What to do when you miss a birth control pill

Many folks are familiar with the rush of dread that comes after the realization that you’ve missed a birth control pill. If that’s you right now–take a deep breath. Almost everyone forgets to take a pill sometimes. Here’s what you need to know to protect yourself from becoming pregnant after missing a pill.

Combination birth control pills vs. progesterone only birth control

To determine the best course of action after missing a pill, it’s important to understand the key differences between combination pills and progestin-only pills (commonly referred to as “mini pills”). Here’s a quick breakdown of each type of oral contraceptive birth control. 

Combination birth control pills (the most popular form of oral contraceptives) contain both estrogen and progestin, which work together to prevent ovulation and make it harder for sperm to reach the uterus. They are typically taken in a 21 or 28 day cycle with a week of hormone-free pills. Combination pills don’t have to be taken exactly at the same time every day, but it’s a good idea to stick to a routine so you don’t miss a dose.

Progesterone only pills, also known as mini pills, don’t contain any estrogen. They rely solely on progestin to thicken cervical mucus and thin the uterine lining, which also prevents ovulation in some users. Most mini pills must be taken at the same time every day, and if a missed dose happens when you’re late by three hours or more. 

Can you get pregnant after you miss a pill?

Missing a birth control pill can increase your risk of pregnancy, but the level of risk depends on several factors:

• How many pills did you miss?
• When did you miss them? 
• What type of pill do you take?

If you take your combination pill every day and take a missed pill within 24 hours of missing it, the steady flow of hormones that keeps you protected from pregnancy is not disrupted. However, a backup method of contraception, like condoms, is still recommended for seven days after missing more than one pill. Missing a mini pill is a different story–missing one pill or taking one more than three hours late does increase your risk of becoming pregnant, and you are more likely to become pregnant if you miss a pill at the beginning or end of the pack. Again, you should use a backup method of contraception for at least seven days.

What should I do if I miss a pill?

Speaking of backup methods, the correct course of action after missing a pill depends on whether you take the combination pill or mini pill and how many pills you missed. Here’s what to do after you miss a pill.

Combination pill

If you missed one pill, take the missed pill as soon as you remember, then take the remaining pills on your regular schedule. This may mean taking two pills in one day–that’s okay. While backup methods of contraception may not be needed after missing one combination pill, it’s not a bad idea to double up on protection with a condom for the next seven days (especially if you missed any other pills from the same pack).

If you missed two pills in a row, take the second missed pill as soon as you remember. Take the next pill on your regular schedule (do not take three pills in one day–the first of the two missed pills will not be taken). Double up with a backup method of contraception, like condoms, for the next seven days. If you had unprotected sex in the previous five days, consider taking emergency contraception. You can get emergency contraception from a pharmacy without a prescription in certain states, or from a healthcare provider, like Hey Jane.

If you missed three or more pills in a row, you are not protected against unplanned pregnancy. You have a few options to get back on track: You can either toss the current pill pack, begin a new pack immediately, and use a backup form of birth control for seven days, or start a new pack of pills the Sunday after your missed pills and use a backup form of birth control for 14 days.

If you miss a placebo pill (the differently colored pills at the end of the pack), don’t worry. These pills contain no hormones and have no impact on protection against unplanned pregnancy.

If you miss three or more pills in a row, you might also get your period early or have some breakthrough bleeding. While the unexpected bleeding can be annoying, it’s okay and expected. Just keep taking your pill every day to get back on track.

Mini pill

Mini pills are time sensitive and should be taken at the exact same time every day. If you take a progestin-only pill more than three hours late, it’s considered “missed,” and you’re at risk for unwanted pregnancy. Take the missed pill as soon as you remember, even if that means taking two pills in one day, then take the rest of your pills on your regular schedule. Use a backup method of birth control, like condoms, for one week. More than 3 hours late is considered a missed dose, so if you miss more than one dose of your mini pill- to be safe you should assume you could get pregnant and use a back up method for a week.

What are the side effects of missing a pill?

When you miss only one birth control pill, you probably won’t notice any side effects! However, your hormone levels may fluctuate—especially when missing multiple pills in a row. This can lead to several potential side effects. However, the most common side effects of missing a pill are cramping and spotting (light bleeding). Here are some potential side effects of missing a birth control pill:

• Spotting or light bleeding: You may experience breakthrough bleeding or spotting, even if you are still taking the rest of your pills as directed.
• Cramping: Some may experience cramping or lower abdominal pain.
• Nausea: Hormonal fluctuations can cause nausea or an upset stomach.
• Breast/chest tenderness: Some people experience breast/chest tenderness when they miss a pill, as hormone levels can affect breast tissue.
• Headaches or migraines: On the combination pill, this is more likely to occur if you miss a pill at the start of a new pack or before your period. 
• Reduced effectiveness: Missing a pill can increase your risk of unintended pregnancy. The risk is higher if you miss multiple pills or miss a pill during the first week of a new pack.
• Ovulation: If you miss more than one pill, you might ovulate, which increases the risk of pregnancy if you have unprotected sex.

Side effects of missing a pill will vary depending on the type of pill you take and how many pills you missed. 

Will missing a pill affect my mood?

Missing a birth control pill can lead to significant hormonal fluctuations, which can impact your mood and potentially cause depressive symptoms. Birth control pills work by maintaining steady levels of hormones in your body, and missing a pill disrupts this balance. This disruption can lead to mood swings, increased irritability, and feelings of sadness or anxiety. In some cases, these changes may be mild. For others, the hormonal imbalance can exacerbate existing mental health conditions or trigger new symptoms. It's important to monitor your mood and mental well-being if you miss a pill and seek support from a healthcare provider if you notice persistent or extreme changes.

Missing a birth control pill (or two) can be stressful, but knowing how to handle it can help you stay protected. Whether you take combination pills or mini pills, stay calm and follow these steps to get back on track. Hey Jane is here to support you and answer any questions you have about missing a birth control pill, so you can manage missed pills with confidence and continue to protect yourself effectively against unintended pregnancy.

Tips to remember when it’s time to take your birth control

It can be easy to miss a pill or two, so if a daily birth control method isn’t for you, you can talk to your provider about non-daily methods that might be a better fit. You can also try the follow tips to avoid missing a dose:

1. Try to pick a time of day you can stick to 

Incorporating birth control into a routine you already have creates one less thing to remember. Think of what time you take other medications, your morning vitamin or coffee, or your evening skincare routine before bed and keep your birth control in that spot!

2. Keep your pills somewhere visible

If safe to do so, keeping your birth control pills somewhere obvious and in view can help you remember to take them every day around the same time. This could be by your toothbrush so you take it every morning, or on your kitchen counter.

Set an alarm

A tried and true method, setting an alarm on your phone at the same time every day. Pick a time where you’ll have access to your pills and won’t mind an alarm going off, such as in the morning, during a lunch break, or after work or school.