What to Do When You Miss Your Birth Control Pill

Young woman holding pack of birth control pills
Dimitri Otis/Getty Images

Missed a birth control pill and now wondering… what should I do? Don’t worry. Navigate these step-by-step instructions so you know what to do about your missed birth control pill. But before you do, it may be helpful to first understand why it is important to take your pill every day.

Why You Don’t Want to Miss Birth Control Pills

As long as you take the pill at the same time every day, you have a super low chance of becoming pregnant (0.3 percentmeaning that of every 100 women who use the pill for a year, less than 1 will become pregnant).

But, let’s face it, how many of us are perfect? I get it, remembering to take the pill at the same time every day can be difficultlet alone at the same time. But  less-than perfect use, like popping one of your pills late one day or forgetting to take it altogether, drops the effectiveness to 91 percent (of every 100 women who do not use the pill perfectly for a year, 9 will become pregnant).

Why is this? When you miss a birth control pill or take it at the wrong time, it increases your chances that there will not be enough hormones in your system to prevent ovulation (which is how the pill works). Part of the risk depends on when you missed the pill, when you took your next pill, and how sensitive your body is. If you miss taking your birth control pill more than once in each pill pack, this risk is even further increased.

What to Do If You Missed Birth Control Pills

The following steps are meant to be general guidelines, so I strongly recommend that you read the package information that came with your pill to know exactly what to do about missed birth control pills.

Also, these guidelines are meant to be followed if you are using a combination birth control pill (one with both estrogen and progestin) AND if your pill brand is monophasic (meaning,that all the active pills in your pill pack have the same amount of estrogen and progestin).

  1. If you miss one pill, you should take the forgotten one (yesterday's) as soon as you remember it. You should then take today's pill at your regular time. If you do not realize that a pill was missed until your regular pill time, you can just take both pills at that time.
  1. Although you will probably not become pregnant, you can always use a backup method (like an over-the-counter birth control option) for the next 7 days, just to be extra cautious.
  2. If you miss two pills in a row, you should take the two pills as soon as you remember and two pills the following day. Don't freak out if some spotting may occur. You should also use a backup birth control method until your next period and pill pack.
  3. If you miss three or more pills in a row, you should use a backup method of birth control immediately.
  4. Some research has suggested that women who miss three pills most likely will not ovulate, but you should still be cautious and take the necessary precautions to prevent pregnancy.
  5. Once you have missed three or more pills, you can:​
    • Begin a new pack of pills the following Sunday (after missing the pills), even if you have started bleeding. You should continue to use an additional birth control method for the first 14 days of the new pack of pills.
    • Take two pills for 3 days to get back on track (while using a back-up birth control method).
    • Choose to stop taking the remainder of the pills, throw away the pack, and start a new pack.

What to Do If You Missed a Progestin-Only Birth Control Pill

The progestin-only pill, or mini-pill, does not contain any estrogen.

Because of this, timing is much more important than for combination birth control pills. The mini-pill really works best when you take it every day, at the same time of day.

  1. If you are more than three hours late taking the mini-pill, you should take your missed pill as soon as possible, go back to taking them at your regular time the following day, and use a backup birth control method (like a condom) for the next two days.
  2. If it’s been less than three hours, follow the same instructions (as #1 above), but you will not need a back-up method.
  3. If you miss your birth control pill completely (meaning, you forgot to take your mini-pill that day and remember the next day), you will have to use another method of birth control for one week. Take the pill you forgot to take (when you remember) and take your pill for that day at your scheduled time.

    What to Do If You Missed Birth Control Pills That Are Biphasic

    Biphasic birth control pills are a type of combination birth control pill. The level of hormones in biphasic pills usually changes one time during your pill pack. Typically, biphasic birth control pills contain the same amount of estrogen each day, but the progestin level is increased about halfway through the pill cycle. If you missed these birth control pills, here’s what you have to do.

    1. If you miss one pill in Weeks 1, 2, or 3, take the missed birth control pill as soon as you remember, and your next pill at your regularly scheduled time. You can take both pills at this time. To be extra safe, you may want to use back-up birth control for one week, but you don't have to.
    2. If you miss two pills in Week 1 or Week 2, you should take two pills the day you remember and two pills the next day. Then continue taking one pill a day until you finish your pill pack. You should also be using a back-up birth control method for the next seven days after missing these birth control pills.
    3. If you miss two pills in the Week 3 or miss  three pills in a row (during any of the weeks), continue taking one pill every day until Sunday. On Sunday, you should throw out the rest of the pill pack and start a new pack that same day. Make sure to use a back-up birth control method of birth control if you have sex in the seven days after missing your birth control pills.

