You may need to take more than one pill to help restore your hormone levels or use a secondary contraceptive for the next 2 to 7 days.

Manufacturers design birth control pills to maintain an even level of hormones in your body. Taking your pill at the same time each day keeps this level of hormones consistent.

Losing a pill or forgetting to take it until later in the day can cause these levels to fluctuate. You may begin ovulation, which can increase the risk of unintended pregnancy.

Doctors usually recommend taking a replacement pill as soon as possible, even if it means taking two pills in a day. Your next steps depend on what type of pill you take and where you are in your pill pack before missing a dose.

You might find consulting with your local pharmacist or prescribing healthcare professional helpful. If you take the pill at night or can’t reach your doctor’s office, these tips can help.

Combination pill packs often contain two types of pills: active and inactive.

In a standard pill pack, the first 21 to 24 doses are active pills that contain a mix of synthetic estrogen and progesterone. The last four to seven doses are inactive or placebo pills without hormones.

In an extended pill pack, the first 84 doses are active pills, and the last 7 doses are placebo pills.

If you miss 2 or more doses, or your dose is more than 24 hours late, it’s important to use a secondary method of birth control for the next 7 days.

Take the next active pill

Take the next active pill to keep moving along in your pack. The days indicated on the pack of pills may not align with the days you’re taking them, so make sure you do not miss any additional doses.

You may reach the end of your pack a day early and need to begin your next pack a day early. This shift doesn’t affect the pill’s effectiveness.

Take the last active pill of your pack

Most combination pills are monophasic, meaning that each active pill contains the same level of hormones. In this case, you can take the last active pill in your pack in place of your missed dose.

This ensures that you take all the remaining active pills on their regularly scheduled day.

This method doesn’t work for multiphasic pills. Biphasic and triphasic pills have different levels of hormones throughout the month. Dosing depends on where you are in the pack at the time of the missed pill.

Take a spare active pill

With monophasic pills, you can take any of the active pills in your spare pack. With multiphasic pills, you must take a dose equivalent to the lost dose.

You can save the rest of the pack in case you lose another pill in the future. Just be sure to watch the expiration date, as you may not take all the active pills within the recommended time.

Is it OK to miss an inactive or placebo pill?

Placebo pills don’t contain any hormones, so missing one won’t increase your risk of pregnancy. Manufacturers design them to help you maintain your routine until you start a new pill pack.

Most progestin-only pill packs only contain active pills. Slynd, which manufacturers introduced in 2019, is the only progestin-only pill that includes placebo pills in each pack.

Progestin-only pills, also known as “minipills,” are monophasic. That means each active pill contains the same level of synthetic progesterone.

Because of this, you have your pick of what to do next. You can take the:

  • next active pill in your current pack
  • last active pill in your current pack to keep your doses aligned with the correct days of the week
  • active pill from a spare pack of progestin-only pills

Your body absorbs synthetic progesterone quicker than synthetic estrogen, so if your dose is more than 3 hours later than usual, it’s important to use a secondary method of birth control for the next 2 days.

You may experience temporary nausea when taking pills in a day.

You may experience breakthrough bleeding if more than 24 hours pass since your last dose. Period-like cramping is also possible. These symptoms usually resolve when you return to your usual schedule.

If you take combination pills, you may develop a headache or migraine due to the decrease in synthetic estrogen. This is more likely if you miss an active pill at the beginning or end of your pack.

You might consider taking an emergency contraceptive pill, like Plan B or ella, if you miss a combination pill at the start of your pack or miss more than one combination or progestin-only pill.

You can make up for a missed dose by moving ahead to the next pill in your pack or replacing a lost pill with a pill from a new pack. When in doubt, use a secondary method of birth control.

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 better suit you and your lifestyle.