How to Make Up Missed Birth Control Pills

Birth control pills are up to 99 percent effective at preventing pregnancy, but only when the pills are used consistently and correctly every day. It sounds simple to do, but inevitably you may forget a pill for any number of reasons: vacation, illness, spontaneous romantic voyage with the love of your life (wishful thinking).

When you use birth control pills, create a list with the following information: drug name (brand/generic), type of drug, dosage, strength/amount of active ingredients and usage instructions. Post this list (see example of information to include: personal health record example) on the inside of a medicine cabinet for quick reference, and always have one copy of the “Patient Information Brochure” easily accessible.

Birth control pills range in levels of synthetic estrogen they contain (most commonly prescribed are the "low dose" of 30 mcg estrogen):

• "very low dose" of 20 mcg of estrogen (ethinylestradiol)
• "low dose" of 30-35 mcg of estrogen
• "high dose" of 50 mcg of estrogen
• “mini-pill” contains no estrogen, only progestin

What can you do if you miss taking your birth control pills?

For 30–35 µg ethinylestradiol pills (most commonly prescribed):
Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late:

• Take an active pill as soon as you remember, and then continue taking pills daily
• No need for any back-up birth control (i.e., no condoms needed)

Missed 3 or more active pills, or if started a pack 3 or more days late:

• Take an active pill as soon as you remember, and then continue taking pills daily
• Important to use condoms or abstain from sex until you have taken active pills for 7 days in a row
• If you missed pills in the third week, finish the active pills in current pack and start a new pack the next day. Do not take the 7 inactive pills.
• If you missed pills in the first week and had unprotected sex, you may consider using emergency contraception.

For 20 µg or less ethinylestradiol pills:
Missed 1 active pill, or started a pack 1 day late:

• Take an active pill as soon as you remember, and then continue taking pills daily
• No need for any back-up birth control (i.e., no condoms needed)

Missed 2 or more active pills, or started a pack 2 or more days late:

• Take an active pill as soon as you remember, and then continue taking pills daily
• Important to use condoms or abstain from sex until you have taken active pills for 7 days in a row.
• If you missed pills in the third week, finish the active pills in current pack and start a new pack the next day. Do not take the 7 inactive pills.
• If you missed pills in the first week and had unprotected sex, you may consider using emergency contraception.

You may have heard about “doubling-up” on taking pills. This is helpful when you miss 1 or 2 pills, and can be done by following this example below (just insert the day(s) you missed):
Friday: oops! Missed pill
Saturday: oops! Missed pill
Sunday: take today's pill (Sunday), and Friday's missed pill
Monday: take today's pill (Monday), and Saturday's missed pill
Tuesday: take your usual daily pill

A word of advice: you do not need to take both pills at the same time, as it can cause nausea. You may want to space out the pills when doubling-up by a few hours. Lastly, always take that day's pill, and then double-up with the first pill missed. This method will only work if missed 1 or 2 pills. If you miss 3 or more pills in-a-row, follow the instructions above.

Bottom line: if you are ever in doubt, abstain from sex or use a condom until you have taken 7 days of active pills!

Source: World Health Organization Selected Practice Recommendations for Contraceptive Use