Illustration by Marta Pucci
Missed a pill and had unprotected sex?
Here’s what to do
Top things to know:
Missing a birth control pill is more common than you might think
Although missing a pill can be stressful, there are steps you can take to prevent an unintended pregnancy
You can track your birth control method and set up daily pill reminders in the Clue app
It can be difficult to remember to take your birth control pill every day. Missing a pill is common, and research shows that missing two or more pills during a cycle nearly doubles the chance of becoming pregnant (1).
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A large study published in 2023 examined how often missed birth control pills led to pregnancy. It found that missing one pill per pack slightly increased the chance of pregnancy, and missing two pills doubled this chance (1). Those who missed two or more pills were 18 times more likely to become pregnant (1).
Missed or late pills are the main reason why about 9 out of 100 people experience an unintended pregnancy within the first year of "typical” contraceptive pill use (2). These pregnancies aren’t due to issues with the pill's effectiveness but because it wasn't taken as intended.
What you need to know about missing a pill
What to do depends on the type of pill you take. It’s important to know whether you take the combined pill, containing estrogen and progestin, or the progestin-only pill (the mini-pill). It also depends on how many pills you’ve missed.
Combined contraceptive pills
The combined hormonal birth control pill contains estrogen and progestin (3). How do you know if you are taking the combined contraceptive pill? Take a look at the label on your birth control packet—it lists the hormones in the pills.
You have technically missed a pill if any of the following are true:
Your last pill was taken more than 24 hours ago.
You vomited within three hours of taking the pill.
You had severe diarrhea for over 24 hours.
What to do if you miss one birth control pill
If you miss one pill or take one late, you don’t need to use another form of birth control as backup (4).
Here’s what to do (5):
Take the missed pill as soon as you remember, even if it means taking two pills in one day.
Continue the rest of the pack as usual.
Follow your regular pill-free break.
You won’t need emergency contraception as long as you haven’t missed any other pills in the first week of your current pack or the last week of your previous pack.
What to do if you miss two or more birth control pills?
If you miss two or more pills, it’s important to avoid sex or use a barrier method for the next seven days to reduce the risk of pregnancy (5).
Here are some steps you can take:
Take the most recent missed pill (even if that means taking two pills on the same day).
Ignore any earlier missed pills.
Use condoms or avoid sex for the next seven days.
Finish the pack of pills as usual. If you’re near the end of the pack, check how many pills are left. If there are more than seven pills left, finish the pack and take your usual pill-free break. If there are fewer than seven pills left, take the remaining pills as usual. Then, skip the pill-free break and start the next pack (5).
Consider emergency contraception like Plan B or Julie if your missed pills were within the first seven days of a new pack (5). Consult your healthcare provider if you’re unsure.
Placebo pills
Most combined contraceptive pills include placebo pills (pills that don’t contain hormones) for either four or seven days. These pills help you stay in the habit of taking your birth control, but there’s no medical reason to take them (2,6).
Skipping your placebo pills means that you won’t have a “period” (which is actually a withdrawal bleed). You are still protected from pregnancy during the placebo days, but you must remember to start taking your next pack after those placebo days (6).
If you plan to have scheduled bleeding in your cycle, start your next birth control pill pack on the right day—even if you are still bleeding (5).
Progestin-only pills (the mini-pill)
The mini-pill contains progestin, the synthetic form of progesterone (7). If you miss a mini-pill, what to do next will depend on which type of mini-pill you take. There are two types: the first contains either norethindrone or norgestrel, and the second contains drospirenone. Look at the box to see which kind of mini-pill you are taking.
If you are taking norethindrone or norgestrel and you missed a pill (5):
Take the missed pill as soon as possible.
Keep taking your pills at the same time each day (even if it means taking two pills in one day).
Don't have sex, or use a barrier method like a condom until you've taken two pills on time for two days.
Consider emergency contraception if you've had unprotected sex.
