Can You Safely Miss Placebo Pills?

Duck asked

Can I start back on my active pill after only missing two placebo pills?

Answer

Missing the placebo, or inactive, pills in your birth control pack is perfectly fine. Doing so will not reduce the effectiveness of your birth control pills and will not increase your risk of pregnancy.

Placebo pills do not contain any hormones. They are included in birth control packs simply as placeholders, to help you stay on a consistent schedule of taking one pill by mouth, every day, at the same time.

For most birth control pill products, the placebo pills do not contain any active ingredients at all, but rather only inactive, or inert ingredients.

Some may contain iron or other vitamins (e.g. Loestrin Fe), but none contain active hormones. The placebo pills have no influence on the overall contraceptive efficacy of your birth control pills.

So, going back to your question, there is no issue with you missing 2 doses (or more) of the placebo pills. Simply start taking your active pills as regularly scheduled.

If you are late in taking your active pills, at that point, your birth control may not be as effective. Always start your active pills as scheduled.

To give one example scenario:

• You finish your pack of birth control pills on a Sunday.


• If you are taking a product with 21 active pills, you are then scheduled to start a new pack on the next Sunday.


• Regardless of how many placebo pills you take or miss in the 7 days in-between packs, you should always start your next pack of active pills at your regularly scheduled day (Sunday in this example).

In the next section, I discuss what placebo pills are in further detail.

Inactive Pills In Birth Control

Birth control pills are typically packaged in a way to help prevent missed doses, as doing so can increase adverse effects (e.g. spotting, bleeding) and of course, the chance of becoming pregnant.

Most pills contain 3 weeks of "active" pills and one week of “inactive” pills. Only active pills contain hormones.

There are some birth control pills that are slightly different (e.g. extended-cycle pills) but the principle among them are all the same. The active pills are the only ones responsible for the contraceptive effect.

Once the active pills are finished, menses (i.e. your period) will occur a few days later. The inactive pills, as discussed in the section above, only serve as a reminder to take your pills every day.

For one example, here is a popular birth control pill, Yasmin:

Yasmin contains 21 active pills and 7 inactive pills.

The 21 'active' pills contain:

• Drospirenone 3 mg
• Ethinyl Estradiol 0.03 mg
• Corn Starch
• Ferric Oxide
• Hypromellose
• Lactose
• Macrogol 6000
• Magnesium Stearate
• Modified Food Starch
• Povidone
• Talc
• Titanium Dioxide

The two active ingredients are Drospirenone, a progestin, and Ethinyl Estradiol, an estrogen. All of the other ingredients are 'inactive', and are used as fillers, binders, coloring agent etc...

Per the FDA, the definition of an active ingredient is:

"According to 21 CFR 210.3(b)(7), an active ingredient is any component of a drug product intended to furnish pharmacological activity or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body of humans or other animals."

The 7 'inactive' pills in Yasmin contain:

• Corn Starch
• Hypromellose
• Lactose
• Macrogol 6000
• Magnesium Stearate
• Modified Food Starch
• Povidone
• Talc
• Titanium Dioxide

As you can see, they do not contain any hormones and no ingredient in the 'inactive' pills are intended to have any pharmacological activity.

It is important to note that some birth control pills have 'placebo' pills with added iron or other vitamins, such as Loestrin Fe and Beyaz.

Although do have some benefit (e.g. replacing lost iron), they don't have any influence on how well your pills work in preventing pregnancy and therefore, missing them isn't of consequence in that regard.