Birth Control Pill - Missed Pills

What should I do if I miss taking one or more birth control pills?

Incorrect use of birth control pills is a major reason for unintended pregnancies. Birth control pills work best if taken according to schedule and at the same time each day. If you miss one or more pills, you increase your chances of releasing an egg (ovulation) that could be fertilized and lead to a pregnancy.

The incidence of pill failure resulting in a pregnancy is roughly 1-2% per year (1 to 2 pregnancies per 100 women) if taken every day as directed, but the average failure rate is approximately 5% per year (5 pregnancies per 100 women per year of use) including women who do not always take the pill exactly as directed without missing any pills.

Your chances for getting pregnant depend upon when you missed your pill during your cycle, the number of pills you missed in a row, and if you had unprotected sex around the time of missed your pill(s).

The highest risk of ovulation occurs when the hormone-free interval (the time when inactive pills are taken or there is a break between active pills) is prolonged for than seven days. This can occur by either delaying the start of your birth control pack or by missing active pills during the first or third weeks of birth control pill use.

What action you take when you have missed taking one or more pills depends upon what type of birth control pill you use. You should review the specific patient package insert that accompanies your birth control pill pack and contact your healthcare provider for the most specific instructions on what to do if you miss one or more birth control pills.

If you are confused at any time about what to do if you have missed any birth control pills, either abstain from sex or use a back-up method of birth control each time you have sex, and take your birth control pill each day until you can talk to your health care provider.

The following general guidelines may be consulted if you miss pills while using the traditional 21- or 28-day combined hormonal birth control pills, progestin-only (“mini”) pills, extended-cycle birth control pills or the continuous-cycle birth control pill (Lybrel). If you have missed a pill and had unprotected sex, there is still a chance you could become pregnant even if you follow these instructions exactly.

  • You may need to use a back-up method of birth control (such as a condom) or abstain from sex for seven days or longer after you miss your pill(s). Your healthcare provider may also recommend that you use an emergency contraceptive. You can use an emergency contraceptive, such as Plan B One Step, Next Choice or Ella for up to five days after unprotected sex, but it works better the sooner you use it, preferably within 24 hours. A copper intrauterine device may also be used as an emergency contraceptive within 5 days of unprotected sex, but this requires a doctor visit.
  • If you find that you frequently forget to take your pill, it may be better to use another form of birth control. Speak to your healthcare provider about other available birth control options that do not require a daily schedule.
  • If you have vomiting or diarrhea for any reason, your pills may not work as well because they may not be adequately absorbed. Use a back-up method (such as a condom) until you can contact your healthcare provider for more information.
  • Certain medications may interfere with the absorption of your birth control pills, including barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, St. John’s Wort and topiramate. Check with your healthcare provider for a drug interaction screening each time you start a new medication.
  • Birth control pills do not protect from sexually transmitted diseases, such as HIV, and a condom should be used in addition to the birth control pill if protection is needed.1,2

Missed Pill for Combined Hormonal Birth Control Pills

What to do if you miss a pill from a 21- or 28-day pack of combined hormonal birth control pills 2,3,4 (except Natazia - see below*)

Number of missed pills Action required Seven day back-up contraceptive method (i.e., condom) needed? Emergency contraceptive (i.e., Plan B One Step) needed?
One active pill (more than 24 hours and up to 48 hours late) -Take your missed pill as soon as remembered (which means you may take two pills in one day)
-Continue with the rest of the pack as usual
No Not usually; but consider if pills missed earlier in the pack, or in the last week of the previous pack. Consider consulting with health care provider for more advice.
Two or more active pills in a row -Take the last pill you missed right away (which means you may take two pills in one day)
-Do not take any earlier missed pills
-Continue with the rest of the pack as usual
-If 2 or more pills are missed in the third week (pills 15-21) omit the pill-free interval by finishing the pills in the current pack and starting a new pack the next day (discard placebo pills).
Yes; or abstain from sex until one pill has been taken every day in a row for 7 days. Consider using emergency contraception if you have had unprotected sex in the previous 7 days and have missed 2 or more pills in the first week of your pack. Consider consulting with health care provider for more advice.
One or more reminder (dummy) pills -Throw away the missed reminder pills
-Take the next reminder pill at the usual time
No No

*If you take Natazia (estradiol valerate/dienogest) and you have missed pills, follow the instructions for missed pills found in the Natazia patient package insert or contact your health care provider.

Missed Pill for Progestin-Only (“Mini”) Pills

The progestin-only pill MUST be taken at the same time each day (no more than 3 hours late). If you miss a pill, you will increase your chances of releasing an egg that could be fertilized and lead to a pregnancy.

You could become pregnant if you miss taking your progestin-only pill (mini-pill) by more than 3 hours. If you miss taking one mini-pill by 3 hours, follow the guidelines below.

