Patient: So, today I was supposed to start a brand new pack of birth control pills. As I was taking the pill out it dropped onto the carpet. I looked for ten minutes and couldn’t find it. I had the idea to take the second pill in the pack. Is this a bad idea? Will I still be protected?
Doctor: Incorrect use of birth control pills is a major reason for unintended pregnancies. Birth control pills work best if take n according to schedule and at the same time each day. If you miss one or more pills, you increase your chances of releasing an egg (ovulation) that could be fertilized and lead to a pregnancy.The incidence of pill failure resulting in a pregnancy is roughly 1-2% per year (1 to 2 pregnancies per 100 women) if taken every day as directed, but the average failure rate is approximately 5% per year (5 pregnancies per 100 women per year of use) including women who do not always take the pill exactly as directed without missing any pills.Your chances for getting pregnant depend upon when you missed your pill during your cycle, the number of pills you missed in a row, and if you had unprotected sex around the time of missed your pill(s).The highest risk of ovulation occurs when the hormone-free interval (the time when inactive pills are taken or there is a break between active pills) is prolonged for than seven days. This can occur by either delaying the start of your birth control pack or by missing active pills during the first or third weeks of birth control pill use.What action you take when you have missed taking one or more pills depends upon what type of birth control pill you use. You should review the specific patient package insert that accompanies your birth control pill pack and contact your healthcare provider for the most specific instructions on what to do if you miss one or more birth control pills. If you are confused at any time about what to do if you have missed any birth control pills, either abstain from sex or use a back-up method of birth control each time you have sex, and take your birth control pill each day until you can talk to your health care provider.The following general guidelines may be consulted if you miss pills while using the traditional 21- or 28-day combined hormonal birth control pills, progestin-only (“mini”) pills, extended-cycle birth control pills or the continuous-cycle birth control pill (Lybrel). If you have missed a pill and had unprotected sex, there is still a chance you could become pregnant even if you follow these instructions exactly. You may need to use a back-up method of birth control (such as a condom) or abstain from sex for seven days or longer after you miss your pill(s). Your healthcare provider may also recommend that you use an emergency contraceptive. You can use an emergency contraceptive, such as Plan B One Step, Next Choice or Ella for up to five days after unprotected sex, but it works better the sooner you use it, preferably within 24 hours. A copper intrauterine device may also be used as an emergency contraceptive within 5 days of unprotected sex, but this requires a doctor visit.So, If you forget to take a birth control pill, take it as soon as you remember. If you don’t remember until the next day, go ahead and take 2 pills that day. If you forget to take your pills for 2 days, take 2 pills the day you remember and 2 pills the next day. You will then be back on schedule. If you miss more than 2 birth control pills, call your health care provider for instructions. Those instructions may be to take one pill daily until Sunday and then start a new pack or to discard the rest of the pill pack and start over with a new pack that same day.Any time you forget to take a pill, you must use another form of birth control until you finish the pill pack. When you forget to take a birth control pill, you increase the chance of releasing an egg from your ovary. However, if you forget to take any of the last 7 (or last 4 of a 4-pill placebo pack or last 2 of a 2-pill placebo pack) out of the 28 day pills, you will not raise your chance of pregnancy, because these pills contain only inactive ingredients. Some pill packs don’t have any placebo pills, so it is best to take all of your pills on schedule so that you can stay on track. If you miss your period and have forgotten to take one or more pills, get a pregnancy test. Many women do not have a period on low dose birth control pills even if they don’t miss any pills. This is considered normal and should not cause any concern.If you find that you frequently forget to take your pill, it may be better to use another form of birth control. Speak to your healthcare provider about other available birth control options that do not require a daily schedule.