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Apr 21, 2021
5 min read

What to do if you miss a birth control pill

If you miss a dose of your birth control pills, you increase your chances of getting pregnant. Depending on which type of pill you take, you may need to use additional methods of contraception, like condoms. In some instances, you may want to consider emergency contraception if you have unprotected sex. Mini-pills increase your risk of pregnancy if you are more than three hours late in taking your pill. Combination birth control pills are a bit more forgiving and give you 48 hours after a missed dose before you need to take extra precautions.

steve silvestro

Reviewed by Steve Silvestro, MD

Written by Chimene Richa, MD

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

If you’ve ever been on birth control pills, you may have experienced that stomach-dropping feeling when you realize that you forgot to take your pill that morning. 

So what should you do if you miss a pill? That depends on the type of birth control pill used, when you were supposed to take your most recent dose, and how many pills you miss. 

Taking your birth control pill, also called oral contraceptive pills (OCPs), daily is vital to preventing pregnancy—if you don’t take them, they won’t work. If you’ve missed pills in the past, you are not alone. Studies show that 7–9% of people using OCPs experience an unwanted pregnancy in the first year of use. Over a million unplanned pregnancies happen in the U.S. because of incorrect birth control pill use (Sundaram, 2017; Zapata, 2013). 

Before you freak out, know that the consequences of missing an OCP depend partly on which type of pill you take. 

The most commonly used birth control pills are “combination pills” or “combined pills,” which contain both estrogens and progestins. Some women use progestin-only pills (also known as the “mini-pill”) that do not contain any estrogen. The two types of pills have somewhat different courses of action following missed doses. Sometimes missing pills can lead to side effects like breakthrough bleeding or spotting. 

What to do if you miss one birth control pill

If you miss just one pill, your next steps will depend on whether you’re on the mini-pill or combined pill. 

Mini-pills

For progestin-only pills or “mini-pills” to be effective, they need to be taken at the same time each day. If you are taking the mini-pill and are within three hours of the time you were supposed to take it, you can just take the pill—this is a “late” pill rather than a missed one. However, if you are more than three hours late taking it, you should (Kaunitz, 2021):

  • Take your most recently missed birth control pill as soon as you remember.
  • Continue to take your remaining pills at the usual time, even if it means you take two pills in one day.
  • You should either avoid sex or use backup contraception (e.g., condom) for the next 48 hours.
  • Consider emergency contraception (e.g., Plan B) if you had unprotected sex in the 48 hours after the missed dose.    

Combination pills

Unlike the mini-pill, combination pills do not have as tight a time frame for taking them. They should be taken around the same time every day, but if you are less than 24 hours late in taking your pill, you can just take it as soon as you remember and continue taking the remaining pills at your usual time.

In addition to the active pills containing both progestins and estrogen, many combination pill packs include 4–7 days of inactive placebo pills. If you miss one of these, it does not matter because they don’t contain any medication (Allen, 2020). Just take the next one to keep yourself in the habit of taking a pill each day. 

If you miss one of the combined hormonal pills, you should (Curtis, 2016):

  • Take your most recently missed birth control pill as soon as you remember.
  • Take your next pill at the usual time, even if it means you take two pills in one day.
  • You don’t need to use additional contraception.
  • Emergency contraception is generally not needed.

What to do if you missed two or more birth control pills

If you miss two or more mini-pills, you’ll do the same as above. If you miss two or more combination birth control pills, you should (Curtis, 2016): 

  • Take your most recently missed birth control pill as soon as you remember. You can throw the other missed pills away. 
  • Continue to take your remaining pills at the usual time, even if it means you take two pills in one day. 
  • You should either avoid sex or use a backup method of birth control (e.g., condom) until you have had seven consecutive days of no missed pills.
  • Consider emergency contraception (e.g., Plan B) if you have unprotected sex, especially if the missed pills are in the first week of your cycle or within five days of unprotected sex.
  • If the missed pills are in the third week of the pack (days 15–21 for 28-day pill packs), finish taking the pills for that week as scheduled. Skip the hormone-free last week and start a new pack the next day. If you can’t start the next pack right away, either avoid sex or use a backup method of birth control (e.g., condom) until you have taken pills for seven days in a row.

Here’s a summary of what to do.

What to do if you miss a pill and have unprotected sex? 

Having unprotected sex after missing birth control pill doses increases your risk of getting pregnant. However, you can still avoid pregnancy in many cases if you remember to take your missed birth control pill within 48 hours. If you are taking the mini-pill, you have a higher chance of getting pregnant if you are more than three hours late taking your dose. If you are unsure, it is always better to err on the side of caution and use additional protection until you are back on track with your pills. 

Chances of pregnancy with missed pills

When birth control methods are studied, two factors are often measured: efficiency and effectiveness. 

  • Efficiency refers to how well a contraception method performs in clinical trials for people who use it perfectly. 
  • Effectiveness is how well it works in the real world with people who may occasionally forget their pills. 

There is no question that the chance of pregnancy increases with forgotten pills, and the more pills missed, the higher the risk of getting pregnant. 

It’s estimated that OCP users in the U.S. have unintended pregnancies 0.3% of the time in their first year of using birth control pills, even with perfect use. With typical (not perfect) usage, the rate of unintended pregnancies is more like 7–9% (Sundaram, 2017; Zapata, 2013). 

You have an increased risk of pregnancy if you miss the first few hormonal pills in a pill pack; this is the same as extending the hormone-free week. By lengthening this hormone-free timeframe, you run the risk of ovulation occurring (when your ovaries release an egg) and increase your chances of getting pregnant. 

When in doubt, if you miss your birth control pill doses, use a backup method of contraception and get back on track with your pills as soon as possible.

What if I miss birth control pills often?

You need to take your birth control pills every day for them to work effectively. If you find that you’re missing pills often, it’s likely that birth control pills are not the proper form of contraception for you. Get medical advice from your healthcare provider about alternative birth control options, like a hormonal patch, vaginal ring, injection, implant, or intrauterine device (IUD), that do not rely on you remembering to take them daily.

When to talk to your healthcare provider

If you are ever unsure about what to do after missing one or more birth control pills, talk to your healthcare provider. Alternatively, if OCPs are not suitable for you, your provider can help you choose a form of birth control that fits your medical and lifestyle needs. 

References

  1. Allen, R.H. (2020, November). Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use. In Schreiber, C.A., Crowley, W.F., Eckler, K., Martin, K.A. (eds.). Retrieved from https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use
  2. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, Whiteman MK. (2016). U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep, 65(4):1-66. doi: 10.15585/mmwr.rr6504a1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27467319/
  3. Kaunitz, A.M. (2021, March). Progestin-only pills (POPs) for contraception. In Schreiber, C.A. & Eckler, K. (eds.). Retrieved from https://www.uptodate.com/contents/progestin-only-pills-pops-for-contraception
  4. Sundaram, A., Vaughan, B., Kost, K., Bankole, A., Finer, L., Singh, S., & Trussell, J. (2017). Contraceptive failure in the United States: estimates from the 2006-2010 National Survey of Family Growth. Perspectives on sexual and reproductive health, 49(1), 7–16. doi: 10.1363/psrh.12017. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363251/
  5. Zapata, L. B., Steenland, M. W., Brahmi, D., Marchbanks, P. A., & Curtis, K. M. (2013). Effect of missed combined hormonal contraceptives on contraceptive effectiveness: a systematic review. Contraception, 87(5), 685–700. doi: 10.1016/j.contraception.2012.08.035. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23083527/