Missing doses of oral contraception is a common error and a leading cause of unintended pregnancies. While the pill is highly effective with perfect use, its effectiveness diminishes when the daily hormone levels are not maintained. If you've missed two pills, understanding the specific risks and necessary steps is crucial for protecting against pregnancy.
The Increased Risk of Missing Two Pills
Oral contraceptives work by delivering a steady dose of hormones to prevent ovulation, thicken cervical mucus, and thin the uterine lining. Missing two pills in a row interrupts this process, allowing hormone levels to drop enough that ovulation may occur, increasing the risk of pregnancy.
A 2023 study published via The ObG Project provided concrete data on this risk. Among participants using combined oral contraceptives, the pregnancy rate per cycle was 0.09% with no missed pills. However, this rate increased to 0.83% for those who missed two pills. A 2007 study from the University of Michigan reported that 27 percent of women who missed two pills in a row risked pregnancy. The exact level of risk is not uniform and depends on several factors, primarily the type of pill and when in the cycle the pills were missed.
Actions for Missed Combination Pills
Combination pills contain both estrogen and progestin. The guidelines for what to do after missing two or more pills depend on the week of your 28-day cycle.
If You Miss Two Pills in Week 1 (Days 1-7)
Missing pills at the start of a pack is particularly risky because it extends the hormone-free interval from the last pack, which can trigger ovulation.
- Action: Take the most recent missed pill as soon as you remember. Discard any earlier missed pills.
- Continued Schedule: Continue taking the rest of the pack at your regular time. This may mean taking two pills on the same day.
- Backup Contraception: Use a backup method like condoms or abstain from sex for the next seven consecutive days.
- Emergency Contraception (EC): If you had unprotected sex in the past five days, consider taking EC. The risk is highest during this week.
If You Miss Two Pills in Week 2 (Days 8-14)
Missing pills in the middle of a pack is less risky than the first week, but protection is still compromised.
- Action: Take the most recent missed pill and discard the other.
- Continued Schedule: Continue taking the rest of the pack at your regular time.
- Backup Contraception: Use a backup method or abstain from sex for the next seven consecutive days.
- Emergency Contraception: Generally not needed, but can be considered if you are unsure or had unprotected sex.
If You Miss Two Pills in Week 3 (Days 15-21)
Missing pills at the end of the active pill cycle also poses a high risk by prolonging the hormone-free interval.
- Action: Take the most recent missed pill and discard the other.
- Continued Schedule: Finish the hormonal pills in your current pack. Do not take the placebo pills. Immediately start a new pack the next day.
- Backup Contraception: Use a backup method or abstain from sex for the next seven consecutive days.
Actions for Missed Progestin-Only Pills (Mini-Pills)
Progestin-only pills are more time-sensitive and must be taken at the same time every day. Missing a dose by more than three hours is considered a missed pill and requires immediate action.
- Action: Take the missed pill as soon as you remember, even if it means taking two pills in one day.
- Backup Contraception: Use a backup method of contraception, like condoms, for at least the next 48 hours to seven days, depending on your healthcare provider's advice.
- Emergency Contraception: If you had unprotected sex in the past five days, consider taking EC.
Comparison Table: What to Do After Missing Two Pills
| Scenario | Action (Combination Pill) | Action (Mini-Pill) |
|---|---|---|
| Realize you missed two doses | Take the most recent missed pill immediately; discard the other. | Take the missed pill immediately (if remembered within 3 hours of late dose). |
| Continue Schedule | Continue with the rest of your pack, taking the next pill at the usual time. | Continue with the rest of your pack at the usual time. |
| Backup Protection | Use condoms or abstain from sex for 7 days. | Use condoms or abstain from sex for at least 48 hours, or longer as advised. |
| Emergency Contraception (EC) | Consider if pills were missed in week 1 and unprotected sex occurred in the last 5 days. | Consider if any dose was missed by more than 3 hours and unprotected sex occurred in the last 5 days. |
| Missed in Week 3 | Skip placebo pills and start a new pack immediately. | Not applicable, as mini-pills do not have a placebo week. |
Conclusion: Prioritize Prompt Action and Communication
Missing two birth control pills, especially combination pills in the first or third week of a pack, significantly increases your risk of an unintended pregnancy. The key takeaway is to act immediately. The specific steps you take depend on your pill type and when the pills were missed, but almost all scenarios require using backup contraception for a specified period and potentially considering emergency contraception if unprotected sex occurred. Always read the package insert that comes with your prescription, and if you are uncertain about what to do, contact a healthcare provider for personalized medical advice.
Optional Authoritative Outbound Link
For detailed guidelines from a leading public health organization, refer to the CDC's recommendations on missed contraception.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional or pharmacist to discuss your specific situation and receive appropriate guidance regarding medication use and reproductive health decisions.
