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Have you ever dropped a birth control pill down the sink? Have you crushed a few pills in the bottom of your purse? People sometimes lose pills. When that happens, it’s important to have a plan of action to make sure this doesn’t affect your birth control’s effectiveness.
Call your doctor if you lose your pill. Ask for guidance about your particular pill type. Each one is different, and your doctor may be able to recommend the best strategy for you.
If you take the pill at night or can’t get in touch with your doctor’s office, you can take matters into your hands with these tips.
The two basic types of prescription birth control pills are minipills and combination pills.
Minipills only contain progestin, or synthetic progesterone. Combination pills have, as the name suggests, a combination of two synthetic hormones, progestin and estrogen.
Combination birth control pills may be monophasic or multiphasic. With monophasic birth control, which is more common, each active pill in a pack contains the same level of hormones. With multiphasic birth control, you receive different levels of hormones on different days.
Combination pills and minipills work in similar ways. First, they work to prevent ovulation (although some pills don’t stop ovulation 100 percent of the time).
Ovulation happens each month when an egg is released from a woman’s ovaries for fertilization. If no egg is released, there’s zero chance of pregnancy.
Birth control pills also thicken the mucus buildup on your cervix, which can prevent sperm from working their way into your uterus. If the sperm makes it to the uterus, an egg released during ovulation could be fertilized.
Some birth control pills also thin the lining of the uterus to prevent implantation. If an egg is somehow fertilized, this thin lining will make it difficult for the fertilized egg to attach and develop.
Birth control pills are designed to maintain an even level of hormones in your body. Taking your pills daily and at the same time each day keeps this level of hormones consistent.
If these levels fluctuate, your body could begin ovulation fairly quickly. This increases your risk of an unplanned pregnancy.
If you take combination pills, you do have a slightly increased level of protection against this hormone dip, as long as you start taking your pills again as soon as possible.
If you take progestin-only pills, the window of protection is much smaller. This window lasts about three hours.
Next time you have an appointment with your doctor, ask them what they recommend you do if you ever lose your pill. Your doctor may suggest one of these first three options:
Take the next pill
Keep moving along in your pack, by simply taking the next active pill. The days indicated on the pack of pills may not align with the days you’re taking the pills, but just make sure that you do not miss taking a pill each day. You’ll reach the end of your pack a day early and will have to begin your next pack a day early. This shift won’t affect the pill’s effectiveness.
Take the last pill of your pack
If you’re still taking active pills (and you’re using monophasic birth control), take the last active pill in your pack in place of your lost pill. This ensures that all remaining pills are taken on their regularly scheduled day. You’ll reach the end of your pack and begin placebo pills — the inactive pills at the end of your pack — a day early.
You can start your next pack a day early, too.
NOTE: This method doesn’t work for multiphasic birth control as the dosing would be interrupted based on where you are in the pack at the time of the missed pill.
Take a spare pill
If you have another pack of birth control pills handy, take one of the pills from that pack to replace the one you’ve lost. Set that pack aside, and keep it in the event you lose a pill at another time.
If you’re taking a multiphasic pill, you can take the appropriate dosed pill for the one you lost.
If you’re taking a monophasic pill, you can take any of the active pills in your spare pack. This method allows you to keep taking pills on the days listed on the pack (Monday’s pill on Monday, Tuesday’s pill on Tuesday, etc.).
Be sure to watch the expiration date on your spare pack, as you may not use all of the active pills within the recommended time.
If you lose a placebo pill
If you lose a placebo pill, you can skip this dose. You can wait until the next day to take your regularly scheduled dose.
Because placebo pills don’t contain any hormones, missing one won’t increase your chances of getting pregnant.
You don’t have as much wiggle room if you lose a progestin-only pill. You need to take one within a few hours of your scheduled dose time, or the effectiveness of your birth control pills may drop.
The next time you have an appointment with your doctor, ask them what they suggest that you do in the event you lose a pill.
You can also do one of the following:
Take the next pill
Take tomorrow’s pill instead, and then continue on with the rest of the pack. Although the day on which you take the medicine will now be a day off from the pill’s scheduled dates, this will keep your level of hormone constant.
Take the last pill of your pack
If you want to keep your pills aligned with the correct days of the week, you can take the last pill in your pack in place of your lost pill. Then take the remainder of the pack as originally scheduled.
You’ll reach the end of your pack sooner, but you can begin your next pack immediately after.
Take a spare pill
Replace today’s pill with a pill from an unopened pack. This will keep your pills lined up for the remainder of your pack, and you’ll begin your next pack on time.
Keep this extra pack of pills handy and set it aside in the event you lose another pill in the future. Be mindful of the expiration date on your spare pack. You want to be sure your backup pills are still effective.
Whether you take combination pills or minipills will determine when you start your next pack.
For combination pills
If you take a combination pill, the answer depends on how you replaced the pill you lost.
If you took the last active pill from your pack to replace the one you lost or you skipped ahead in your pack by one day, you’ll begin your placebo pills a day early. That means you’ll also reach the beginning of a new pack a day early. You should begin taking the next pack a day early to maintain efficacy of the birth control.
If you took a pill from another pack, you should be on your regular pill schedule. In that case, you’ll begin taking your next pack on the same day you would if you hadn’t lost a pill. Take your placebo pills, and immediately begin your next pack.
If you take progestin-only minipills, start the next pack as soon as you end the one you’re currently using.
Progestin-only pills deliver hormones with every single pill. You don’t get the placebo pills with progestin-only pill packs, so you can begin your next pack of pills as soon as you reach the end of your pack.
If you lost a pill and skipped taking it entirely, you may experience some breakthrough bleeding. Once you resume taking your daily birth control pills, the bleeding should end.
If you take combination pills, you should use some form of backup protection if you skip two or more pills, or if it has been greater than 48 hours since you should have taken your pill. You should use this backup method for the next seven days. If you replace the lost pill with another pill, and you did not actually miss taking a pill, you will not need backup contraception.
If you take progestin-only pills and skip your lost pill, your risk of getting pregnant will increase. Use a backup method of birth control for at least 48 hours after you resume taking your pills daily.
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These best practices can help you avoid an unplanned pregnancy or possible side effects caused by birth control:
- Take the pill every day at the same time. Set a reminder on your phone, or pick a time of day that you can easily remember, such as breakfast. You should take your pill every day for highest effectiveness.
- Limit alcohol use. Alcohol doesn’t influence the pill’s effectiveness, but it can affect your ability to remember to take it. If you take your pill and then throw up within a few hours, whether from illness or alcohol consumption, you may need to take another pill.
- Check for interactions. Some prescription drugs and over-the-counter (OTC) herbal supplements may affect your birth control’s effectiveness. Before you begin taking the pill or any other medicine, ask a doctor or pharmacist if it’s safe for you to mix the two.
If you lose a pill, you can easily remedy the problem by calling your pharmacist or doctor’s office and getting advice, moving ahead to the next pill in your pack, or replacing the lost pill with a pill from a new pack.
Instead of waiting until you’ve lost a pill to figure out what to do, be proactive. Ask your doctor now how you should handle losing a pill so that you’ll know what to do if it ever happens.
If you lose pills frequently or find yourself skipping pills regularly, you may want to discuss switching to a new birth control option. One that doesn’t require daily upkeep may be better suited for you and your lifestyle.
Birth control options such as a vaginal ring, patch, or intrauterine device (IUD) can help you maintain protection against an unplanned pregnancy without having to take a daily pill.