Resuming Combined Oral Contraceptives After Missing Two Days
Take the most recent missed pill immediately, discard the other missed pill, continue the remaining pills at the usual time (even if taking two pills on the same day), and use backup contraception (condoms) or avoid intercourse for 7 consecutive days. 1
Immediate Actions
- Take one pill as soon as possible – specifically the most recent missed pill, and discard any other missed pills 1, 2
- Continue the pill pack at the regular time, which may mean taking two pills on the same day 1, 2
- Start backup contraception immediately – use condoms or abstain from intercourse for the next 7 consecutive days after resuming pills 1, 2
Special Timing Considerations
If Pills Were Missed in Week 3 (Days 15-21 of a 28-Day Pack)
- Skip the hormone-free interval entirely – finish the current pack and start a new pack the next day without taking the placebo pills 1
- If unable to start a new pack immediately, use backup contraception until hormonal pills from a new pack have been taken for 7 consecutive days 1
If Pills Were Missed in Week 1 (Days 1-7)
- Consider emergency contraception if unprotected intercourse occurred in the previous 5 days 1, 2
- The copper IUD is the most effective emergency contraception option 2
- Ulipristal acetate (Ella) may be more effective than levonorgestrel formulations, especially after 72 hours and in women who are overweight or obese 2
Why the 7-Day Rule Matters
The risk for ovulation increases significantly when two or more consecutive pills are missed (≥48 hours since a pill should have been taken) 1. Studies show that missing pills adjacent to the hormone-free interval poses the highest risk because the ovaries have already had 7 days without hormonal suppression 3. The 7-day backup period allows sufficient time for the resumed pills to re-establish ovarian suppression 1.
Regarding Other Medications
You can start other (non-contraceptive) medications immediately – there is no need to delay other treatments while resuming birth control pills. The backup contraception requirement applies only to pregnancy prevention, not to drug interactions with other medications you may need to start.
Critical Pitfall to Avoid
Do not assume you are protected during the first 7 days after resuming pills – this is the most common cause of contraceptive failure after missed pills 2. Inconsistent use and failure to use backup contraception significantly increases pregnancy risk 2.
Consider Long-Acting Alternatives
If you frequently miss pills, consider switching to a less user-dependent method such as an IUD, contraceptive implant, or injectable contraception, which have higher continuation rates and effectiveness 2.
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