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June 28, 2018

What to Do When You’ve Missed Your Birth Control Pill...again!

(Illustration by Katherine Killeffer)

"Oh, crap.” That moment when you remember you missed your date with your trustworthy little pal, the pill. You were running late, had a million things to do, or it simply just slipped your mind. We get it. We’ve all been there. Luckily, there is no need to panic. If you’re wondering what you can do, we’ve got you covered. Don’t worry, there’s no need to cancel your Friday night plans. Put your mind at ease and follow these few simple steps.

If you are taking a combination pill (estrogen and progestin):

And you missed one pill:

Take the pill as soon as you remember, even if this means taking two in one day. It is not the end of the world, and according to the Center for Disease Control (CDC) recommendations, a backup method is not necessary. For combination pills, “missed” means you were 24+ hours late taking the pill.

If you missed two or more pills:

Maybe you’ve been having a really rough week and missed two pills in a row. No judgements, that’s what we are here for. First, take a second to breathe. Are you good? Okay, now here’s what you need to do:

  1. Take two pills the day you remember.
  2. Discard the other pill that was missed. Take two pills the next day as well. You will be back on track then.
  3. Use a backup method, such as a condom, for the next week.
  4. If the two pills you missed were in the last week of your hormonal pills, then skip the placebo week of pills. Depending on your prescription, you should either start a new pack that same day, or finish your last hormone week and start a new pack the next day.
  5. If you are taking monophasic, continuous pills you should continue the active hormone pills and use a backup method for 7 days.
  6. If you are taking triphasic pills, you should throw away your current pack and start new pack. You should also use a backup method for 7 days.
  7. If you are taking pills cyclically (taking placebo pills), you should use a backup method for 7 days and start new pack within 7 days.

If you missed three or more pills:

Once you forget one, it’s easy to fall off track — sometimes three or more days go by before you realize that you’ve forgotten your pills! But, don’t fret! Follow these steps:

  1. Take two pills the day you remember.
  2. Discard any other missed pills.
  3. Use a backup method, such as a condom, for the next week.

If your pill ran away and you can’t get it back:

Those little suckers can be so devious. You’re going about your usual morning or bedtime routine, when all of a sudden, your pill scurries away and down the drain. There are a few solutions to even this horror.

  1. Take your pill for the next day now and you will just be one pill ahead in the cycle. If you choose this option remember to start your next pack one day early.
  2. Keep an extra pack around in case this terrible luck ever happens again.
  3. Call your doctor and explain the situation.

If you are on progestin-only pills (mini pills):

If you are 3 or more hours late taking your pill, use a backup method until you’ve taken your pill on time for at least two consecutive days.

If and when to use emergency contraception:

Life doesn’t always go as planned. If you missed a few pills and did not use a backup method, emergency contraception can help minimize your risk of pregnancy. You may want to consider this option if:

  1. You missed any number of pills during the first week AND you had unprotected sex in the placebo interval or in the first week of hormonal pills.
  2. You missed two or more pills in the second week AND you had unprotected sex.

A few things to keep in mind:

  1. Although uncommon, taking two pills in one day may cause nausea in some women.
  2. You may experience some light bleeding or spotting from missing a pill.
  3. Missing a few random pills throughout the month is not the same as missing pills consecutively. However, if you are struggling to remember you may want to speak with your physician about an alternative method.
  4. Be careful if you miss pills at the very beginning or end of your pack, which might increase your risk of ovulation. If you miss the first or last active tablet, consider using a backup method, such as a condom, for the next week.

As always, if you have questions you can always consult some of the below sources and the instruction set that came with your pill pack. You know, the one that could probably be mistaken for a blanket it is so large.

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Sources:

  1. Center for Disease Control and Prevention
  2. Faculty of Sexual and Reproductive Healthcare
  3. U.S. Selected Practice Recommendations for Contraceptive Use, 2016 | MMWR