    What to Do If You Missed a Triphasic Birth Control Pill

    Triphasic birth control pills (like Ortho Tri-Cyclen Lo) have three different doses of hormones—so the hormone combination will generally change about every seven days throughout the pill pack. Depending on the pill brand, the amount of estrogen may change as well as the amount of progestin. This makes missing birth control pills a little more challenging.

    The pill may not be as effective if you miss certain dosage combinations offered at varying points throughout the pill package (particularly at the beginning of Week 1 or the end of Week 3). So, the risk of pregnancy increases with each birth control pill missed.

    There are several brands of triphasic birth control pills, so it is super important that you check the instructions that come with your particular brand if you miss birth control pills. That being said, the following is a general guideline to follow (that applies to many triphasic pill brands).

    1. If you miss one pill during Weeks 1, 2, or 3, take it as soon as you remember. Take your next pill at your regular time. This means that you may take two pills in one day, but you do not need to use a back-up birth-control method if you have sex.
    2. If you miss two pills in a row during Week 1 OR Week 2 of your pack, take two pills on the day you remember and two pills the next day. Then, take one pill a day until you finish the pack. Keep in mind that you may become pregnant in the seven days after you miss pills, so you should use another birth control method (such as condoms, spermicide, or sponge) as a back-up for those seven days.
    3. If you miss two pills in a row in Week 3:
      • If you are a Day 1 Starter: Throw out the rest of the pill pack and start a new pack that same day.

      • If you are a Sunday Starter:
 Keep taking one pill every day until Sunday.
 On Sunday, throw out the rest of the pack and start a new pack of pills that same day.

      Use a back-up birth control method for the following seven days after starting your new pill pack. You may not have your withdrawal period this month—but this is expected. But, if you miss your period for two months in a row, call your doctor because you may be pregnant.  

    4. If you miss three or more pills in a row (during the first 3 weeks):

      • If you are a Day 1 Starter: Throw out the rest of the pill pack and start a new pack that same day.
      • If you are a Sunday Starter: 
Keep taking one pill every day until Sunday.
 Throw out the rest of your pack on Sunday, and start a new pack of pills that same day.

      Since you can become pregnant for the next week, use a back-up birth control method for the week after starting your new pill pack. You may not have your period this month—but, again, this is normal. If you miss your period two months in a row, call your doctor.

    What If I Miss a Pill During Week 4?

    Most combination birth control pills will have placebo pills—pills that don't contain any hormones. The placebo time-frame varies between pill brands, but is usually all or part of Week 4 for most combination pills and during Week 13 for extended cycle pills.

    If you miss birth control pills during the placebo week, you have nothing to worry about. It's a good idea, though, to keep taking them (even if you forget one), so you stay on track and start your next pill pack on time. The EXCEPTION to this rule has to do with progestin-only pills. All the birth control pills in these packs contain hormones, so there are NO placebo pills.

    How to Avoid Missing Birth Control Pills

    You should always try to take your birth control pill at the same time, every day. Even on the weekends. Even on vacation. But there is a little wiggle-room. Missing your pill time by one to two hours presents less pregnancy risk than if you miss the pill by fifteen hours. You may have a body that is very sensitive, so that little bit of time is enough for your body to ovulate, and you can become pregnant.

    So how can you avoid missing birth control pills?

    • Make taking the pill a regular part of your morning or evening routine.
    • Some women say that it is easier to remember to take the pill in the morning because they are tired at night, and more likely to forget.
    • Use a birth control apps or an alarm that is specifically designed to remind you to take your pill.
    • Keep your pill pack in a place where you are guaranteed to see it every day (like next to your hair brush or cell phone).

    One Final Pointer

    Although it is okay to take two pills at a time when you realized you have missed your birth control, your stomach may not agree with this practice. It is not uncommon to become nauseous, have stomach pain, or even vomit after taking two pills.

    You can try to prevent this by taking an anti-nausea medication before taking the additional pills. If you do end up throwing-up after taking your missed birth control pills, the best idea is to call your doctor or pharmacy to find out what to do next and how to best be protected against becoming pregnant.

    Source:

    Bastianelli C, Farris M, Bruno Vecchio RC, Rosato E, Guida M, Benagiano G. "An observational study of adherence to combined oral contraceptive regimens." Gynecological Endocrinology. 2016;33(2):168–172.

    Continue Reading