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 miss 1 active pill or are late taking your pill:
- Take the missed/late pill as soon as you remember.
- Take the next pill at your regular time, even if that means you take 2 pills in one day.
- Emergency contraception is not usually needed.
If you miss 2 active pills in a row in week 1 or week 2 of your pack:
- Take the most recently missed pill as soon as you can, even if that means taking two pills the same day.
- Then take 1 pill a day until you finish the pack.
- Use back-up (like a condom) until you have been on pills for 7 days.
If you miss 2 active pills in a row in week 3 or later of your pack:
- Take the most recently missed pill as soon as you can, even if it means taking 2 pills the same day.
- Take 1 pill a day until you finish the pack.
- Throw away the inactive pills at the end of this pack and go straight into the next pack. You will most likely NOT have a period this month. You don’t need to throw away the pack if you are using an extended cycle pack of pills. In that case keep going.
- Use a backup form of contraception until you have been on active pills for at least 7 days.
If you miss 3 or more active pills in a row (during the first 3 weeks):
- Throw out the rest of the pill pack and start a new pack that same day.
- If you are using an extended cycle pack of pills keep on going.
- Use backup contraception until you have taken 7 days of active pills.
You could become pregnant if you have sex in the 7 days after you restart your pills. You must use a back-up birth control method (such as condoms) for those 7 days.
If you had unprotected sex before you were back on the pill for 7 consecutive days, and that occurred within the last five days, you may need to take emergency contraception.
If you forget any of the “reminder” placebo pills in week 4
- Just throw away the pills you missed.
- Keep taking 1 pill each day until the pack is empty.
- Start your new pack on time, the same day you usually start
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.
Finally, if you are still not sure what to do about the pills you have missed, keep taking one active pill every day and use a backup method when you have sex. Message us at Nurx to answer your questions.
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.