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

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 4, 2024.

Overview | Effectiveness | What to do if I miss a pill? | Emergency contraceptive | Warnings

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?

There are many different types of birth control pills today with different instructions. If you miss one or more pills, it's best to view the specific instructions in your product information, or call your heath care provider or pharmacist. You can also view your specific birth control package insert here. Look for the section in your patient package insert that addresses what to do for missed pills.

Overview

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, norgestimate or drospirenone are examples of progestins found in COCs. Pills with only a progestin, like norethindrone, are called progestin-only pills (POP) or "mini-pills".

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.11

If you did not take a COC 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. If you miss more than two pills, you should also use a backup method of birth control (like condoms or other barrier method) each time you have sex for seven days in a row.11 If you do not get your period when you expect it to occur, take a pregnancy test and contact your doctor or clinic.1

Consider emergency contraception (EC) if you have had sex since you missed your pill. Although the manufacturers state that over-the-counter (OTC) EC pills should be used for up to 72 hours after unprotected sex, many guidelines and Planned Parenthood state they are effective up until 5 days, but effectiveness may decline over this time. The sooner you take EC, the better it works. You can get EC from a clinic or drugstore.1

Be sure you have another kind of non-hormonal birth control (such as condoms or other barrier method) ready at all times, to use as a back-up in case you miss pills. You might also consider buying EC ahead-of-time to have in case you need it.1

See Tables 1-3 and further information below if you take progestin-only pills (the "mini-pill"), an extended cycle or continuous cycle pill, or need an emergency contraceptive.

Missed Birth Control

How effective is the pill?

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) even if it's taken perfectly every day as directed. 

In the real world, the average effectiveness of the pill is about 93% (7 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 to work best. 

Your chances for getting pregnant if you missed a pill depends upon when you missed your pill during your ovulation 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 and 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:

Certain drug interactions can also lower the effectiveness of the pill. Always double check for any interactions with your pharmacist or doctor. Tell them about all of the medicines you use, including prescription, over-the-counter (OTC), herbal supplements or vitamins.

What should I do if I keep forgetting my pill?

Forgetting to take 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.

If you find that you frequently forget to take your pill, it may be better off using another form of birth control (such as an IUD, implant, shot, vaginal ring or patch). Speak to your healthcare provider about other available birth control options that do not require a daily schedule for you to remember.

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. The directions below are for general use from clinical guidelines and may not apply specifically to your pill.

Always use a condom (or other barrier method) to protect against sexually transmitted infections (STIs) each time you have sex.

Important Note: If you take Natazia (dienogest and estradiol) and you have missed any 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 (estrogen + progestin)

Number of missed pills Action required Is a seven day back-up contraceptive method (such as a condom or other barrier method needed?) Emergency contraceptive needed? (i.e., Plan B One Step)
One hormonal pill (more than 24 hours and up to 48 hours late)1,11

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.

Not usually. 

But if it's been longer than 48 hours since you last took a pill you need to use a non-hormonal back-up method (like a condom or other barrier method) for 7 days in a row also.

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 pills from the pharmacy or health clinic. Go to the clinic for other options like the copper IUD.1

Do not use ella (generic name: ulipristal acetate) as an EC because the active ingredient in ella may counteract the progestin in oral contraceptives.

Talk to your health care provider or pharmacist for more advice.
Two or more hormonal pills missed in a row (more than 48 hours late)11,18

Take the last pill you missed right away. Continue taking the rest of your pills at your normal time, even if it means taking two pills on the same day.

Use a back-up birth control, such as a condom or other barrier method, or do not have sex until you have taken a pill for seven days in a row.

If 2 or more pills are missed in the third week (pills 15-21 of a 28-day pack), start a new pack the next day.

If you are not able to start a new pack right away, use back-up nonhormonal birth control (like a condom or other barrier method) or avoid sex until hormone pills from a new pack have been taken for 7 days in a row.11,18

Yes.

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

Consider using emergency contraception (EC) if hormonal pills were missed during the first week of new pack and unprotected sexual intercourse occurred in the previous week.11,18

Emergency contraceptive may also be considered at any other appropriate time.

Do not use ella (generic name: ulipristal acetate) as an EC because the active ingredient in ella may counteract the progestin in oral contraceptives.

