The Importance of Knowing Your Pill Type
Before determining the right action for a missed pill, you must first identify the type of oral contraceptive you are using. The two main categories are combination pills and progestin-only pills, also known as 'mini pills'. These two types function differently and, as a result, have distinct rules for missed doses.
- Combination Pills: Contain both estrogen and progestin. They prevent ovulation and are more forgiving if a single dose is missed. Most packs contain 21 to 24 active pills and 4 to 7 placebo (inactive) pills.
- Progestin-Only Pills (Mini Pills): Contain only progestin and must be taken at a very precise time each day to maintain effectiveness. There are no inactive pills in a mini pill pack. For most mini pills (like norethindrone), the window for a dose is just three hours.
Combination Pills: The Rules for Missed Doses
If You Missed 1 Active Pill
If it has been less than 48 hours since you should have taken your last pill, you are likely still protected against pregnancy. You should:
- Take the missed pill immediately as soon as you remember, even if it means taking two pills in one day (one from yesterday and one for today).
- Continue with the rest of your pill pack as scheduled. You might finish the pack a day early, which is fine.
- No backup contraception is typically needed, but using condoms for the next seven days is an option if you are worried or have missed pills earlier in the pack.
If You Missed 2 or More Active Pills
If it has been 48 hours or longer since you were supposed to take your last pill, your contraceptive protection is compromised, and more immediate action is required.
- Take the most recent missed pill immediately. Discard any older missed pills.
- Continue taking one pill daily from that point on at your regular time.
- Use a backup birth control method, such as condoms, or abstain from sexual activity until you have taken seven consecutive active pills.
- Consider Emergency Contraception (EC), especially if you had unprotected sex within the five days before or after missing the pills, or if the missed pills occurred during the first week of a new pack.
Special Instructions for Missed Pills in Week 3
If you miss two or more pills during the third week of active pills (days 15-21 in a 28-day pack), you should finish the active pills in the current pack but skip the inactive (placebo) pills and immediately start a new pack. Use backup contraception for seven days.
What About Inactive (Placebo) Pills?
Missing one or more inactive pills, found at the end of many combination packs, does not affect contraceptive protection. Their only purpose is to help you stay in the daily habit of taking a pill. Simply discard the missed placebo pills and start your new pack on time.
Progestin-Only Pills: No Room for Error
Unlike combination pills, the timing with a progestin-only pill is critical. For most mini pills, the daily dose must be taken within a very strict, three-hour window.
If You Missed a Mini Pill (More Than 3 Hours Late)
- Take the missed pill as soon as you remember. Continue taking the next pill at your usual time, even if it means taking two pills in one day.
- Use a backup contraception method or abstain from sex for the next 48 hours (two consecutive days of taking the pill correctly).
- Consider Emergency Contraception (EC) if you had unprotected sex within the previous five days.
Comparison of Missed Pill Protocols
| Scenario | Combination Pill (Missed 1 Active) | Combination Pill (Missed ≥2 Active) | Mini Pill (Missed ≥3 Hours) |
|---|---|---|---|
| Action for Missed Pill(s) | Take missed pill immediately (may mean two in one day). | Take most recent missed pill immediately. Discard older ones. | Take missed pill immediately (may mean two in one day). |
| Resume Schedule | Continue rest of pack as normal. | Continue rest of pack as normal. | Continue rest of pack as normal. |
| Backup Protection | Not required for single miss, but optional. | Required for 7 consecutive days of correct pill-taking. | Required for 48 hours (2 consecutive days). |
| EC Consideration | No | Yes, especially if in week 1 or unprotected sex. | Yes, especially if unprotected sex occurred. |
| Side Effects | Mild nausea, spotting possible. | Mild nausea, spotting likely. | Mild nausea, spotting possible. |
Potential Side Effects of Doubling Up
While taking two active pills in one day is standard protocol for a missed combination pill, the higher dose of hormones can sometimes cause temporary side effects. These may include:
- Nausea or upset stomach
- Breakthrough bleeding (spotting)
- Breast tenderness
- Headaches
These side effects are usually mild and resolve quickly as your body adjusts. Taking the pills with food can help alleviate nausea.
Staying on Track with Your Pills
If you find yourself frequently forgetting doses, it may be time to re-evaluate your method. Consider these options to improve adherence:
- Set a daily alarm: Choose a consistent time each day, such as when you wake up, brush your teeth, or eat dinner, to take your pill.
- Use a pill tracker app: Several smartphone apps can help track your cycle and send daily reminders.
- Consider a different method: For those who struggle with a daily routine, a long-acting reversible contraceptive (LARC) like an IUD or implant may be a better option.
For more detailed information and recommendations, including specifics on different types of progestin-only pills, consult the official U.S. Selected Practice Recommendations for Contraceptive Use by the Centers for Disease Control and Prevention.
Conclusion
Yes, for a combination birth control pill, you can and should take two pills today if you forgot yesterday's dose, but only if it's a single missed pill. For multiple missed doses or a missed progestin-only pill, the rules are different and require more caution, including the use of backup contraception. The most important step is to act quickly based on your pill type. If you are unsure, the safest course of action is to use backup contraception and consult your healthcare provider.
