What I Need to Know About Missing Birth Control Doses

What happens if I forget to take my birth control pill? Will I get pregnant?

Hormonal contraceptives include birth control pills, the patch (Ortho Evra, Evra (Canada)), the vaginal ring (NuvaRing), and injections (Depo-Provera). Hormonal contraceptives are nearly 100% effective with perfect use. But missed pills, loose patches, or vaginal rings that have slipped out can result in unintended pregnancy. The risk of unintended pregnancy depends on:

  • how long it has been since your last dose
  • how long the patch has been loose or the ring has been out
  • how many doses you missed
  • when you last had sex
  • when during the menstrual cycle the missed dose occurred

The risk of pregnancy is highest when you have been off birth control for more than seven days, or have missed doses before seven continuous days of use. This could happen by forgetting to start a new cycle on time, missing a dose during the first week of the cycle, or missing several doses during week three of your menstrual cycle.

How many doses can I miss before I need to worry?

The definition of a missed dose depends on the type of birth control you are using:

  • Pill packs (Ortho-Cept, Yaz, etc) with 28 pills: missing a dose by 24 or more hours
  • Progestin-only pills (mini-pills, e.g., Micronor, etc): missing a dose by more than 3 hours
  • Extended cycle or continuous pills (Seasonale, etc):
    • missing eight or more pills (after 21 days of continuous use)
    • missing a dose by 24 or more hours (after less than 21 days of continuous use)
  • Patch (Ortho Evra, Evra (Canada)):
    • application delayed or patch is loose or falls off for 24 or more hours
    • leaving the same patch on for nine days or more
  • Vaginal ring (NuvaRing):
    • ring removed for more than 3 hours
    • delaying starting new ring for 24 hours or more
    • ring left in more than 28 days
  • Injection (Depo-Provera): last shot 14 or more weeks ago

What should I do if I miss a dose?

Get instructions on what to do about missed doses before they occur. Information specific to your birth control product can be found in the patient instructions that come with it. If you aren't sure what to do, contact your prescriber or pharmacist. Depending on how many doses you missed and when during your cycle you missed a dose, you might be instructed to use a "back-up," nonhormonal form of contraception (e.g., a condom) for a while. In some circumstances, "emergency contraception" pills (e.g., PlanB) will be advised. Your healthcare provider can help you make the best decision regarding the need for emergency contraception.

I often forget to take my birth control pills. Is there something else I can use?

If you miss doses frequently, talk to your prescriber about switching to a form of birth control that will be easier for you to remember. Alternatives to a daily pill include the injection, patch, vaginal ring, intrauterine device (IUD), and implantable rod (Implanon). No matter what birth control product you use, it must be used correctly to prevent unplanned pregnancy.

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