If you are taking the drospirenone mini-pill and it's been 48 hours or more since you've taken a pill:
Take your missed pill as soon as possible.
Take one pill every day until you finish your birth control pack. There will be one or more pills left in your pack.
Don't have sex (or if you do, be sure to use a barrier method like a condom) until you've taken at least seven hormonal pills.
If you missed pills during the first week of your pack, consider emergency contraception if you've had sex in the past five days.
How late is too late to take a missed pill?
The time frame for how late is too late to take a missed pill varies depending on the type of birth control pill you use. Be sure to read the information leaflet included with your brand of pill or speak with your healthcare provider or pharmacist if you’re unsure.
Should I double up on my birth control if I've missed one pill and had unprotected sex?
It depends on when you missed the pill and which type of pill you take. Follow the instructions above. Sometimes you may need to take two pills in one day. You may also need to use condoms for the next seven days.
Should I continue taking my birth control pills after missing one and having unprotected sex?
Yes, continue taking your birth control pills if you have missed one pill. Your next steps are based on the type of pill you take and when in the pack you missed it. If you stop taking your pill but want to avoid pregnancy, use condoms until you find another contraceptive method.
How to avoid missing birth control pills
About 3 out of 10 people miss one or more pills in a monthly pack (4). Using the Clue pill tracking option can help you establish a routine and remember to take your pills on time. You can also set daily reminders that will pop up in your notifications when it’s time to take your pill. There’s even an option to log a missed or late pill.
Should I switch birth control methods?
If you find that you miss pills regularly, it might be worth considering other contraceptive options. Some forms of birth control like the IUD (hormonal and non-hormonal) and the implant, don’t require you to remember to take them daily.
There’s also the hormonal patch, which is changed weekly; the vaginal ring, which is worn for three weeks; and the progestin-only injection, which protects for three months (3,7). Other non-hormonal methods, such as diaphragms and condoms, are also available. Talk to your healthcare provider if you are considering changing your contraceptive method.
What are the side effects of missing a birth control pill?
Missing a birth control pill isn't just about unintended pregnancy risks—you could also experience unpredictable bleeding. When you miss a birth control pill, your body will not have access to the same amount of hormones it normally does. You may experience breakthrough bleeding as your body withdraws from these hormones (8).
With Clue, you can track when you have forgotten to take a birth control pill. Some people check to see if they are before or after their ovulation date, but remember that the “cycle” displayed in Clue while you’re on hormonal birth control isn’t the same as your natural cycle. Birth control pills—whether combined or progestin-only—are designed to prevent ovulation. In other words, if you’re taking your pill as directed, ovulation should not occur unless pills are missed (8).
For this reason, using Clue’s fertile window feature to assess your risk of pregnancy is not recommended and could increase your risk of unintended pregnancy.
How soon do you ovulate after missing a pill?
It’s unclear how soon you ovulate after missing a pill. One study found that missing 1–4 pills was enough to encourage immature egg growth and increase reproductive hormones, but there was no indication of ovulation (9). More concrete research is needed, but it is possible to ovulate soon after missing your pill. Following the instructions on your pack is the best way to prevent pregnancy.
How soon after unprotected sex can you test for pregnancy?
If you’ve had unprotected sex, missed more than one pill, and were unable to follow the instructions above, there is a chance of pregnancy. The chance increases if you’ve missed more than one pill (8). It’s recommended to wait at least two weeks after unprotected sex to take a pregnancy test. This is because it can take around 10 days for a fertilized egg to implant in the uterus (10) Testing too early may result in a false negative because the pregnancy hormone might not yet be high enough to detect.
If you have not experienced vaginal bleeding between your pill packs, take another pregnancy test. If you get a negative result at home but don’t have vaginal bleeding and are still concerned you might be pregnant, you should visit a healthcare provider.
Emergency contraception
If you don’t want to risk getting pregnant, you may need emergency contraception—especially if you had sex without a condom during the seven days before or after missing your pill (11). There are a few emergency contraception options, what you choose depends on how many days it has been since you had sex (12).
