What to Do if You Miss a Birth Control Pill

If you have missed a birth control pill once or twice, you are not alone.

Studies show that nearly one in four people who take the pill have missed a pill within their last cycle.

In this article, we will go over everything you should do if you miss a pill and the effects that it may have on your body. 

What to Do if You Miss a Birth Control Pill

When you miss a birth control pill, your next steps will depend on the kind of pill you take (the combination birth control pill or the progestin-only pill) and how many pills you have missed.

Missed progestin-only pill 

A progestin-only pill is considered “missed” when it has been more than three hours since you were scheduled to take the pill.

If you have missed your progestin-only pill, be sure to take it as soon as possible, and then continue taking your pills on schedule—even if that means taking two pills in one day. 

In addition, if you miss a pill, you should use backup contraception, such as condoms, until you have taken the pill on time for two days in a row.

For example, if you missed the pill you were supposed to take Friday at 8:00 a.m. and took it instead on Friday at 12:30 p.m., take the pill correctly for Saturday and Sunday, and use backup protection until Monday. 

If you had unprotected sex within five days of missing a pill, discuss with your doctor whether it is appropriate to use emergency contraception. 

Missed combination pill 

Combination birth control pills contain estrogen as well as progestin.

The active pills that contain hormones are taken for 21-24 days, followed by 3-7 days’ worth of hormone-free placebo pills.

Some combination birth control pills are prescribed without any breaks at all.

It’s important to remember that missing the hormonal pill is what increases your risk of pregnancy, not missing the placebo pill.

A combination pill is considered “missed” if it has been more than 24 hours since you last took an active pill. 

Here is an example: If you take the medication at 10:00 a.m. on Monday, you should take your next pill at 10:00 a.m. on Tuesday.

However, if you forget to take your Tuesday morning pill until 12:00 p.m. on Wednesday, you can consider the Tuesday pill missed, since it has been more than 24 hours since you last took your pill. 

Missing your pill is different from taking the pill a bit late.

For example, taking the pill at 5:00 p.m. on Tuesday instead of at 10:00 a.m. is considered a late pill, not a missed pill. 

If it has been less than 48 hours

A general rule of thumb to keep in mind is the 24- to 48-hour safety window: You can catch up on a missed pill up to 48 hours after you took your last active pill and still be protected against pregnancy.

However, after the 48-hour window has closed, you are no longer as protected against pregnancy. 

If it has been less than 48 hours since your last active pill and you missed one hormonal pill, take your missed pill as soon as possible, and then continue taking your pills on schedule—even if that means taking two pills in one day.

You do not need to use backup contraception, but you certainly can for up to a week if it will make you feel better.

If it has been more than 48 hours

If it has been more than 48 hours since your last active pill and you missed two consecutive hormonal pills, you should take the most recently missed pill as soon as possible, discard any extra missed pills, and then continue taking your pills on schedule—even if that means taking two pills in one day. 

In addition, you should use backup contraception, such as condoms, until you have taken the hormonal pill on time for seven days in a row.

If you missed more than two days and had unprotected sex within five days of your missed pill, the best thing to do is to contact your healthcare provider and consider taking emergency contraception. 

Emergency contraception use

Taking emergency contraception will reduce the chance of pregnancy after unprotected sex.

Emergency contraception is commonly used when a person forgets to take one or several birth control pills in a row.

The emergency contraception pill is also taken if a condom slips off or breaks, or if there was no birth control method used at all.

Chances of pregnancy after a missed pill 

Birth control pills are a highly effective way to prevent unwanted pregnancy when used properly.

But if you miss one pill or multiple pills, the rate of effectiveness decreases. 

The specific pill that you miss can also make a difference in your risk of unwanted pregnancy. 

For those who take combination oral contraceptives, if you miss a pill during the first week of a new pack, your risk of pregnancy is greater.

This happens because you start a new pack after taking a break from the hormone pills (by taking your placebo pills).