Talk to your health care provider or pharmacist for more advice.
One or more inactive (nonhormonal) reminder pill

Throw away the missed, nonhormonal reminder pill.

Take the next reminder pill at the usual time.

 No No

Table 1 References: 1,2,3,11,13, 15,18,19,24

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 both 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). 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 with norethindrone include: Camila, Errin, Heather, Jencycla, and Lyza.

In July 2023 the U.S. Food and Drug Administration approved Opill, the first nonprescription, over-the-counter (OTC) birth control pill (oral contraceptive). Opill, a progestin-only ("mini") pill, is available online, on pharmacy shelves and at other retailers in March of 2024.

Learn more: What is Opill, where can I get it and how much does it cost?  

Important Note: Slynd is a a newer type of progestin-only pill (POP) that contains drospirenone instead or norethindrone. It's effective for up to 24 hours in the event of a delayed or missed pill. However, it's always best to take your pill at the same time each day to help you stay on track. View instructions here on what to do if you miss one or more pills from your Slynd packet.

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 or other barrier method) 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.19

For Slynd, see package insert directions for missed pill.

 Anytime

Take a pill as soon as you remember you missed it.

Take the next pill at the usual time (which means you may take two pills in one day).

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

If you have or had unprotected sex during the 48 hours you were supposed to use a back-up contraceptive method (like a condom or other barrier method), talk to your provider about emergency contraception (EC).

Do not use ella (generic name: ulipristal acetate) as an EC because the active ingredient in ella may counteract the progestin in oral contraceptives.

Talk to your healthcare provider or pharmacist for more advice.

 

Table 2 References: 1,5,16,19,20

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 (13 weeks) 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.18

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 color pills are active and which pills are inactive in your pack. 

Follow the directions in the product label of your birth control if you miss one or more pills from an extended-cycle pack. If you are not sure which pills are active or inactive, review your patient package insert that comes with your prescription and ask your pharmacist or doctor.

Examples of extended-cycle birth control pills include: Amethia, Amethia Lo, Camrese, Daysee, Introvale, Jolessa, LoSeasonique, Quartette, Rivelsa, Seasonique, and Seasonale.

Continuous Cycle Birth Control Pill

A continuous cycle birth control pill is taken every day, year around, with no hormone-free intervals. Continuous cycle birth control allows a woman to skip her period completely. There are no breaks for hormone-free intervals.

All 28 pills in the pack are active (with both low-dose estrogen and progestin). There are no inactive (reminder) pills. 

Amethyst is the only continuous cycle birth control pill available in the U.S. If you are using any other 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.

Table 3. What to do if you miss a pill from Amethyst?

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 or other barrier method) 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 or other barrier method) as a back-up method 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 or other barrier method) 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 or other barrier method) 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 or other barrier method) as a back-up for those 7 days.

Table 4 References: 6

IMPORTANT NOTE: 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 or other barrier method) EVERY time you have sex. Contact your healthcare provider for further advice.

Emergency contraceptives

If you have missed a pill and had unprotected sex, your healthcare provider may recommend that you use an emergency contraceptive. There is still a chance you could become pregnant even if you follow the instructions exactly. 

You can use a levonorgestrel emergency contraceptive (EC) pill such as Plan B One Step, Next Choice One Dose, My Way, 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. EC is not intended to be used a routine form of birth control

Although the manufacturers state that EC pills should be used for up to 72 hours after unprotected sex, many guidelines and Planned Parenthood state they are effective up until 5 days, but effectiveness may decline over this time. The sooner you take EC, the better it works.

Do not use ella (generic name: ulipristal acetate) as an EC because the active ingredient in ella may counteract the progestin in oral contraceptives.

Where do I get emergency contraceptives?

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 purchase over-the-counter (OTC) EC pills ahead of time so that you always have them if needed. Search for available EC here and talk to your pharmacist about available options.

Does ella require a prescription?

Yes, ella (ulipristal) is a prescription emergency contraceptive pill that may be used for up to 5 days after unprotected sex or a contraceptive failure. Con tact your doctor for a prescription.

Certain intrauterine devices (IUD) may also be used as an emergency contraceptive, but this requires a doctor visit for insertion. Intrauterine devices (IUDs) are the most effective EC method.

