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Missed taking your birth control pill? Here's what to do next

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Mar 7, 2020.

What should I do if I miss taking my birth control pill?

It happens. A late night, a missed refill, or just plain forgetfulness. What do you do if you miss one or more birth control pills?

Hormonal contraceptives like the pill are the most commonly used type of birth control. Pills that contain both an estrogen and progestin are called combined oral contraceptives (COCs). Ethinyl estradiol is a common estrogen and norethindrone is a common progestin found in oral contraceptives.

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 that could be fertilized and lead to a pregnancy.

In general, if you forget to take one of your combined oral contraceptive pills (each pill contains both an estrogen and progestin), you should take it as soon as you remember. Take your next pill at the normal time. This may mean that you will take two pills in the same day. Continue taking your pills as prescribed. If you miss more than two pills, you should use a backup method of birth control (like condoms and spermicide) for seven days in a row.12 If you did not take a pill for over 48 hours, you are not protected against pregnancy again until you take your pill every day for 7 days in a row.1 See Tables 1-4 below for further information. You can also view your birth control package insert here

Even if you take the pill exactly as you are supposed to every day, it still isn't perfect. The incidence of pill failure resulting in a pregnancy is roughly 1% to 2% per year (1 to 2 pregnancies per 100 women) if taken perfectly every day as directed.

In reality, the average pill failure rate is approximately 5% to 9% per year (5 to 9 pregnancies per 100 women) including women who do not always take the pill exactly as directed - even if they still take their pill each day.1 For example, some pills like progestin-only pills (POPs) need to be taken within a 3 hour window each day.

Your chances for getting pregnant depend upon:

  • when you missed your pill during your ovulation cycle
  • the number of pills you missed in a row
  • if you had unprotected sex around the time of missed your pill(s).

The highest risk of ovulation (and a possible a pregnancy) occurs when the hormone-free interval (the time when inactive pills are taken or there is a break between active pills) is prolonged for more 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.

Options

What action you take when you have missed taking one or more pills depends upon what type of birth control pill you use.

  • Contact your doctor, nurse or pharmacist for the most specific instructions on what to do if you miss one or more birth control pills.
  • You should review the specific patient package insert that accompanies your birth control pill pack. Look for the section in your patient package insert that addresses what to do if you miss any pills.
  • If you are confused at any time about what to do if you have missed any birth control pills, either do not have sexual intercourse or use a reliable backup barrier method of birth control (like a condom and spermicide) each time you have sex. Keep taking your birth control pill each day until you can talk to your doctor or clinic.
  • Be truthful with yourself: if you think you can't reliably keep up with a pill every day, choose a more foolproof method of of birth control like the IUD, implant or injection. Talk to your doctor or clinic about these choices.

Missed Pills: How to Handle It 

Directions on what to do if you miss a pill can vary between different brands of birth control pills. It is always best to review the specific instructions in your Patient Information Handout and speak to your health care provider about your individual case. 

Important Note: If you take Natazia (dienogest and estradiol) and you have missed pills, follow the patient instructions for missed pills found in the Natazia package insert or contact your healthcare provider.

Table 1. Missed Pills for Combined Oral Contraceptive Pills

Number of missed pills Action required Is a seven day back-up contraceptive method (such as a condom, spermicide) needed? Emergency contraceptive (i.e., Plan B One Step) needed?
One hormonal pill (more than 24 hours and up to 48 hours late)15,18

Take your missed pill as soon as possible (which means you may need to take two pills in one day). Continue with the rest of the pack as usual.

No.

But if it's been longer than 48 hours since you last took a pill you need to use a 7-day, non-hormonal back-up method (such as a condom and spermicide).

Not usually, but you may want to use emergency contraception (EC) if you've had sexual intercourse since you missed your pill(s).

Consider EC use if pills missed earlier in the pack, or in the last week of the previous pack.

You can get EC from the pharmacy or health clinic; to the clinic for other options like the IUD.1

Do not use ella (ulipristal acetate) as an emergency contraceptive because the active ingredient in ella may counteract the progestin in combined oral contraceptives.

Consult with a health care provider for more advice.

Two or more hormonal pills (more than 48 hours late)15,18

Take the last pill you missed right away (you may take need to take two pills in one day). Discard any other 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 of a 28-day pack) finish the hormonal pills in the current pack, omit the inactive pills and start a new pack the next day. Discard the inactive pills.

If you are unable to start a new pack immediately, use back-up nonhormonal contraception (such as condoms) or abstain from sexual intercourse until hormonal pills from a new pack have been taken for 7 days in a row. 

