Chloe asked
I am 100% sure that I did not take yesterday’s birth control pill but when I went to take today’s and yesterday’s to make up for it, yesterday’s pill was missing from the pack. I either took two pills in a previous day by accident or it somehow fell out. I am on the last two days of my pack before placebo and I’m experiencing some spotting and cramps. I’m also worried because I’m sexually active. How should I go about taking the next few pills and the next pack?
Answer
Although recommendations can vary slightly depending on your specific birth control product, the following is what you should do (according to the CDC) if you miss one active (i.e. hormone containing) birth control during the last week of your pack:
- Take the late or missed pill as soon as possible.
- Continue taking the remaining pills at your usually scheduled time, even if it means that you take two pills in one day.
- You are still protected from pregnancy if you miss one dose and therefore, back-up contraception is not needed if you are sexually active.
It is important to note that missing one pill during your last week increases your chance of spotting, breakthrough bleeding or even an early period as the lack of hormones from the pill is the signal for your body to menstruate.
What If You Miss Two Pills The Last Week?
In your situation, you have the caveat that you not only missed one dose, you are also missing one pill. Unless you are able to take a replacement pill from a spare pack, you will then be missing two doses in your last week (the one dose you already missed, and the dose you may miss since you lost a pill). This is where things get a little tricky and you should reference the patient instructions for your specific birth control product as it will walk you through what to do.
Nevertheless, for most birth control products, the following is the recommendation if you miss two doses in your last week (from the patient information for Yasmin):
- If you are a Day 1 Starter (i.e. started your pack on the first day of menses): Throw out the rest of the pill pack and start a new pack that same day.
- If you are a Sunday Starter: Keep taking one pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of pills that same day.
Whatever method you utilize, if you miss two or more doses in your last week of active pills, you must use back-up contraception until you have taken 7 consecutive days of active pills. In addition, following the above recommendations, you may not have your period since you will be continually taking active pills but you may experience spotting.
Lastly, the CDC has similar recommendations to the instructions from Yasmin when missing two or more doses from your last week of pills:
- Omit the hormone-free interval (i.e. placebo pills) by finishing the hormonal pills in the current pack and starting a new pack the next day.
- Use backup contraception (e.g., condoms) or avoid sexual intercourse until you have taken 7 consecutive days of active, hormone containing pills.
