Exactly What to Do If You Missed Birth Control Pills
Contraception is a hot topic as of late (thanks, Texas!), and roughly two-thirds of women in the U.S. are using some form of contraception. Oral contraceptives — aka the pill — continue to be one of the most popular choices among them all, but these meds do more than just prevent pregnancy.
"The non-contraceptive benefits of birth control pills are many," from reducing ovarian and endometrial cancer risk to helping treat polycystic ovary syndrome, says Catharine Marshall, M.D., board-certified ob-gyn and gynecologic surgeon at Scripps Memorial Hospital in La Jolla, California.
One of the pitfalls, though? Human error. It can be impossible to remember to do something every single day at the same time (hello…have you ever tried doing a meditation challenge?). But when it comes to birth control pills, missing one — or two...or five — can have life-altering implications. Ahead, what you need to know about missed birth control pills by type, timing, and quantity — and what to do if you miss a birth control pill.
Here's How Birth Control Pills Work
To understand what happens when you miss a pill, it's important to know what these pills are doing to your body in the first place, and how they prevent pregnancy. And, here's the thing: Different pills use different hormones and have different timelines for how quickly they break down and are absorbed. That means depending on which pill you're taking, missing one pill could have varying effects. (In case you're curious: Could Widespread Vasectomies Be a Better Form of Birth Control?)
Combination Pills: These contain both estrogen (a sex hormone) and progestin (a synthetic version of the sex hormone progesterone). "Combination birth control pills prevent ovulation, thin the uterine lining, and thicken cervical mucus," all of which team up to help prevent the fertilization of an egg, says Dr. Marshall. (Thinning the uterine lining makes it more difficult for a fertilized egg to attach, and thickening cervical mucus hinders sperm from entering the uterus, according to the U.S. National Library of Medicine.) The final week of combination packs are sugar pills, sometimes referred to as placebo pills, which do not prevent pregnancy and allow you to have your monthly period. (It doesn't matter if you miss these, but many patients like to keep the regular habit of a daily pill so they don't make a habit of skipping pills.)
Progestin-Only Pills (aka the Minipill): These pills only contain the progestin (a synthetic version of the sex hormone progesterone). "Progesterone-only pills thin the uterine lining and thicken cervical mucus, but don't completely suppress ovulation," says Marshall. "These are slightly less effective at preventing pregnancy, and are used when women are nursing, or have reasons that they cannot use an estrogen-containing birth control pill (such as high blood pressure, migraines, risk factors for blood clots and strokes, sickle cell anemia, and smokers)."
What Happens If You Miss One Birth Control Pill?
Combination Pills: If you've landed on this article because you missed one birth control pill in a combination packet — regardless of where you are in the cycle — the recommendation is to take the pill as soon as you notice that you've forgotten, says Dr. Marshall. From there, continue taking one pill each day as prescribed, she adds.
It's typically no biggie if you missed one birth control pill. You're chillin'. "One missed pill does not reverse ovarian suppression," says Dr. Marshall. Meaning, you won't ovulate and thus have a chance of becoming pregnant. "It may cause spotting or other uncomfortable symptoms — but no additional contraception is required." (Also read: Can Antibiotics Affect Your Birth Control?)
Progestin-Only Pills (aka the Minipill): The minipill is "not as potent a suppressor of ovulation as a combination pill," says Dr. Marshall. Because of this, progestin-only pills are trickier when it comes to missed or delayed doses. In fact, it's considered "missed" if it's been more than three hours since you should have taken your pill, according to the Cleveland Clinic. (However, if your minipill also contains the medication desogestrel — it should be noted on your pack — you have a 12-hour window before it's considered missed, according to the U.K. National Health Service.)
"If you miss a minipill, take that one as soon as you remember — sometimes that means taking two pills in the same day or even at once," says Dr. Marshall. "Using a backup contraception method after one missed dose of the minipill for at least two days is recommended."
What If You Miss Two (or More) Birth Control Pills?
Combination Pills: If you've missed two birth control pills (or more), your chance of pregnancy goes up. Keep taking your pills regularly at their usual time and use backup contraception (e.g. condoms), advises Dr. Marshall. "With two or more missed pills, there is a risk of ovulation." You should continue to use backup protection until after your next period. FYI, You may experience symptoms from missed pills, too, such as breakthrough bleeding/spotting, cramps, etc.
Timing also comes into play here. If you miss two or more pills in the first week of your cycle — and have unprotected intercourse during that week — you should use emergency contraception (such as Plan B) because you're most fertile at the beginning of the cycle, right after your period, she explains. And "if you miss two or more pills in the last week of hormone pills — week three or days 15 to 21 in a 28-day cycle — you should finish that last week of pills, then skip the placebo pills (the fourth week or row), and immediately start a new pack in the next day," says Dr. Marshall.
Progestin-Only Pills (aka the Minipill): In this case, you're not protected against pregnancy and should use a backup method (or not have sex). Take your missed pill as soon as you remember — but only one, even if you've missed two or more. Then take your next pill at the usual time, even if that means taking your missed pill and your next pill together. Carry on taking your pills as normal, and after you've taken your minipill on time for two consecutive days, you should be protected from pregnancy again.
When in doubt, drop your ob-gyn a line or check your BC package for more info (though they're not always in the plainest English).
If You're Regularly Missing a Lot of Pills…
Dr. Marshall has a suggestion if you're missing more than one pill on a somewhat regular basis: change your contraception. Depending on your physiological needs and your stage of family planning or pregnancy prevention, there are a plethora of options. (Related: Here's How to Get Birth Control Delivered to Your Door)
As far as recommended replacements, Dr. Marshall believes the following are excellent substitutions: "NuvaRing, Annovera ring, and Ortho Evra patch [are great] for young women who need contraception, or non-contraceptive benefits from combination contraceptives. These three options allow you to absorb the same hormones as in the pill through your skin. They are an excellent workaround for women who frequently miss pills and have problems from that." Other long-term options like IUDs are also great contraceptive options for women solely looking to prevent pregnancy, as well.