All women who use the Pill as their preferred form of birth control know how easy it is to forget to take that pesky pink pill at the same time every day. Chances are, you've forgotten to pop one or two (or more) in a row and had a minor panic attack. Now what? Do you take all of them at once? How many is too many to have forgotten? Do you need to start a new pack? For how long do you have to turn to condoms? Are you going to start bleeding?
Unfortunately, this isn't one of those situations where the anxiety comes flooding on for no reason. Remembering to take your birth control pill is super important, and forgetting about it often can have dire consequences.
So, BRIDES spoke with Ana Cepin, ob/gyn at NewYork-Presbyterian/Columbia University Irving Medical Center, and Raquel Dardik, gynecologist at NYU Langone Health, to better understand why taking your birth control pill every day is so important and what to do when you miss one or more.
Why Missing Pills Gets Messy
Your course of action when you forget a pill depends largely on the type you are taking. Cepin explains there are two types of pills that women commonly take: combined oral contraceptive and the minipill (or progestin-only pill).
The combined oral contraceptive is the most common of the two, and it contains both estrogen and progestin, a man-made form of the hormone progesterone. Most packs have 21 active pills and seven inactive/placebo pills. There are also variations with 24 active pills and four inactive pills, 84 active pills and seven inactive pills, and a full 365-day active pill pack.
Combined oral contraceptives prevent ovulation by maintaining a constant level of hormones that block the regular monthly cycle. “When you miss a pill, the levels of estrogen and progesterone drop,” explains Dardik. "Skipping for 24 hours may give you side effects such as spotting, but usually the drop is too short to do anything else.” When you skip two or more pills, however, it can lead to bleeding—and for some women it can start a new menstrual cycle and trigger ovulation.
The minipill contains only a low dose of progestin and does not contain estrogen. It's important to note that the pack contains 28 minipills with no placebos.
The minipill works by thickening the cervical mucus and changing the lining of the uterus. Unlike the combination pill, Cepin explains, “The medication has a short half-life, which means it doesn't last very long in our system. If a dose is late or missed, the effects wear off.”
If you’re uncertain which type of pill you are on, be sure to ask your pharmacist or physician.
When You Miss One Pill
It happens. Your alarm goes off but your pill pack is at home, you’re on an overnight trip, or you just plain forget. But before you panic, is it a huge deal? With missing only one pill, not really.
Dardik advises that if you miss one pill dose, simply “double up the next day." The birth control should still be effective. Cepin agrees, adding that you should take it as soon as you remember, and you may end up taking two pills in one day. You don’t need to use any backup contraception in this instance.
If you’re on the mini pill, however, hours can matter. Cepin says even if you are only three or more hours late in taking the minipill, condoms should be used for seven days.
When You Miss Two or More Pills
When you miss two pills, Cepin says you should take two pills when you remember, two pills the following day and then resume your normal schedule. You should use backup contraception such as condoms for seven days.
Missing three pills gets a bit more complicated. If three pills are forgotten, Cepin advises you throw out that pack and start a new one, using backup contraception for seven days.
“If you miss three pills, you should definitely not count on the pills being effective contraception,” Dardik adds. "What to do depends on where in the cycle of pills you are, so a call to the doctor is a must.”
It sounds simple in theory, but remembering to take medication can be more of a hassle than you anticipated. Dardik suggests setting a daily reminder on your phone, leaving pills in a visible area, or keeping them with you if you take them in the middle of the day. Cepin adds that perhaps you can keep the pills next to something you do at the same time every day—like brushing your teeth.
If you’re still finding it difficult to remember and maintain consistency, you have other options. Cepin explains, “The most effective methods of contraception are the long-acting reversible methods, or LARCs. These are the IUDs and contraceptive implant.” Their efficacy is rooted in the fact that there is no action needed, and no remembering necessary.
She adds, "These work best for women who have difficulty using a method consistently.” Injections every three months, the contraceptive ring that stays in place for three weeks at a time, or a weekly patch are all options worth considering in this situation.
So next time you miss a pill, try not to panic. But if it’s a consistent occurrence, you’ll definitely want to consult your doctor about your options.