I Missed a Birth Control Pill (or Two). What Should I Do?

I take birth control pills. I took an active white pill two days ago. I accidentally skipped a pill yesterday. Is that OK? How should I proceed?

-Beach Girl

We often get questions at HealthCentral from people who have accidentally taken their birth control pills incorrectly; luckily, there are guidelines to help you get back on track and stay protected.

Birth control pills are packaged for you to take one pill each day for either 21 or 28 days in a row. The two main types of pills are:

  1. Combination pills: These pills contain both estrogen and progestin, are the most common type of birth control pills used, according to Planned Parenthood. You take pills containing these hormones for 21 days. In 28-day packages, there are seven inactive, or placebo, pills which do not have any hormones. These are included to help you stay in the habit of taking a daily pill and to remind you when to start the next packet.

  2. Progestin-only pills: These pills come in packages of 28 pills. Each pill contains hormones, and you must take these pills within a three-hour window each day; for example, if you take it at 7 a.m. one day, you have until 10 a.m. the next day to take the next pill to remain protected from unintended pregnancy. When taking progestin-only pills, there is no break between cycles. You continue taking one pill every day.

To maintain consistent protection from pregnancy, it is important to take your birth control pills as directed. But, sometimes, you might forget to take a pill (or two) or start your pack late. What you should do when that happens depends on what type of pill you use (combination or progestin-only) and when during the month you missed the pill.

What to do if you skip combination pills

If you miss 1 pill

If you missed one pill or are late starting your package by one day, you should take the missed pill as soon as you realize you forgot it, even if that means taking two pills in one day. You can then continue to take the remaining pills according to your original schedule. When one pill is missed, you should not need to use backup birth control or take emergency contraception (EC). However, you might consider using EC if your missed pill was either very early in the cycle or within the last week of the previous cycle, according to the Centers for Disease Control and Prevention (CDC).

If you miss 2 pills

If you missed two pills in a row, you should take one pill as soon as you realize you have missed one, even if that means taking two pills in one day. You should discard the second missed pill. Then, continue taking the remainder of the pills on your regular schedule.

If you missed two pills in the third week of hormonal pills (days 15 through 21), the CDC suggests that you continue taking the remainder of the pills but that you skip the inactive pills or the week in between pill packages and immediately start the next cycle of pills.

If you have gone 48 hours without taking a pill, you should abstain from intercourse or use a backup birth control method until you have taken a pill for seven days in a row. You might consider using EC if the pills you missed were in the beginning of the cycle and you had unprotected sex.

The risk of an unintended pregnancy is greatest if you miss pills in the beginning of the pack (starting your pack late) or at the end of the active pills, according to the University of California - Davis. Missing inactive pills will not cause any problems. If you missed these pills, you can safely discard them and skip the day without taking any additional precautions.

What to do if you skip progestin-only pills

When you miss a progestin-only birth control pill, you should take the missed pill as soon as you realize you missed it. Then you should continue taking your pills as directed.

If you take progestin-only pills and you get menstrual periods, you should abstain from intercourse or use backup contraception for the next two days. You might consider EC if you have had unprotected sex in the five days prior to missing a pill, according to Cornell University Health.

How will missing pills affect your period?

Sometimes, missing a pill or two can cause your period to start early, or it may cause you to spot or be lightre than usual, according to Planned Parenthood. Regardless of these menstrual changes, it's important to follow the guidelines above to ensure you stay protected against pregnancy. When you miss pills, it's normal for your period to be thrown off for the next month or so, but once you get back on track, things should return to normal.

Other options

If you routinely miss taking birth control pills, you may want to talk to your medical provider about other methods of birth control that do not require you to remember taking pills each day, such as the IUD or vaginal ring. Additionally, Planned Parenthood offers a missed pill tool that allows you to answer questions regarding your prescription, when you missed the pill, and how many pills you have missed and then provides you with information on what you should do.

If you have a question for our HealthCentral experts, please submit here.

You should know: The answer above provides general health information that is not intended to replace medical advice or treatment recommendations from a qualified healthcare professional.

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