Forgetting to start a new pack of birth control is a common error that can cause anxiety, but knowing the correct course of action can help you regain your protection. The proper steps depend primarily on the type of birth control you use: a combination pill (containing estrogen and progestin) or a progestin-only pill (also known as the 'mini-pill'). It is important to act quickly once you remember, as the risk of pregnancy increases the longer you go without active pills.
Combination Pills: Protocol for a Late Start
Combination pills work by providing a steady level of hormones to prevent ovulation. The contraceptive effect can be maintained for short periods without hormones (the placebo week), but extending this hormone-free interval increases the risk of pregnancy.
If you started your pack 1 day late
- Action: Take the missed pill as soon as you remember. Continue taking the rest of your pills at your regular time, even if it means taking two pills in one day.
- Contraceptive Protection: Your protection is not compromised.
If you started your pack 2 or more days late (more than 48 hours)
- Action: Take the most recently missed pill immediately and continue taking the rest of your pack as scheduled. Discard any other missed pills.
- Contraceptive Protection: You are not protected. Use backup contraception, such as condoms, or avoid sex until you have taken active pills for seven consecutive days.
- Emergency Contraception (EC): Consider EC if you had unprotected sex in the last five days, especially if you missed pills during the first week of the pack. Pregnancy risk is greatest when active pills are missed at the beginning or end of a cycle.
What to do at the end of the pack
- Fewer than 7 active pills left: If you are in the last week of hormonal pills (days 15-21 in a 28-day pack), finish the active pills and immediately start a new pack, skipping the placebo pills. Continue using backup contraception for the first seven days of the new pack.
- 7 or more active pills left: Finish the pack and take your usual placebo break before starting the next pack. Continue using a backup method for the first seven days of the new pack.
Progestin-Only Pills (Mini-Pill): Protocol for a Late Start
The mini-pill is extremely time-sensitive, requiring consistent daily timing for maximum effectiveness. It primarily works by thickening cervical mucus, and even a slight delay can increase your pregnancy risk.
If you are more than 3 hours late to start your pack
- Action: Take the missed pill as soon as you remember, even if it means taking two pills in one day. Then, continue taking the rest of your pills at your regular time.
- Contraceptive Protection: You are not protected. You must use backup contraception (like condoms) for at least the next 48 hours. Some newer progestin-only pills, like Slynd, require backup for seven days.
- Emergency Contraception (EC): If you had unprotected sex in the last five days, especially in the 48 hours after the missed pill, consider emergency contraception.
Addressing Potential Pregnancy and Emergency Contraception
If you have had unprotected sex since forgetting to start your new pack, your risk of pregnancy increases, especially for mini-pill users or combination pill users who missed pills during the first week of their cycle.
Types of Emergency Contraception
- Levonorgestrel (e.g., Plan B One-Step): This is available over-the-counter and works best when taken within 72 hours of unprotected sex, though it can be taken up to five days later. Its effectiveness can decrease in individuals who weigh more than 165 pounds.
- Ulipristal Acetate (e.g., Ella): This requires a prescription and is more effective than levonorgestrel, working up to five days after unprotected sex. Its effectiveness is also affected by weight.
- Copper IUD: A healthcare provider can insert a copper IUD up to five days after unprotected sex, and it is the most effective form of emergency contraception. It then offers long-term contraception.
Comparison of Birth Control Pill Types and Missed-Dose Protocols
| Feature | Combined Oral Contraceptive (COC) | Progestin-Only Pill (Mini-Pill) |
|---|---|---|
| Late/Missed Threshold | More than 48 hours late for active pills | More than 3 hours late for any pill |
| Mechanism of Action | Primarily suppresses ovulation; also thickens cervical mucus | Primarily thickens cervical mucus; may not always suppress ovulation |
| Action for Missed Pack | Take most recent missed pill, continue pack, use backup for 7 days. | Take missed pill immediately, continue pack, use backup for 48 hours (or 7 days for Slynd). |
| Backup Contraception | Required for 7 consecutive active pills. | Required for 48 hours (or 7 days for Slynd). |
| EC Consideration | Especially if unprotected sex occurred in the 5 days prior to missing the first week of active pills. | If unprotected sex occurred in the 5 days prior, anytime. |
| Effect of Weight | Not a significant factor in EC effectiveness, unlike some EC pills. | Some EC pills (levonorgestrel, ulipristal acetate) are less effective for higher body weights. |
Conclusion
Forgetting to start a new pack of birth control can result in a lapse of contraceptive protection, but taking the right steps promptly can help prevent unintended pregnancy. The specific protocol depends on whether you use a combined or progestin-only pill. Combination pill users have a slightly wider window before their protection is compromised, while mini-pill users must be more vigilant about timing. Regardless of the pill type, if more than two active pills are missed or if unprotected sex occurred around the time of the missed dose, using a backup method and considering emergency contraception is crucial. To prevent future mistakes, consider setting a daily reminder or discussing alternative, less frequent birth control methods with your healthcare provider. For further guidance, refer to the package insert or consult your doctor or pharmacist.