Options include:
The copper intrauterine device (IUD).
The 52 mg hormonal IUD with levonorgestrel.
Morning-after pills with levonorgestrel or ulipristal acetate (5).
The morning-after pill:
Levonorgestrel 1.5mg: Effective if taken within 72 hours (3 days) after unprotected sex (12). In the USA, this option is available over the counter at most pharmacies.
Ulipristal acetate 30mg: Effective if taken within 120 hours (5 days) after unprotected sex (12). In the USA, a prescription is required to obtain this option.
While ulipristal acetate is generally considered more effective at preventing pregnancy than levonorgestrel, some studies suggest that it can interact with hormones in birth control pills, which may reduce its effectiveness as an emergency contraception option (5,12). If you are using birth control pills and wish to use ulipristal acetate for emergency contraception, speak to your healthcare advisor for guidance (5).
Non-hormonal IUD (Copper IUD or Copper coil):
This is a T-shaped device made of copper and plastic that sits at the top of your cervix. It can be inserted within 120 hours (5 days) after sex and provides long-term contraception for 10 years. It is the most effective form of emergency contraception but needs a specially trained healthcare professional to insert it (12).
Can I use birth control pills for emergency contraception?
Yes, you can use your birth control pill as emergency contraception, but it may be less effective than other emergency contraception methods (5). Each brand has specific instructions on how many pills to take and when to take them as emergency contraception. Read the instructions in your pill pack, or ask your healthcare provider or pharmacist before using your pill as emergency contraception.
How to cope with the anxiety and stress of missing a pill?
We understand how stressful and anxiety-inducing missing a pill can be. Follow the instructions provided here or in the information leaflet with your pill pack. If you're unsure what to do, consult your healthcare provider or a pharmacist for guidance.
Here are some ways you can help manage your anxiety:
Communicate openly with your partner(s)
Be honest with your partner: Explain that you missed a pill and are managing the situation. Let them know what steps you’ve taken to minimize the risk.
Involve them: If you need to use backup contraception, like condoms, for a few days, let them know why and for how long.
Express your feelings: Share your concerns so your partner understands the emotional impact it’s having on you.
Encourage shared responsibility: Reassure your partner that contraception is a shared responsibility. This can open the door to discussing how they can support you moving forward, whether that’s by reminding you to take the pill or exploring other contraceptive options together.
Use a backup method of contraception going forward
Use condoms or change your contraception: If you have any concerns, then using condoms during sex will provide additional protection. If your anxieties around missing pills persist, it may be worth considering changing to a long-term contraceptive method.
Seek mental health resources
Talk about it: Speaking to a trusted friend, healthcare provider, or counselor can help you process any anxiety you’re feeling.
Consider therapy if stress is persistent: If anxiety around contraception is ongoing, a therapist may help with coping strategies.
Risk of STIs
It’s important to remember that the birth control pill does not protect you from STIs. We always recommend that you use a condom to prevent any STIs, especially if you are unsure of the STI status of your sexual partner(s).
Takeaway
Missing your birth control pill can be frightening and anxiety-inducing, but it's more common than you might think. Make sure to follow the recommended steps, and reach out to your healthcare provider or pharmacist if you have any concerns. Open communication with your partner is important, and managing your stress through relaxation techniques or talking to someone can be very helpful. Remember, you’re not alone in this.
FAQs
What are the chances of getting pregnant if I’ve missed one pill?
There is no simple answer to this. A study published in 2020 found that fewer than 5 in 100 people with cycles who missed a birth control pill became pregnant during that cycle (13). Beyond this study, there is limited evidence or specific statistics on how likely you are to get pregnant after missing one pill. Following the instructions in your birth control packet is the best way to know what to do after you miss a pill.
Do I need to take Plan B if I missed one pill?
The Centers for Disease Control (CDC) states that if you miss one pill, you don’t need any backup birth control (11).
