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What should I do if I miss a dose of birth control?

Susan Vachon

Medically reviewed by Susan Vachon, PA-C on January 13, 2020

Birth control pills are 99% effective at preventing pregnancy, in theory anyway. That 99% stat refers to “perfect use,” which means taking a pill every day, ideally at the same time each day. Think of it this way: each birth control pill is effective for 24 hours, not beyond that. But with “typical use,” meaning results based on how real women really use their birth control pills, 9 out of 100 women will get pregnant during their first year on the pill — and one of the main causes of those unintended pregnancies is women forgetting to take their pills. To prevent that from happening to you, read our guide to how to deal when you miss a day (or more).

The first thing to understand: The rules for dealing with a missed pill are different depending on whether you take combination or progestin-only birth control pills.

 

If You’re on Combination Pills
Combination pills, as the name implies, include a combination of two hormones, estrogen and progestin. Most women who use oral birth control are prescribed combination pills. “Missing a pill” when taking combination pills means missing the normal time you take it by 24 hours or more.

If you’ve missed one pill: Don’t panic! Take your pill as soon as you remember it, which may mean taking two pills at the same time (that’s totally safe).

If you’ve missed two pills in a row, and you’re still in the first or second week of your cycle, you can take two pills the day you notice you’ve missed them and two pills the following day before returning to your regular schedule. But use back-up protection, like a condom, for seven days.

If you’ve missed three pills at any time, in any week of your pack, take two pills as soon as you realize you’ve missed three pills, then take another two pills the next day, and two pills the third day. Use backup contraception for seven days. Keep in mind that taking 2 or 3 pills at a time may cause nausea. This is because the dosage is higher, but is not harmful.

If you miss two or more pills near ovulation (usually between five and 12 days after the last day of your period according to AmericanPregnancy.org), and you have sex without a condom, you might want to use emergency contraception like Ella or Plan B to prevent pregnancy.

 

If You’re on Progestin-Only Pills
Progestin-only pills (POP), often referred to as minipills, contain progestin but no estrogen. The amount of progestin in the minipills is lower than in combination pills, making pregnancy more likely if you miss just one pill. For this reason, if you miss just one progestin-only pill you should use back-up protection for at least two days. “Missing a pill” when taking the progestin-only pill means missing the normal time you take it by 3 hours or more.

 

What to Do if You Miss Placebo Pills
Combination birth control pills, such as Seasonique, include a blend of the hormones estrogen and progestin. These types of products have placebo pills. What happens if you miss a placebo pill?

The answer is simple: Do nothing. You might notice seven pills in your birth control pack that are a different color from the rest. These are placebos or sugar pills. If you miss one, two, or all seven pills, you’re still safe. Manufacturers place these pills in your pack to alert you that your next menstrual cycle is about to start. Placebo pills don’t contain any active ingredients to help prevent pregnancy.

In some cases, and with doctor approval, women skip placebo pills and start on a new pack as soon as they’ve finished the active pills from the previous month. Skipping placebo pills often prevents a menstrual cycle from occurring because hormone levels reached when taking active pills stay continuously elevated.

Women who are skipping placebo pills should follow the birth control catch-up method. If you skip the placebo pills that leaves you seven days short of one month of coverage. If this method will leave you short, Nurx™ provides affordable, easy access to birth control options and delivers birth control pills right to your door.

 

The Effect of Missing Birth Control Pills on Your Cycle
This process of playing contraception catch-up can affect your cycle, so don’t be surprised if your period comes early, late or, not at all. But if you miss a period you should take a home pregnancy test to ensure you’re not pregnant. If you ever are unsure about how many pills you missed or what you should do, please don’t hesitate to contact us. A member of our Medical Team will help you determine the best next steps.

 

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