Because you already have a lack of pregnancy-preventing hormones in your system when you begin a new pack, missing a hormone-containing pill in the first week increases that deficit.

Missing several pills and still having unprotected sex will also increase your risk of pregnancy.

If you do come to this point, emergency contraception may be considered along with contacting your medical provider about any uncertainty. 

If you are nervous about missing a pill, it is never a bad idea to use extra protection.

Condoms and other preventative birth control measures can help you feel more secure and decrease your risk of pregnancy. 

What are the side effects of missing a birth control pill?

The two most common side effects caused from missed birth control pills are breakthrough bleeding (commonly known as spotting) and pregnancy.

Birth control hormones will wear off after approximately 36 hours if you are not continuously taking them.

After a day and a half has passed, your hormone level will decrease, and spotting may occur as a result. 

Your individual chance of pregnancy depends on how many active pills you have missed and where in the pack you are.

When you miss a pill, it is recommended to use a backup birth control method to prevent pregnancy. 

You may experience nausea if you miss multiple pills and then make up for them both in one day.

Taking higher doses of hormones can make people feel nauseous or dizzy. 

Emergency Contraception

When to use emergency contraception

Emergency contraception, also called the morning-after pill, will help prevent pregnancy when you have had unprotected sex.

You can take it after missing your birth control pill, having your birth control fail, or having unprotected sex.

Although it is called the “morning-after” pill, you can take it up to three days after unprotected sex.

Emergency contraception primarily works by delaying or preventing ovulation.

If an egg is not released from the ovary (ovulation), then there is no egg for the sperm to fertilize, and pregnancy is avoided.

However, emergency contraception will not terminate a pregnancy that has already implanted.

The morning-after pill is not the same as mifepristone (Mifeprex^Ⓡ), which is commonly known as RU-486 or the abortion pill.

This drug will terminate an established pregnancy—meaning a fertilized egg has attached to the uterine wall and has begun to develop. 

Side effects and risks 

Side effects of the morning-after pill typically do not last longer than a few days. 

These side effects may include:

• Headache
• Dizziness
• Nausea or vomiting
• Fatigue
• Breast tenderness
• Lower abdominal pain
• Heavier menstrual bleeding 
• Bleeding in between periods

Taking emergency contraception is an effective method of preventing pregnancy after having unprotected sex, but it is not as effective as other contraceptive methods, it is not recommended for continuous use, and it may not be recommended for everyone.

Additionally, emergency contraception can sometimes fail even when used properly.

The morning-after pill also does not offer any protection against sexually transmitted infections. 

Emergency contraception may not be for everyone, and you should avoid taking the morning-after pill if:

• You think you have been pregnant for several days
• You have vaginal bleeding for an unknown reason
• You have an allergy to any component of the medication
• You are taking other medications that can decrease the potency of the morning-after pill, such as St. John’s wort or barbiturates 

Oral emergency contraception and weight

The morning-after pill will sometimes feature a weight restriction.

Specifically, you may see packaging or articles that claim oral emergency contraceptives, like Plan B, may be less effective in preventing pregnancy if you are overweight (BMI 25-29.9 kg/m²) or obese (BMI over 30 kg/m²). 

The U.S. Food and Drug Administration has concluded that the data supporting this claim is conflicting and inconclusive.

However, other experts recommend the copper intrauterine device (IUD) as an alternative emergency contraception, which is highly effective at preventing pregnancy and not affected by weight. 

This doesn’t mean oral emergency contraception won’t work for you, but it is important to talk to your doctor about your options.

When to See a Medical Provider

Speak to your healthcare provider if you have questions about your birth control schedule, are not sure how many pills you have missed, or are struggling to stick to your schedule.

Birth control pills are most effective when taken every day at the same time.

If this schedule does not work for you, contact your healthcare provider to discuss your options.

While the pill may not be the best birth control option for you, there are still many options that can better suit your schedule and lifestyle!

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