hormones, missing these pills has absolutely no effect on your chances of getting pregnant. You can simply throw out any missed inactive pills, breathe a sigh of relief, and make sure you don’t make the same mistake with your active pills (9).
Minipill users, things are once again a bit more complicated for you. Every pill in your pack is active, which means missing any of them is a no-no (10). Regardless of what week it is, you will need to follow the instructions listed above for the best chance of preventing pregnancy if you missed your dose.
TIPS TO AVOID MISSING PILLS
While you’re probably thrilled to hear that your missed pill doesn’t necessarily mean the end of the world, we’re sure you’re probably wondering what you can do to prevent such a mistake from happening in the first place. Here are some hacks to remember to take your BC:
The Old-Fashioned Phone Alarm: There’s nothing quite like the sound of a blaring siren to convey the urgency of taking your birth control pill. Phone alarms have the advantage of being extremely easy to set up, and because most people always have their phone within reach, you aren’t likely to miss your reminder. If you have a habit of hitting the snooze button or forgetting to charge your phone, however, this option may not be for you.
Association Games: Chances are you have certain habits you engage in every day. Whether it’s brushing your teeth (we hope) or washing your face, you should try following your established habit with a dose of birth control. Your brain will start to associate your routine action with taking your pill, making it hard to do one without the other. Of course, if you have no consistency in your routine, this psychological trick is probably not gonna work.
The Buddy System: We all have that one person in our lives that is infuriatingly responsible. Why not borrow some of their accountability? Until taking your pill becomes second nature, ask your designated third-party to shoot you a text each day to remind you of your obligation. Bonus points if you can find a buddy who also takes birth control, and you two can help remind each other to take your pill.
If you try all of these tips and you still find yourself missing pills (like a certain author of this article), it may be worth looking into more permanent forms of birth control to keep yourself protected. These methods—such as the IUD, implant, injection, or vaginal ring—require far less effort on your end to be effective, meaning there is less of a chance for human error. No method is one-size-fits-all, so be sure to speak with your healthcare practitioner to determine what method is best for you.
THE FINAL VERDICT
If you missed one (or 2 or 3) of your birth control pills and stumbled across this article as a result of panicked Googling, we hope the information presented here has your feeling at least a little more assured. While it is never a great thing to miss your birth control pills, the fact of the matter is that mistakes happen. Luckily, this is a mistake that can be fixed—just try not to make a habit of it!
Written by: Briana Finneran, health care enthusiast in San José, Costa Rica.
Medically Reviewed by: Danielle LeBlanc, RN
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