Is It Better To Take Your Birth Control Pill Earlier Or Later?

Patricia asked

Hello! My contraceptive pill is Estinette, a combined hormone one. I take my contraceptive pill every day at 11.30 PM, more or less before going to bed. Today I will have to go to bed earlier and I was wondering if I can take my pill 2 hours earlier or if it's better to take later (at 3 AM... more or less when I wake up)? Thank you.

Answer

It is well-documented that taking your birth control pill at the same time every day is the best way to ensure it is most effective in preventing unplanned pregnancy.^[1]

Nevertheless, there certainly are situations where it may not be possible to take your next dose at your usual scheduled time.

The ramifications of this depend on a number of factors, including:

• Type of birth control pill you are taking (e.g. a combined hormone pill or a progestin-only pill).
• How far apart you take your dose from when it is usually scheduled.

Combined hormone pills (those that contain both an estrogen and progestin) have a lot more leeway in regard to missing your usually scheduled time.

In fact, most sources (including the Centers for Disease Control) state that even if you miss a dose and it has been up to 48 hours since your last dose, you likely do not need to use emergency contraception.^[2]

So, changing the time you take one dose in your entire pack by a few hours (like in your situation), there shouldn't be any issue as long as you take the rest of your pills at your normally scheduled time.

It is important to point out that if you were taking progestin-only pills (which are also known as 'mini-pills'), taking a dose a few as 3 hours from your usually scheduled time could increase your risk of pregnancy. They are a lot less forgiving than combined hormone pills.

Earlier Or Later?

The question here is, if you know you won't be able to take your birth control pill at your normally scheduled time, is it better to take it earlier in the day or later?

The answer, of course, depends on what you are looking to do, but as a general point, both result in essentially the same situation (that you are going to be taking a 'late' dose one way or another).

Earlier

If you take a pill earlier in the day, you will not be late for that dose, but if you resume taking your pills at your normal time the next day, your next dose will technically be late. For example:

• You usually take your pill at 11:30 PM. You decide to take your next dose early, at 9:30 PM. When you resume taking your pills at your regularly scheduled time the next day (11:30 PM), this would mean that there has been more than a 24 hour time period between your doses. This would be considered a late dose.

Now, if you decide that you want to continue taking your pills at your new time (e.g. 9:30 PM), then there is no problem.

Taking a pill earlier than scheduled would be considered ideal versus taking a pill later than scheduled since the risk of pregnancy increases only you are late with a pill (not early).

Nevertheless, if taking a pill early is a one-time thing, then, as mentioned in the example above, your next dose will end-up being late anyway.

The good news is that, as long as you are taking a combined hormone birth control pill, being a few hours late with a dose shouldn't decrease its effectiveness.^[3]

Later

Being consistently late with doses of birth control pills can increase your risk of pregnancy. If you otherwise take all your pills when you are supposed to though, you should be safe.

According to most sources, if you aren't consistently late (i.e. allow more than 48 hours to elapse since your last dose), the risk of pregnancy isn't thought to be greatly increased and emergency contraception is not likely to be required (this is for combined hormone pills only).^[4]

The following chart is provided by the CDC and describes what to do if you have missed (or are late with) a dose of a combined hormone pill.

As you can see, as long as 48 hours or more hasn't elapsed since your last dose (combined hormone pills only), you can catch up and you likely won't require emergency contraception.

If you have previously missed doses during your month of pills though, it may be a good idea to consider.

Which Is Better?

If you need to take your birth control pill at a different time than when you usually take it, it doesn't really matter if you take it earlier or later by a few hours.

Unless you are switching the time you take your pill every day to an earlier time, you are going to end up being late for a dose either on the day you switch your time or the day after (as discussed in the sections above).

Everything can be boiled down to these two main points:

• For combined hormone birth control pills (those which contain an estrogen and a progestin), as long as you aren't more than 48 hours late with your dose, your risk of pregnancy is not greatly increased and emergency contraception isn't needed (just follow the CDC instructions on how to get back on schedule).
• For progestin-only pills, if you are more than three hours from your usual dose, you will need to use emergency contraception as your risk of pregnancy is increased.

Final Words

So, overall, since you are taking a combined hormone pill, it doesn't much matter if you take one dose a little earlier or later than usual. Your risk of pregnancy shouldn't be significantly affected. As long as you take your other pills consistently, you should be protected.

If you have had missed doses during this pack, it would be prudent to consider using back-up contraception though (until you have taken 7 consecutive days of pills).

As a final point, anytime you don't take your pills consistently, you may experience some mild side effects, like spotting or breakthrough bleeding. In most cases though, you should return to normal your next cycle.