Yes.

Or abstain from sexual intercourse until one hormonal pill has been taken for 7 days in a row.

Consider using emergency contraception (except ella [ulipristal acetate]) if hormonal pills were missed during the first week of new pack and unprotected sexual intercourse occurred in the previous week.3,15,18

Emergency contraceptive may also be considered (with the exception of ella [ulipristal acetate]) at any other appropriate time.

Consult with a health care provider for more advice.

One or more  inactive (nonhormonal) pills

Throw away the missed, nonhormonal reminder pills.

Take the next reminder pill at the usual time.

No No

Table 1 References: 1, 2, 3, 4, 15, 18,19

Table 2. Missed Pill for Progestin-Only Pills

Progestin-only pills (POPs or the "mini-pill") are often recommended for women who are breastfeeding and women who cannot use the combined oral contraceptive pill (with estrogen and progestin) for medical reasons. You might find the progestin-only pills a little trickier to use than combined hormonal birth control pills because the progestin-only pill MUST be taken at the same time each day (no more than 3 hours late). 

Examples of progestin-only pills include: Camila, Deblitane, Errin, Heather, Incassia, JencyclaJolivette, LyzaNor-QD, Nora-BE, Norlyroc, Norlyda, Ortho Micronor, Sharobel, Slynd, Tulana.

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.

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

Missed pills When in cycle pills were missed Action required Is a 48-hour back-up contraceptive method (such as a condom, spermicide) needed?

Missed one or more pills by more than 3 hours.

If you start your pills more than five days from the onset of your period.

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).

If you had sex in the last 3 to 5 days, talk to your provider about emergency contraception (not including ella [ulipristal acetate]).

Yes, use a nonhormonal back-up method (such as condoms) every time you have sex for the next 48 hours (2 full days).

If you are not sure what to do about the pills you have missed, keep taking your POPs as scheduled and use a backup method until you can talk to your doctor or clinic.

Table 2 References: 5, 16, 17, 20

Table 3. Missed Pill for Extended-Cycle Birth Control Pills

More and more women are using extended-cycle pills to avoid the inconvenience of a monthly period. Extended-cycle packs have 84 active tablets and 7 inactive (or low-dose estrogen) tablets and result in only four periods per year. Taking low-dose estrogen in the last 7 pills helps to reduce side effects like bleeding and bloating linked with a hormone-free interval.10

The gradual increase in estrogen in Rivelsa may reduce breakthrough bleeding experienced during early cycles of extended-use pills compared with other extended-use pills.

It is important that you take your pill each day at the same time. 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.

Follow the directions in the table below if you miss one or more pills from an extended-cycle pack. If you are not sure which pills are active or inactive, or if your pill is not listed, review your patient package insert that comes with your prescription and ask your pharmacist or doctor. 

  • 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.

Examples of Extended-Cycle Birth Control Pills

Name ACTIVE pill color (84 tablets per pack) INACTIVE or low dose estrogen pill color (7 tablets per pack)
Amethia White Light blue
Amethia Lo Orange Yellow
Camrese Light blue-green Yellow
Camrese Lo Orange Yellow
Daysee Light blue Mustard (or yellow-colored)
Introvale Peach White
Jolessa Pink White
LoSeasonique Orange Yellow
Quartette, Rivelsa (generic for Quartette) Light pink (42 tabs), pink (21 tabs), purple (21 tabs) - the dose of estrogen gradually increases Yellow
Seasonique Light blue-green Yellow
Seasonale Pink White
Slynd White Green
Quasense White Peach

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

Number of active pills missed (see chart above to determine which pills are active or inactive) When in cycle pills were missed Action required Is a seven day back-up contraceptive method (such as a condom, spermicide) needed?
One active pill Days 1-84

Take one 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).

Continue taking one pill every day until you finish the pack.

No
Two active pills in a row Days 1-84

Take 2 (two) active pills on the day you remember. Then take 2 (two) active pills the next day.

Continue taking 1 (one) pill every day until you finish the pack.

Yes

You could become pregnant if you have sex in the 7 days after you miss two pills. You must use a back-up method (such as a condom) if you have sex during the first 7 days after you restart your pills.

Three or more active pills in a row Days 1-84

Do NOT take the missed pills.


Keep taking one 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 previously missed pills.

You may have some bleeding or spotting if you miss three pills in a row.

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. You must 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 pill or low dose estrogen pill. Days 85 to 91

Throw away the missed pills.

Keep taking scheduled pills until pack is finished.

