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

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 13, 2022.

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.

• 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 if you take progestin-only pills.
• You can also view your specific birth control package insert here.
• Be sure you have another kind of non-hormonal birth control (such as condoms and spermicides) ready at all times, to use as a back-up in case you miss pills.

If you find that you frequently forget to take your pill, it may be better to use 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.

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.

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) 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 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
• 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.

What are my options if I miss my pill?

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 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 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 Contraceptive (estrogen + progestin)

^{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 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).

Examples of progestin-only pills include: Camila, Deblitane, Errin, Heather, Incassia, Jencycla, Jolivette, Lyza, Nor-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.

Important Note: Slynd (drospirenone, 4 mg) has contraceptive efficacy for up to 24 hours in the event of a delayed or missed pill, but it's best if you 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

^{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

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 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

• Amethia
• Amethia Lo
• Camrese
• Camrese Lo
• Daysee
• Introvale
• Jolessa
• LoSeasonique
• Quartette
• Rivelsa (generic version of Quartette)
• Seasonique
• Seasonale
• Slynd
• Quasense

^{Table 4 References: 6,7}

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 and spermicide) 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.⁹
• Ella is not intended for routine use as a contraceptive.

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.
• Other IUD options for emergency contraception are the levonorgestrel (LNG) 52 mg IUD (brand names: Mirena, Liletta), which can also be left in for long-term contraception.²¹ Mirena can be left in for up to 7 years; Lilletta can left in for up to 6 years).

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 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.

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 emergency contraception 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

• Birth Control Pills
• Birth Control Pills - Periods
• Birth Control Pills and Breakthrough Bleeding
• Birth Control Pills: Benefits, Risks and Side Effects
• Emergency Contraception
• Emergency Contraceptives Available in the U.S.
• Grapefruit and Birth Control Pills: Your Questions Answered
• Hormonal Birth Control (Non-Pill Options)
• Non-hormonal Birth Control
• Permanent Birth Control

Further information

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

Medical Disclaimer