Examples of progestin-only pills include: Camila, Errin, Heather, Jolivette, Nor-QD, Nora-BE, Ortho Micronor

What to do if you miss a pill from a progestin-only (“mini-pill”) pack of birth control pills 5

Number of missed pills (by more than 3 hours) When in cycle pills were missed Action required 48-hour back-up method (i.e., condom) needed?
One or more Anytime -Take a pill as soon as remembered
-Take the next pill at the usual time (which means you may take two pills in one day)
Yes

Missed Pill for Extended-Cycle Birth Control Pills

Follow the directions in the table below if you miss one or more pills from an extended-cycle pack. Extended-cycle packs have 84 active tablets and 7 inactive tablets and allow for only four periods per year. All extended-cycle packs have the same general directions for missed pills, but it is important you know which pills are active and which pills are inactive in your pack.

The chart below lists colors for active and inactive pills, but be aware these colors may change, and generic equivalents (if available) of the below brands may be different colors. If you are not sure which pills are active or inactive, review your patient package insert or ask your pharmacist or doctor.

Extended-Cycle Birth Control Pills (examples: Introvale, Jolessa, LoSeasonique, Seasonique, Seasonale, Quasense)

Name ACTIVE pill color (84 tablets per pack) INACTIVE pill color (7 tablets per pack)
Introvale Peach White
Jolessa Pink White
LoSeasonique Orange Yellow
Seasonique Light blue-green Yellow
Seasonale Pink White
Quasense White Peach

What to do if you miss a pill from an extended-cycle pack of birth control pills6

Number of active pills missed (see chart above to determine which pills are active or inactive) When in cycle pills were missed Action required Seven day back-up method (i.e., condom) needed?
One active pill Days 1-84 -Take an active pill as soon as remembered
-Take the next active pill at the usual time (which means you may take two pills in one day)
No
Two active pills in a row Days 1-84 -Take 2 active pills on the day you remember
-Take 2 active pills the next day
-Then take one pill a day until the pack is finished
Yes
Three or more active pills in a row Days 1-84 -Do NOT take the missed pills
-Keep taking 1 pill every day until you have completed the pack (for example, if you resume taking the pill on a Thursday, take the pill under “Thursday” and do not take the missed pills. You may experience bleeding during the week following the missed pills.)
-Yes. You could become pregnant if you have sex during the days of the missed pills or during the first 7 days after restarting your pills. Use a back-up method the days you miss your pills and for the next seven days after you restart your pills.
-Call your healthcare provider if you do not have your period during the time you take your inactive pills as you could be pregnant.
One or more inactive (dummy) pill Days 85-91 -Throw away the missed pills
-Keep taking scheduled pills until pack is finished
No

Missed Pill for Lybrel, a Continuous Cycle Birth Control Pill

Lybrel is a continuous cycle birth control pill that is taken all year around, with no hormone-free intervals. Continuous cycle birth control allows a woman to skip her period completely.

What to do if you miss a pill from Lybrel (levonorgestrel/ethinyl estradiol), a continuous-cycle birth control pill7

Number of missed pills (all pills in Lybrel are active) When in cycle pills were missed Action required Seven day back-up method (i.e, condom, spermicide) needed?
One pill Anytime -Take a pill as soon as remembered
-Take the next pill at the usual time (which means you may take two pills in one day)
Yes
Two pills, and remembered on the day of the second missed pill Anytime -Take 2 missed pills on the day you remember
-The next day you are back on schedule to take one pill per day
Yes
Two pills, and remembered on the day AFTER the second missed pill Anytime -Take the 2 missed pills on the day you remember
-The next day take 2 more pills
-The following day you are back on schedule to take your pills
Yes
Three or more missed pills Anytime -Contact your healthcare provider for advice
-Do not take the pills you missed
-Keep taking one pill every day until you reach your healthcare provider
Yes; continue back-up method (i.e., condom) for at least 7 days or until your healthcare provider advises that you no longer need to use a back-up method.

See Also:

References

  1. Planned Parenthood Website. Birth Control Pills. Accessed July 21, 2012
    http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm
  2. Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. Combined Hormonal Contraception. Clinical Effectiveness Unit. October 2011. Accessed July 22, 2012.
    http://www.fsrh.org/pdfs/CEUGuidanceCombinedHormonalContraception.pdf
  3. Princeton University. Office of Population Research. The Emergency Contraceptive Website. Updated June 14, 2012. When to Use Emergency Contraception. Accessed July 24, 2012.
    http://ec.princeton.edu/questions/missedocs.html
  4. Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. CEU Statement (May 2011). Missed Pill Recommendations. Accessed July 22, 2012.
    http://www.fsrh.org/pdfs/CEUStatementMissedPills.pdf
  5. Ortho MicroNor Package Insert. Janssen Pharmaceuticals. DailyMed. Accessed July 21, 2012.
    http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6fea0c04-cfbc-4bd2-8a1f-fa3d5ed2a941#nlm42230-3
  6. Introvale Package Insert. Sandoz Pharmaceuticals. DailyMed. Accessed July 21, 2012.
    http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0eb14772-6a46-4590-bfc1-98494062c071
  7. Lybrel Package Insert. Pfizer Inc. DailyMed. Accessed July 22, 2012.
    http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0a5ce8f7-2f8e-4944-7692-5a1c549f451a#nlm42230-3

Last updated: 2013-02-07 by Leigh Anderson, PharmD.

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