No

Table 3 References: 6, 10, 21

Table 4. Continuous Cycle Birth Control Pill

A continuous cycle birth control pill is taken all year around, with no hormone-free intervals. All pills are active (with both estrogen and progestin), and there are no inactive (dummy) pills. Continuous cycle birth control allows a woman to skip her period completely. contains low doses of both progesterone and estrogen and is designed to be taken continuously for one year. There are no breaks for hormone-free intervals.

Amethyst is one brand name of a continuous cycle birth control pill. Amethyst is the same drug combination as Lybrel, which is no longer available on the U.S. market. If you are using another brand of continuous cycle birth control pill, refer to the package insert, or ask your doctor or pharmacist for the correct instructions if you miss a pill.

What to do if you miss a pill from Amethyst, a continuous-cycle birth control pill.

Number of missed pills (all pills are active) When during cycle pills were missed Action required Is a seven day back-up contraceptive method (such as a condom, spermicide) needed?
One pill missed Anytime

Take a pill as soon as remembered.

Then take one pill per day for the rest of the pack (which means you may take two pills in one day).

Yes.

You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a non-hormonal birth control method (such as condoms) as a back-up for those 7 days.

Two pills missed, 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.

You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a non-hormonal birth control method (such as condoms) as a back-up for those 7 days.

Two pills missed, 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.

You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a non-hormonal birth control method (such as condoms) as a back-up for those 7 days.

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.

You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a non-hormonal birth-control method (such as condoms) as a back-up for those 7 days.

Table 4 References: 7

IMPORTANT NOTE: If at any time you are not sure what to do when you have a missed a pill, use a back-up non-hormonal birth control (i.e., condom) EVERY time you have sex. Contact your healthcare provider for further advice.

Emergency contraceptives

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. Your healthcare provider may recommend that you use an emergency contraceptive.

You can use a levonorgestrel emergency contraceptive (EC) pill such as Plan B One Step, Next Choice One Dose, EContra EZ, or similar products for up to 72 hours (3 days) after unprotected sex, but it works better the sooner you take it, so do not delay.

  • These products are available over-the-counter (OTC) in the U.S., but speak to your pharmacist if you cannot find it on the shelves. In the U.S., these are available without age restrictions to women and men.
  • You can get EC pills ahead of time so that you always have them if needed. You can purchase them in advance.

ella (ulipristal) is an emergency contraceptive pill that may be used for up to 5 days after unprotected sex or a contraceptive failure, but it requires a prescription.

  • After use of ella, a reliable barrier method of contraception (such as a condom) should be used with sexual intercourse that occurs in that same menstrual cycle.
  • Ella is not intended for routine use as a contraceptive.

A copper intrauterine device (ParaGard) may also be used as an emergency contraceptive within 5 days of unprotected sex, but this requires a doctor visit for insertion.

  • A copper IUD can be expensive if you don't have insurance, but it can last for up to 10 years.13
  • Being overweight or obese may lower how well EC pills work to prevent pregnancy. If you are overweight or obese, you may want to consider having a copper IUD inserted. Copper IUDs are effective in women of any weight.21

Can I use birth control pills for emergency contraception?

If you take combined hormonal birth control pills that contain both an estrogen and progestin, and have no other options, higher doses of regular birth control pills can be used as an emergency contraceptive, taken as two doses 12 hours apart. However, the number of pills you would take will depend upon the brand you are taking.22 A doctor, clinic nurse, or pharmacist can tell you how many pills you should take based on the type and brand of oral birth control that you use. Call your healthcare provider as soon as possible.

On the days you take extra pills to make up for missed pills, you may feel a little sick to your stomach (nauseous), but this should go away.

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.

Learn MoreEmergency Contraception and the Morning After Pill

Birth control pill drug interactions

Ask your pharmacist for a drug interaction review each time you start a new medication or a new type of birth control. Certain medications may interfere with the absorption of your birth control pills, including:

  • barbiturates - used for anxiety, insomnia, and seizure disorders, but not frequently used today due to addiction and overdose potential
  • bosentan (Tracleer) - used to treat pulmonary arterial hypertension
  • carbamazepine (Carbatrol, Tegretol, Epitol) - a seizure medicine also used to treat bipolar disorder
  • felbamate (Felbatol) - a seizure medicine used in epilepsy
  • griseofulvin (Gris-Peg) - an antifungal medication
  • oxcarbazepine (Oxtellar XR, Trileptal) - a seizure medicine used in epilepsy
  • phenytoin (Dilantin, Phenytek) - a seizure medicine used in epilepsy
  • rifampin (Rifadin) - an antibiotic used to treat or prevent tuberculosis (TB)
  • St. John’s Wort - an herbal dietary supplement for depression or menopausal symptoms
  • topiramate (Topamax, Qudexy XR) - a seizure medicine used in epilepsy

Additional warnings

Birth control pills do not protect from sexually transmitted diseases (STD), such as HIV infection (AIDS) or gonorrhea. A condom should be used in addition to the birth control pill if STD protection is needed.1,2

If you have vomiting or diarrhea for any reason, your pills may not work as well because they may not be adequately absorbed into your bloodstream. Use a backup method (such as a condom) until you can contact your healthcare provider for more advice.

