Missing doses of birth control can be a source of stress and confusion, with many women wondering about the best way to get back on track. While taking two pills in one day is sometimes part of the recovery plan for missed doses, the strategy for handling two consecutive missed pills does not typically involve taking three pills in one day. The correct course of action is more nuanced and depends on the type of pill you take and where you are in your cycle.
The Difference Between Pill Types
Before you act, it's crucial to identify which type of birth control pill you are on. The guidelines for combination pills, which contain both estrogen and progestin, are different from those for progestin-only pills, also known as the mini-pill.
- Combination Pills: These pills work by preventing ovulation and thickening cervical mucus. While a few hours' delay won't significantly affect efficacy, missing pills for 48 hours or more can compromise protection.
- Progestin-Only Pills (POPs): These pills must be taken within a very strict, three-hour time frame every day to maintain a consistent hormonal level. The primary mechanism is thickening cervical mucus, which can be affected by even a slight delay.
| Feature | Combination Pill (Missed 2 Days) | Progestin-Only Pill (Missed >3 Hours) |
|---|---|---|
| Action on Day of Realization | Take the last missed pill. | Take the missed pill as soon as possible. |
| Other Missed Pills | Discard any other missed pills from earlier days. | N/A (Each missed pill is addressed). |
| Next Steps | Take the next pill at your regular time. | Continue taking pills at your regular time. |
| Backup Contraception | Use condoms or abstain for 7 consecutive days. | Use condoms or abstain for at least 2 days. |
| Emergency Contraception (EC) | Consider EC if missed in the first week and had unprotected sex. | Consider EC if unprotected sex occurred in the last 5 days. |
What to Do If You Missed Two Combination Pills
If you are on a combination pill and realize you have missed two active pills, your action plan is determined by when in your cycle you missed them. Taking three pills in one day is not recommended because it will not restore protection faster and can increase side effects.
If missed in week 1 or 2
This is a high-risk time because it’s close to the placebo week, when your hormone levels are lower, and missing pills can allow ovulation to occur.
- Take the most recently missed active pill as soon as you remember. Throw away the other missed pill.
- Take your next pill at your regular time.
- Use a backup birth control method (like condoms) or abstain from sexual intercourse for the next seven consecutive days.
- If you had unprotected sex in the five days before or during the missed pills, consider using emergency contraception.
If missed in week 3
In the third week of a 28-day pack, the process is slightly different to prevent extending the hormone-free interval, which would increase pregnancy risk.
- Take the most recently missed active pill as soon as you remember and throw away the other missed pills.
- Finish the active pills in your current pack.
- Skip the hormone-free (placebo) pills entirely and start a new pack the very next day.
- Use a backup birth control method for the next seven consecutive days.
What to Do If You Missed Two Progestin-Only Pills
Progestin-only pills are highly time-sensitive, and missing even one dose by more than three hours is considered a missed pill. If you missed two or more active mini-pills, your contraceptive protection is very likely compromised.
- Take the most recent missed pill as soon as possible.
- Continue taking one pill a day at your regular time.
- Use backup contraception for the next 7 days.
- Consider emergency contraception if you had unprotected sex in the past five days.
The Dangers of Taking Extra Pills
While taking three pills in one day is not the correct way to handle a missed dose, accidentally taking two pills in one day is sometimes necessary and generally harmless. However, taking more than the prescribed dosage, even for a single day, can lead to side effects because of the sudden increase in hormone levels.
- Nausea and Vomiting: The most common side effects from taking too many pills are nausea and vomiting.
- Spotting: You may experience light, irregular vaginal bleeding or spotting as your body adjusts to the hormonal surge.
- Breast Tenderness and Headaches: Hormonal fluctuations can cause breast tenderness, headaches, or mood changes.
- No Added Protection: It's important to remember that taking extra pills does not provide extra protection against pregnancy.
If you experience severe symptoms like heavy bleeding, extreme fatigue, or chest pain, you should contact a healthcare provider immediately.
Conclusion
Handling missed birth control pills requires specific actions based on the type of pill and when the doses were missed. Taking three birth control pills in one day is not the correct procedure for missed doses and can lead to unnecessary side effects. In most cases of missed combination pills, you will take the most recent missed dose and use backup contraception. For time-sensitive mini-pills, any significant delay requires immediate action and backup protection. Always consult your healthcare provider or the pill's package insert for personalized advice. Consistency is key for effectiveness, so setting a daily alarm can help prevent future missed doses. If you frequently forget pills, consider discussing alternative long-acting reversible contraception (LARC) options with your provider.
For more information, you can visit Planned Parenthood's guide on what to do if you miss a birth control pill.
