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What to do if you missed birth control pills (besides not freak out)


Contraception is a hot topic as of late, and roughly two-thirds of women in the USA are using some form of contraception. Oral contraceptives — aka the pill — continue to be one of the most popular choices among them all, but these meds do more than just prevent pregnancy.

“The non-contraceptive benefits of birth control pills are many,” from reducing ovarian and endometrial cancer risk to helping treat polycystic ovary syndrome, says Catharine Marshall, MD, board-certified ob-gyn and gynecologic surgeon at Scripps Memorial Hospital in La Jolla, California.

One of the pitfalls, though? Human error. It can be impossible to remember to do something every single day at the same time (hello…have you ever tried doing a meditation challenge?). But when it comes to birth control pills, missing one — or two…or five — can have life-altering implications. Ahead, what you need to know about missed birth control pills by type, timing, and quantity — and what to do if you miss a birth control pill.

Birth control pills
Image: Courtesy Reproductive Health Supplies Coalition/Unsplash

Here’s How Birth Control Pills Work

To understand what happens when you miss a pill, it’s important to know what these pills are doing to your body in the first place, and how they prevent pregnancy. And, here’s the thing: Different pills use different hormones and have different timelines for how quickly they break down and are absorbed. That means depending on which pill you’re taking, missing one pill could have varying effects.

Combination Pills: These contain both estrogen (a sex hormone) and progestin (a synthetic version of the sex hormone progesterone). “Combination birth control pills prevent ovulation, thin the uterine lining, and thicken cervical mucus,” all of which team up to help prevent the fertilisation of an egg, says Dr Marshall. (Thinning the uterine lining makes it more difficult for a fertilised egg to attach, and thickening cervical mucus hinders sperm from entering the uterus, according to the US National Library of Medicine.) The final week of combination packs are sugar pills, sometimes referred to as placebo pills, which do not prevent pregnancy and allow you to have your monthly period. (It doesn’t matter if you miss these, but many patients like to keep the regular habit of a daily pill so they don’t make a habit of skipping pills.)

Progestin-only Pills (aka the Minipill): These pills only contain progestin (a synthetic version of the sex hormone progesterone). “Progesterone-only pills thin the uterine lining and thicken cervical mucus, but don’t completely suppress ovulation,” says Marshall. “These are slightly less effective at preventing pregnancy, and are used when women are nursing, or have reasons that they cannot use an estrogen-containing birth control pill (such as high blood pressure, migraines, risk factors for blood clots and strokes, sickle cell anaemia, and smokers).”

What Happens If You Miss One Birth Control Pill?

Combination Pills: If you’ve landed on this article because you missed one birth control pill in a combination packet — regardless of where you are in the cycle — the recommendation is to take the pill as soon as you notice that you’ve forgotten, says Dr Marshall. From there, continue taking one pill each day as prescribed, she adds.

It’s typically no biggie if you missed one birth control pill. You’re chillin’. “One missed pill does not reverse ovarian suppression,” says Dr Marshall. Meaning, you won’t ovulate and thus have a chance of becoming pregnant. “It may cause spotting or other uncomfortable symptoms — but no additional contraception is required.”

Progestin-Only Pills (aka the Minipill): The minipill is “not as potent a suppressor of ovulation as a combination pill,” says Dr Marshall. Because of this, progestin-only pills are trickier when it comes to missed or delayed doses. In fact, it’s considered “missed” if it’s been more than three hours since you should have taken your pill, according to the Cleveland Clinic. (However, if your minipill also contains the medication desogestrel — it should be noted on your pack — you have a 12-hour window before it’s considered missed, according to the UK National Health Service.)

“If you miss a minipill, take that one as soon as you remember — sometimes that means taking two pills in the same day or even at once,” says Dr Marshall. “Using a backup contraception method after one missed dose of the minipill for at least two days is recommended.”

missed birth control
Image Credit: Reproductive Health Supplies Coalition/Unsplash

What If You Miss Two (or More) Birth Control Pills?

Combination Pills: If you’ve missed two birth control pills (or more), your chance of pregnancy goes up. Keep taking your pills regularly at their usual time and use backup contraception (eg condoms), advises Dr Marshall. “With two or more missed pills, there is a risk of ovulation.” You should continue to use backup protection until after your next period. FYI, You may experience symptoms from missed pills, too, such as breakthrough bleeding/spotting, cramps, etc.

Timing also comes into play here. If you miss two or more pills in the first week of your cycle — and have unprotected intercourse during that week — you should use emergency contraception (such as Plan B) because you’re most fertile at the beginning of the cycle, right after your period, she explains. And “if you miss two or more pills in the last week of hormone pills — week three or days 15 to 21 in a 28-day cycle — you should finish that last week of pills, then skip the placebo pills (the fourth week or row), and immediately start a new pack in the next day,” says Dr Marshall.

Progestin-Only Pills (aka the Minipill): In this case, you’re not protected against pregnancy and should use a backup method (or not have sex). Take your missed pill as soon as you remember — but only one, even if you’ve missed two or more. Then take your next pill at the usual time, even if that means taking your missed pill and your next pill together. Carry on taking your pills as normal, and after you’ve taken your minipill on time for two consecutive days, you should be protected from pregnancy again.

When in doubt, drop your ob-gyn a line or check your BC package for more info (though they’re not always in the plainest English).

If You’re Regularly Missing a Lot of Pills…

Dr Marshall has a suggestion if you’re missing more than one pill on a somewhat regular basis: change your contraception. Depending on your physiological needs and your stage of family planning or pregnancy prevention, there are a plethora of options.

Long-term alternative options like IUDs are also great contraceptive options for women solely looking to prevent pregnancy, as well.

This story first appeared on www.shape.com

(Main and Feature Image Credit: Getty Images)

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