Cigarette smoking increases the risk of serious cardiovascular events (heart attack, stroke, blood clots, or developing high blood pressure) from combined oral contraceptive use. Women who are over 35 years old and smoke should not use combined oral contraceptives.

See Also

Sources

  1. Planned Parenthood Website. Birth Control Pill. Accessed March 6, 2020 at https://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  2. MedLine Plus. Birth control pills - Combination. Accessed March 6, 2020 at https://medlineplus.gov/ency/patientinstructions/000655.htm
  3. Princeton University. Office of Population Research. The Emergency Contraceptive Website. Updated Feb 22, 2019. When to Use Emergency Contraception. Accessed March 3, 2020. https://ec.princeton.edu/questions/missedocs.html
  4. Types of Birth Control Pills (Oral Contraceptives). Drugs.com. Accessed May 8, 2018 at https://www.drugs.com/article/birth-control-pill.html
  5. Ortho MicroNor Package Insert. Janssen Pharmaceuticals. Drugs.com. Accessed May 8, 2018 at https://www.drugs.com/mtm/ortho-micronor.html
  6. Introvale Package Insert. Sandoz Pharmaceuticals. DailyMed. Accessed May 8, 2018. https://www.drugs.com/mtm/introvale-extended-cycle.html
  7. Amethyst Package Insert. Actavis Pharma. Accessed March 6, 2020 at https://www.drugs.com/pro/amethyst.html#s-34076-0
  8. MedLine Plus. Birth control pills - progestin only. Accessed March 7, 2020 at https://medlineplus.gov/ency/patientinstructions/000656.htm
  9. ella (uliprostal). Product Labeling. Afaxys Pharma. Accessed March 6, 2020 at https://www.drugs.com/ella.html
  10. Delaying your period with birth control pills. Drugs.com. Accessed May 8, 2018 at https://www.drugs.com/mca/delaying-your-period-with-birth-control-pills
  11. Curtis K, Jatlaoui T, Tepper N, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1.
  12. Up to Date. Patient education: Hormonal methods of birth control (Beyond the Basics). Accessed February 22, 2020 at https://www.uptodate.com/contents/hormonal-methods-of-birth-control-beyond-the-basics
  13. Paragard Copper IUD. Product Information. Accessed February 23, 2020 at https://14wub23xi2gmhufxjmvfmt1d-wpengine.netdna-ssl.com/wp-content/uploads/2018/10/PARAGARD-PI.pdf
  14. FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended July 2019). Accessed February 23, 2020 at https://www.fsrh.org/documents/combined-hormonal-contraception/
  15. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. RR-4):1–66. Accessed February 23, 2020 at DOI: http://dx.doi.org/10.15585/mmwr.rr6504a1.
  16. Tulana Package Insert. Aurobindo Pharmaceuticals. Accessed February 23, 2020 at https://www.drugs.com/pro/tulana.html#s-34076-0
  17. Incassia Package Insert. Aurobindo Pharma Ltd. Accessed February 23, 2020 at https://www.drugs.com/pro/incassia.html#Section_16
  18. Allen R. Up to Date. Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use. Accessed March 6, 2020 at https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use
  19. Women'sHealth.gov. Birth control methods. Office on Women's Health. Accessed March 6, 2020 at https://www.womenshealth.gov/a-z-topics/birth-control-methods
  20. Kaunitz A. Up to Date. Progestin-only pills (POPs) for contraception. Accessed March 6, 2020 at https://www.uptodate.com/contents/progestin-only-pills-pops-for-contraception
  21. Emergency Contraception. American College of Obstetricians and Gynecologists (ACOG). Accessed March 6, 2020 at https://www.acog.org/Patients/FAQs/Emergency-Contraception#possible
  22. Princeton University. Office of Population Research. The Emergency Contraceptive Website. Types of Emergency Contraception. Updated Feb. 22, 2019. Accessed March 6, 2020 at https://ec.princeton.edu/questions/dose.html

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.