What Happens When You Skip a Birth Control Pill?

If you’ve ever panicked about a missed birth control pill, you’re not alone. Life is busy and sometimes we simply just forget to pop that tiny little pill.

There are a lot of questions around if and when you should take your birth control pill if you’ve missed a dose. What happens if you miss a day of birth control? Can missing a dose of birth control lead to pregnancy or breakthrough bleeding?

Ob/Gyn Ashley Brant, DO, MPH, discusses what to do if you forget a pill, your risk of pregnancy and other side effects to watch for.

What to do if you miss a birth control pill

You’ll first need to figure out what type of pill you take. There are two main types of pills:

• The combination pill, which is the most popular and includes both estrogen and progestin. A combo pack usually contains 21 to 24 consecutive days of hormone pills, followed by a week or less of placebos pills (also called reminder pills), which don’t contain the hormones.
• The progestin-only pill, also called the minipill, should be taken at the same time every day, even more so than the combination pill. With progestin-only pills, taking your pill even a few hours late can be an issue as the hormones wear off much sooner than with combination pills. This means that there’s a higher risk of pregnancy with missed pills and unprotected sex.

Recommendations for a missed combination pill

When it comes to a combination pill and what to do if you miss a dose, the scenarios vary based on how many pills you’ve missed. Dr. Brant explains.

What to do if you miss one pill

Take the pill as soon as you remember. Then take the rest of the pills like you normally would. To stay on schedule, this might mean that you have to take two pills in one day.

You might be asking yourself: Can I get pregnant after missing one pill? Back-up birth control or emergency contraception typically aren’t needed. However, if you previously missed pills in the same pack you should consider using a back-up method of protection, like condoms.

What to do if you miss two pills

Take the pill you most recently missed as soon as you remember. Then continue taking the rest of your pills like normal. For example, if it’s now Wednesday and you missed Monday’s and Tuesday’s pills, take Tuesday’s pill right away and take Wednesday’s pill at the usual time. Use back-up birth control or avoid sex until you have taken seven days of hormonal pills in a row. If you had unprotected sex in the last five days, consider using emergency contraception.

What to do if you miss three or more days of the pill

If you’ve missed three or more pills, it’s akin to having a hormone-free interval and you should restart the hormone pills and take one per day until you finish the pack’s hormone pills. Skip the placebo pills and start a new pack the next day.

If you haven’t been taking the pill for at least 21 days continuously, you should use back-up protection for seven days. If you’ve been on the pill more than 21 days, then it can be treated like a normal pack hormone-free interval and you should simply restart the pill. Consider emergency contraception if you’ve had unprotected sex in the last five days.

Recommendations for a missed progestin-only pill

Progestin-only pills are very time-sensitive. What if you took birth control four hours late?

It’s considered “missed” if it’s been more than three hours since you should have taken your pill. A single missed pill means you’re at risk for getting pregnant.

Here’s what to do with a missed minipill:

• Take your missed pill as soon as you remember.
• Continue taking your pills daily like normal, even if it means taking two pills in one day to get back on track.
• Use back-up contraception or avoid sexual activity until you have taken the pills correctly and consecutively for two days.
• Call your doctor or use emergency contraception if you’ve had unprotected sex in the last five days.

“Progestin-only pills work by thickening the cervical mucus, making it difficult for sperm to get through to the uterus,” explains Dr. Brant. “It can take about two days for the cervical mucus to thicken back up after a missed pill, so that’s why it’s advised to use back-up or emergency contraception with missed progestin-only pills.”

How late is too late to take a missed pill?

Dr. Brant says the general rule of thumb for the combination pill is to consider the 24- to 48-hour safe window. You can play catch up with missed pills before that, but after that time window has passed, you’re no longer protected against pregnancy.

If you’ve missed three or more days or if you haven’t taken a pill in 48 hours and have had unprotected sex in the last five days, it’s best to call your doctor and use an emergency contraception.

“It’s never wrong to reach out to your provider if you’re confused about what type of pills you take or what to do if you’ve missed multiple days,” says Dr. Brant. “They can help you decide what to do next.”

Consider what you take the pill for

If you’re taking birth control pills for other reasons besides preventing pregnancy (like reducing cramps or controlling acne breakouts), you don’t need to do anything besides get back on track. Missing a couple days of pills typically won’t affect the other reasons you take the pill if it’s not to prevent pregnancy.

What are the side effects of missing a birth control pill?

The two biggest side effects for missing birth controls pills are breakthrough bleeding (also known as spotting) and pregnancy. The hormones in birth control pills wear off in about 36 hours if you don’t continue taking them. After about a day and a half, your hormone levels will drop off, which can cause spotting.

Your chance of pregnancy will depend on how many days you missed and where in the pack you were. The main way that birth control pills work is by halting ovulation. Anytime you miss a pill it’s a good idea to use a back-up method of birth control, just in case.

“You might also notice nausea if you missed multiple pills and then had to take two in one day,” says Dr. Brant. “The higher dose of hormones can make some people feel queasy.”

What are the chances of getting pregnant after a missed pill?

In general, birth control pills are very effective at preventing pregnancy when used correctly. But when you miss a pill (or multiple pills), your chances of protection significantly decrease.

Where in your pack you missed a pill can make a difference in pregnancy risk. With the combination pill, missing a pill in the first week of your pack increases your chance of pregnancy more than missing a pill in the middle of the pack. This is because you just came off a seven-day break from the hormones to begin with, so there’s already a lack of them in your system.

Missing multiple pills and having unprotected sex equals a higher chance of pregnancy, especially during the last half of your pack or in the very beginning of a new one. At that point, it’s a good idea to use emergency contraception or contact your doctor.

If you’ve missed a pill and you’re nervous, it’s never wrong to use condoms as back-up protection. And remember, missing a hormonal combo pill (not the placebo or reminder pill) is what counts.

If you keep forgetting to take your pill

Talk to your provider if remembering to take your pill is becoming an issue. There are many effective forms of birth control out there — some that don’t require daily adherence.

The ring, the patch, the shot or an IUD are all great options if forgetfulness is getting the best of you.

“If you’d like to remain on the pill, trying using an app on your phone to remind you, setting an alarm or pair taking the pill with another daily activity, like brushing your teeth or eating breakfast,” suggests Dr. Brant.