What should I do if I miss a birth control pill?

Managing Missed Birth Control Pills

If you miss a birth control pill, take the missed pill as soon as possible and continue with your regular schedule, with specific additional actions based on how many pills were missed and when in your cycle they were missed. 1

Management Protocol for Missed Combined Hormonal Contraceptive Pills

For One Missed Pill (Less Than 48 Hours Late)

• Take the missed pill as soon as you remember
• Continue taking remaining pills at the usual time (may require taking two pills on the same day)
• No backup contraception needed
• Emergency contraception generally not required 1

For Two or More Missed Pills (48 Hours or More Late)

• Take the most recent missed pill immediately
• Discard other missed pills
• Continue taking remaining pills at the usual time
• Use backup contraception for 7 consecutive days
• Consider emergency contraception if pills were missed in the first week of the pack and you had unprotected intercourse in the past 5 days 1

Special Consideration for Week 3 Missed Pills

• If pills are missed during the last week of active pills (days 15-21 of a 28-day pack):
  • Finish the active pills in your current pack
  • Skip the placebo/inactive pills
  • Start a new pack immediately
  • Use backup contraception for 7 consecutive days 1

Management for Progestin-Only Pills (Mini-Pills)

• If taken more than 3 hours late (more than 27 hours since last dose):
  • Take one pill as soon as possible
  • Continue taking pills at the usual time
  • Use backup contraception for 2 consecutive days
  • Consider emergency contraception if you had recent unprotected intercourse 1

Emergency Contraception Options

• Consider emergency contraception especially if:
  • Pills were missed during the first week of the cycle
  • Unprotected intercourse occurred in the previous 5 days 1
• Options include:
  • Ulipristal (Ella) - more effective than levonorgestrel after 72 hours and for women who are overweight or obese
  • Levonorgestrel formulations (Plan B)
  • Copper IUD (most effective option, can be inserted up to 5 days after unprotected intercourse) 1

Common Pitfalls and How to Avoid Them

Misunderstanding Instructions

• Research shows that women have more difficulty understanding what to do after missing 2 or 3 pills compared to missing just 1 pill 2
• Many women struggle with complex instructions in package inserts 2
• Consider using graphic-based instructions rather than text-only instructions for better comprehension 2

Inconsistent Use

• Missing 1-3 pills per cycle is common among 15-51% of users, particularly adolescents 3
• Risk factors include:
  • Younger age
  • Difficulty establishing a routine
  • Pill unavailability
  • Side effects
  • Loss of motivation 3

Delayed Restart After Emergency Contraception

• If using ulipristal acetate (UPA) for emergency contraception after missed pills, restart your birth control pills immediately rather than waiting 5 days
• Research shows that immediate restart significantly reduces the risk of ovulation compared to delayed restart (0% vs 17.4% risk) 4

Prevention Strategies

• Set a daily alarm or use a smartphone app as a reminder
• Keep pills in a visible location tied to a daily routine (e.g., next to toothbrush)
• Consider alternative contraceptive methods that don't require daily adherence, such as:
  • Long-acting reversible contraceptives (IUDs, implants) with <1% failure rate
  • Injectable contraception with 0.3-6% failure rate 5
• For women who prefer oral contraceptives, continuous or extended cycle regimens may reduce risks associated with missed pills 3

Remember that combined hormonal contraceptives are completely reversible with no negative effect on long-term fertility, and use for more than 3 years provides significant protection against endometrial and ovarian cancers 5.