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Late, late, for a very important pill?

Forgot to take your pill on time? Stay calm and read on...

by Andrea Jackson, MD

First, the short answer: If you miss a pill, you should take the pill you missed as soon as you can. If you take the pill less than 24 hours after you were supposed to and it's not the first week of a new pack, you don't need a back-up method—just take the pill you missed and relax. If it's the first week of a new pack of pills, you'll want to use a back-up method like condoms if you have sex in the 7 days after missing your pill.

Now, some more detail.

The pill works best if you take it every single day. You may have seen information about “perfect use” stating that the pill is 99.7% effective, but the reality is that with typical use it's 91% effective. (That means that of 11 women taking the pill for a year, one will become pregnant.)

In the real world, it’s a challenge for anyone with a daily medication to take it perfectly. Even people with serious medical conditions like high blood pressure have a hard time taking medicine every day. The World Health Organization estimates that about half of people with chronic medical conditions take their medication late or skip it completely on some days. In a study of young women using the pill, the majority (80%) missed one or more pills within the first few months.

If you take the pill, your health care provider probably recommended that you take it at the same time every day. Making it part of a daily routine can help you remember. Some women keep the pill packet next to their toothbrush, or get fun text message reminders every day.

What should I do about a late pill?

When your routine is a little off, you can still protect yourself from an accidental pregnancy. Exactly what to do depends on three things:

1) What type of pill you use. If you’re on the mini-pill, a.k.a. the progestin-only pill, ignore the chart and see the section on mini-pills below.

2) If you’re a combination pill user, as most pill users are, it depends on whether it’s the first week of a new pill pack, and

3) how long it’s been since you took the last pill.

I’m using the mini-pill—is that different?

About 1% of women taking the pill in the U.S. are using the mini-pill, or progestin-only pill. The active ingredient in mini-pills doesn’t stay in your body as long as combined pills, and there are no placebo pills. If you are late or skip a mini-pill at any time, follow the instructions above and use a back-up method like a condom (or EC if you miss the condom) if you have sex in the next two days. Yup, with mini-pills you have to use back-up even if you’re only a few hours late.

Um, you didn’t answer my question

If it’s not urgent, ask below and I’ll get back to you! If it is urgent, call your health care provider or a local clinic for help. If you can’t get through on the phone and you need help right away, you can also ask a pharmacist at a drug store.

Andrea Jackson, MD, is an Obstetrician/Gynecologist and a clinical fellow in Family Planning at the University of California, San Francisco. She’s passionate about educating young girls, teens, and women about their bodies, and empowering them to make smart choices in their lives. She loves running, her hyperactive dog Coco, and her nephews Aaron, Solomon, and Alexander.

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