Being overweight or obese may lower how well EC pills work to prevent pregnancy, although recent studies suggest weight may not be a factor.21 If you are overweight or obese, you may want to consider having an IUD inserted. IUDs for EC are very effective in women of any weight.21 Talk to your doctor about your best option.

The copper IUD (Paragard) can be expensive if you don't have insurance, but it can last for up to 10 years.13,21 It should be inserted within 5 days of unprotected sex.

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 bit sick to your stomach, but this should go away.

Learn More: Emergency Contraception and the Morning After Pill

Additional warnings

Birth control pills do not protect from sexually transmitted infections (STI), such as HIV (AIDS) or gonorrhea. A condom or other barrier method should be used in addition to the birth control pill if protection from sexually transmitted infections (STIs) 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 nonhormonal backup method (such as a condom or other barrier method) 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.

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.

This is not all the information you need to know about birth control for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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. Types of Birth Control Pills (Oral Contraceptives). Drugs.com. Accessed May 8, 2018 at https://www.drugs.com/article/birth-control-pill.html
  4. Ortho MicroNor Package Insert. Janssen Pharmaceuticals. Drugs.com. Accessed May 8, 2018.
  5. Introvale Package Insert. Sandoz Pharmaceuticals. DailyMed. Accessed May 8, 2018. https://www.drugs.com/mtm/introvale-extended-cycle.html
  6. Amethyst Package Insert. Actavis Pharma. Accessed Sept. 13, 2022 at https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=a7e19182-57b5-4783-9c7f-bb83961f1803&type=display
  7. MedLine Plus. Birth control pills - progestin only. Accessed March 7, 2020 at https://medlineplus.gov/ency/patientinstructions/000656.htm
  8. ella (uliprostal). Product Labeling. Afaxys Pharma. Accessed March 6, 2020 at https://www.drugs.com/ella.html
  9. Delaying your period with birth control pills. Drugs.com. Accessed May 8, 2018 at drugs.com/mca/delaying-your-period-with-birth-control-pills
  10. 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. DOI: http://dx.doi.org/10.15585/mmwr.rr6504a1
  11. Kaunitz A (author). Up to Date. Patient education: Hormonal methods of birth control (Beyond the Basics). Accessed Feb. 16, 2024 at https://www.uptodate.com/contents/hormonal-methods-of-birth-control-beyond-the-basics
  12. Paragard Copper IUD. Product Information. Accessed February 23, 2020 at https://14wub23xi2gmhufxjmvfmt1d-wpengine.netdna-ssl.com/wp-content/uploads/2018/10/PARAGARD-PI.pdf
  13. FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception. BMJ Sexual and Reproductive Health. Accessed Feb 16, 2023 at https://doi.org/10.1136/bmjsrh-2018-CHC
  14. 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.
  15. Tulana Package Insert. Aurobindo Pharmaceuticals. Accessed February 23, 2020 at https://www.drugs.com/pro/tulana.html#s-34076-0
  16. Incassia Package Insert. Aurobindo Pharma Ltd. Accessed February 23, 2020 at https://www.drugs.com/pro/incassia.html#Section_16
  17. 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
  18. Women'sHealth.gov. Birth control methods. Office on Women's Health. Last updated Dec. 29, 2022. Accessed Feb 16, 2024 at https://www.womenshealth.gov/a-z-topics/birth-control-methods
  19. Kaunitz A (author). Up to Date. Contraception: Progestin-only pills (POPs). Accessed Feb 16, 2024 at https://www.uptodate.com/contents/contraception-progestin-only-pills-pops
  20. Emergency Contraception. American College of Obstetricians and Gynecologists (ACOG). Accessed March 6, 2020 at https://www.acog.org/Patients/FAQs/Emergency-Contraception#possible
  21. Turok D (author). Emergency contraception. Up to Date. Accessed Sept. 13, 2022 at https://www.uptodate.com/contents/emergency-contraception
  22. How to use birth control pills for emergency contraception. Table. Up to Date. Accessed Sept. 13, 2022 at https://www.uptodate.com/
  23. Mirena. Product information. Drugs.com. Accessed Mar 27, 2023 at https://www.drugs.com/mirena.html
  24. Missed a birth control pill? Here's what to do. Cornell Health. Updated 11/2022. Accessed Feb. 16, 2024 at https://health.cornell.edu/sites/health/files/pdf-library/missed-birth-control-pill.pdf

Further information

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