What Happens When You Miss A Birth Control Pill?

Missing birth control pills can create panic, especially in couples who have not planned to start a family anytime soon. They are oral contraceptives taken to prevent unwanted or unintended pregnancies and have an efficacy rate of 99% (1) (2). But, incorrect intake of pills could lead to an unwanted pregnancy even after its use. According to the US Centers for Disease Control And Prevention (CDC), combined oral contraceptives and progestin-only pills have a 7% failure rate upon typical-use failure (3).

Read on to know about the types of birth control pills, including the side effects of a missed pill and measures to take if you miss the pills.

Types Of Birth Control Pills

There are two main types of birth control pills (4):

1. A combination pill or combination oral contraceptive (COC) is a birth control pill containing both estrogen and progestin hormones. One pack of combination pills has 21 to 28 hormone pills (active pills) and placebo pills (inactive or non-hormonal pills). Placebo pills, also called reminder pills, are inactive and do not contain hormones.

2. A progestin-only pill (POP), also known as a mini pill, contains only progestin hormones. You should take these pills at the same time every day to prevent pregnancy. Taking the mini pill a few hours later than usual can cause the hormones to wear off sooner than in combination pills. Hence, missed mini pills and unprotected sex pose a higher risk of pregnancy than missed combination pills.

Knowing the type of contraceptive pill you are taking is necessary to figure out the next best step if you miss a pill.

Recommendations For Missed Combination Pills

You can consider a 24- to 48-hour safe window for combination pills, and taking the next pill within that time can help. However, it will not work if you take a pill beyond this safe time (5).

Follow the instructions based on the scenario that fits you (5)(6):

1. Missed one hormonal pill (active pills) or started a pack one day late

Hormone pills are active pills containing hormones that prevent pregnancy. If you miss one hormone pill or begin a pack one day later than prescribed, take the pill as soon as you remember and continue the daily dose on time from the next day onwards.

You will not require additional contraceptive protection with condoms or other methods if you are planning an intercourse. Emergency contraception (the morning-after pill) is also unnecessary if you missed one hormone pill and had unprotected sexual intercourse.

2. Missed two or more hormone pills (active pills)

The instructions vary for women who missed two or more hormone pills based on when they missed the pill and whether they had unprotected sex. Some scenarios are given below:

• Missed two or more pills in the beginning or started a pack two or more days late

Take the hormone pill (active pill) you most recently missed as soon as possible and continue taking the remaining pills at the usual time. When doing so, you may end up taking two hormone pills on the same day. For example, you may take the previous day’s missed pill that morning and that day’s regular pill in the evening. It is also recommended to abstain from sex or use condoms until you have taken hormone pills for seven consecutive days.

• Missed two or more hormone pills and had unprotected sex in the first week

Take an emergency contraceptive pill (ECP) in addition to the most recent pill you missed to prevent pregnancy. Try to take an ECP no later than 72 hours after unprotected sex or contact a doctor for other methods, such as copper-bearing intrauterine devices (IUDs) (7).

• Missed two or more hormone pills in the third week

Continue to take the hormone pills (active pills) from the current pack daily. However, once you finish taking all the active pills, begin a new pack the next day. This means you should not take the seven placebo pills after missing two or more hormone pills in the third week.

3. Missed one or more placebo (inactive) pills

Placebo pills are non-hormonal pills, so you can discard the missed pill and continue as scheduled. There are not more than seven consecutive placebo pills in between combo packs.

It is fine to skip these reminder pills (placebo pills) as they do not increase your risk of pregnancy.

Recommendations For Missed Progestin-Only Pills

A single missed POP puts you at risk of pregnancy. If you are more than three hours late to take your POP, take it as soon as you remember and continue the next dose, even if you need to take two pills in a day to get back on a regular schedule (5).

It is recommended to use backup contraception methods, such as condoms, or avoid sexual intercourse until you take pills for two consecutive days at the regular time.

Scenarios To Consider While Taking Birth Control Pills

Consider the following factors if you are taking a combination pill or mini pill:

• Taking birth control pills for other reasons

If you are taking birth control pills for reasons other than contraception, such as to control acne or reduce menstrual cramps, missing a couple of pills should not affect you, and you don’t need to do anything to get back on track. You may continue when you remember (5).

• Taking pills during illness

The effectiveness of birth control pills may be reduced during episodes of vomiting and diarrhea. Therefore, it is recommended to use backup contraception for seven days after any illnesses with diarrhea and vomiting, such as stomach flu (stomach bug), even if you have taken your pills regularly (8).

• Taking pills with other medications

If you take other prescription medications, inform your doctor before obtaining contraceptive pills. For example, epilepsy medications such as barbiturates and phenytoin and tuberculosis medications such as rifampin may interfere with the efficacy of birth control pills (8).

When You Are Not Sure What To Do?

If you are unsure which type of pill or how many pills you missed, continue to take the pill regularly and use other contraceptives such as condoms. Also, contact your doctor in case of confusion (9).

Side Effects Of Missing Birth Control Pills

Missing doses of birth control pills can lead to the following complications (10):

• Unplanned pregnancy if you have had unprotected sex

• Nausea

• Menstrual cramps

• Irregular bleeding

• Early menstruation

Usually, women who have missed pills for more than 36 hours may experience breakthrough bleeding or spotting. It would also help to consider when and how many pills were missed to understand the risk of pregnancy.

Chances Of Getting Pregnant After Missed Birth Control Pills

Not all women who miss the pill and have unprotected sex become pregnant. The chances of getting pregnant after missed pills may depend on the following factors (5):

• The type of pill missed: The risk of pregnancy is higher if you miss hormonal pills.

• How many pills were missed: Missing more than two combination pills or progestin-only pills can increase the risk of pregnancy.

• When the pills were missed: The chance of pregnancy is higher if you missed pills at the beginning or end of the pack. The hormone-free interval is extended at this time, increasing the chances of ovulation and a favorable environment for

Tips To Take Birth Control Pills On Time

The following tips may help in remembering to take the daily pills on time (10):

• Take them at the same time every day.

• Set phone reminders or use pill reminder apps.

• Associate the pill time with something consistent in your day, such as breakfast or dinner.

• Keep an additional pack in your bag or purse so you can take the pill if you forget to take it at home.

• Remember to adjust pill timings if you travel to another time zone.

What To Do If You Miss Birth Control Pills Often?

Inform your doctor if you forget to take your contraceptive pills often. Doctors may suggest other effective birth control methods that do not require daily adherence. For example, birth control patches, implants, and IUDs do not require daily administration. With some guidance, you can choose an effective and more convenient method of birth control for yourself.

It is not uncommon to forget your daily pills in your busy schedule. You could contact your doctor or take the pill according to your scenario. Always consider which pill you missed before deciding the next step. Additionally, use backup contraception, such as condoms, if you miss a pill.

References

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Dr. Mona HardasMD

   

Dr. Mona Hardas is a practicing Ob/Gyn from Flint, Michigan, with over 20 years of experience in private practice. She is also actively involved in teaching medical students and residents as an associate clinical professor from MSU College of Human Medicine.

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