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

Medically reviewed on May 8, 2018 by L. Anderson, PharmD

What Should I Do if I Miss Taking One or More Birth Control Pills?

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?

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% to 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 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 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.

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 reliable back-up barrier method of birth control (i.e., a condom/spermicide) each time you have sex. Keep taking 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 Amethyst continuous-cycle birth control pill. 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/spermicide) 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 a levonorgestrel emergency contraceptive pill such as Plan B One Step, Next Choice One Dose, 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.
  • ella (ulipristal) is an emergency contraceptive pill that may be used for up to 5 days after unprotected sex, but it requires a prescription. After use of ella, a reliable barrier method of contraception should be used with sexual intercourse that occurs in that same menstrual cycle.9
  • A copper intrauterine device may also be used as an emergency contraceptive within 5 days of unprotected sex, but this requires a doctor visit for insertion.
  • If you take combined hormonal birth control pills that contain both estrogen and progestin, and have no other options, higher doses can be used as an emergency contraceptive, taken as two doses 12 hours apart. The number of pills you would take will depend upon the brand you are taking. 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.
  • 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 review each time you start a new medication.
  • Birth control pills do not protect from sexually transmitted diseases (STD), such as HIV/AIDS, and a condom should be used in addition to the birth control pill if STD protection is needed.1,2

Learn MoreTypes of Birth Control Pills (Oral Contraceptives)

Missed Pill for Combined Hormonal Birth Control Pills

What do you do if you miss one or more pills from your combination pill pack?2,3,4

(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.)

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 need to 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 (more than 48 hours late)

-Take the last pill you missed right away (which means you may take need to 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 5 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 or inactive) pills

-Throw away the missed reminder pills

-Take the next reminder pill at the usual time

No No

Missed Pill for Progestin-Only Pills (the Mini-Pill)

Progestin-only pills are often recommended for women who are breastfeeding and women who cannot use the combined oral contraceptive pill 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, Errin, Heather, JencyclaJolivette, LyzaNor-QD, Nora-BE, Ortho Micronor

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 5

Number of missed pills (by more than 3 hours) When in cycle pills were missed Action required Is a 48-hour back-up contraceptive method (i.e., condom/spermicides) needed?
One 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, consider asking your provider for emergency contraception.

Yes

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 ethinyl estradiol) tablets and allow for 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

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 your pill is not listed, check with your doctor or pharmacist.

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 that comes with your prescription and ask your pharmacist or doctor.

Examples of Extended-Cycle Birth Control Pills

Name ACTIVE pill color (84 tablets per pack) INACTIVE or low dose ethinyl estradiol 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 Yellow
Introvale Peach White
Jolessa Pink White
LoSeasonique Orange Yellow
Quartette, Rivelsa Light pink (42 tabs), pink (21 tabs), purple (21 tabs) 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 contraceptive method (i.e., condom/spermicide) 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 previously 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 or low dose ethinyl estradiol Days 85-91 -Throw away the missed pills
-Keep taking scheduled pills until pack is finished.
No

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, and there no inactive (dummy) pills. Continuous cycle birth control allows a woman to skip her period completely.

Amethyst is one example 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 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.7

Number of missed pills (all pills are active) When in cycle pills were missed Action required Seven day back-up contraceptive method (i.e., condom/spermicide) needed?
One missed pill 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 nonhormonal birth-control method (such as condoms and/or spermicide) as a back-up for those 7 days.
Two missed 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. You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a nonhormonal birth-control method (such as condoms and/or spermicide) as a back-up for those 7 days.
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. You could become pregnant if you have sex during the 7 days after you restart your pills. You MUST use a nonhormonal birth-control method (such as condoms and/or spermicide) 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; continue nonhormonal back-up method (i.e., condom/spermicide) for at least 7 days or until your healthcare provider advises that you no longer need to use a back-up method.

Learn More: Emergency Contraception and the Morning After Pill

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/spermicide) EVERY time you have sex. Contact your healthcare provider for further advice.

See Also

Sources

  1. Planned Parenthood Website. Birth Control Pill. Accessed May 9, 2018 at https://www.plannedparenthood.org/learn/birth-control/birth-control-pill
  2. MedLine Plus. Birth control pills - Combination. Accessed May 8, 2018 at https://medlineplus.gov/ency/patientinstructions/000655.htm
  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. 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 April 30, 2018 at https://www.drugs.com/pro/amethyst.html#s-34076-0
  8. MedLine Plus. Birth control pills - progestin only. Accessed May 9, 2018 at https://medlineplus.gov/ency/patientinstructions/000656.htm
  9. ella (uliprostal). Product Labeling. Afaxys Pharma. 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

Further information

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

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