What To Do After Missing One Dose Of Birth Control Pills

Lou asked

I have been on birth control pills for 5 months. I started the pack at 9 AM in the morning. The next day, I took the pill at 11 PM since as my gynecologist said that I should take the pill at night. In the same day, I had sex with a condom. After 3 days, I had sex for less than 5 minutes, but with no ejaculation. What is the risk of pregnancy?

Answer

Whether or not your birth control pills will be less effective after essentially missing one dose depends on the type of birth control pill that you take. The two types of pills are:

• Combined hormone pill
• Progestin-only pill (e.g. 'mini-pill')

Combined hormone pills contain both an estrogen (typically ethinyl estradiol) and a progestin (of which there are many types).

Combined hormone pills are much more forgiving in regard to missed doses, or taking a dose later than your usually scheduled time.

In your case, you changed your administration time from 9 in the morning to 11 at night, for a 14-hour difference. This essentially counts as one missed dose.

Combined Hormone Pills

Fortunately, for one missed dose, contraceptive efficacy doesn't seem to be significantly impacted if you are taking a combined hormone pill.

CDC guidelines state neither back-up contraception nor emergency contraception is generally needed if you are late or miss one dose:

Progestin-Only Pills

Administration with progestin-only pills, also known as mini-pills, is a lot less forgiving than combined hormone pills.

If you are more than 3 hours late taking a progestin-only pill, you are recommended to:

• Take the missed pill as soon as you remember.
• Continue taking your pills at your regular time.
• Use a backup method (e .g. condoms, spermicide) anytime you have sex for the next 48 hours.
• If you have had sex within 48 hours and did not use backup contraception, you might consider an emergency contraceptive, such as Plan B.