It can be easy to lose a pill in a handbag or down the drain. If this happens, the best course of action depends on the type of pill.
In this article, we discuss what a person should do if they lose a combination or progestin-only birth control pill. We also explore how missing a pill can affect pregnancy rates and medical conditions.
What to do if you lose a combination pill
If a person loses a combination pill, they should take the next active pill and request a replacement pack.
Combination pills contain both estrogen and progestin.
Combination pills come in 21- or 28-day packs, which have slightly different instructions:
- People need to take every pill in a 21-day pack to prevent pregnancy. After finishing these pills, they take no pills for 7 days, then start a new pack.
- People also need to take every pill in a 28-day pack, but the final seven pills will contain no medication. These are placebo pills.
If a person loses a pill, they should call their doctor and ask for a replacement pack as soon as possible. In the meantime, the doctor may offer the following advice:
- If you lose an active pill, take the next active pill in the pack as soon as possible.
- If you lose a placebo pill, it is fine to skip the dose, as these pills do not contain any hormones.
If a person loses a pill and fewer than 48 hours have passed since they took their last pill, the Centers for Disease Control and Prevention (CDC) recommend:
- taking the skipped dose as soon as possible
- continuing to take a pill at the regular time of day, even if it involves taking two pills in 1 day
- considering using emergency contraception if pills were also lost or skipped in the last week of the previous cycle or earlier in the current cycle
If a person has lost only one pill and returned to a regular dosage immediately, it is not usually necessary to use alternative methods of contraception, such as condoms. However, it is best to use these if there are any doubts.
Returning to a reliable dosage of birth control becomes more difficult if a person has missed two or more doses, or it has been longer than 48 hours since the last dose.
If this is the case, a person should:
- Take the skipped dose or doses as soon as possible.
- Continue taking a new pill at the regular time, even if it means taking more than one pill in a day.
- Use an additional form of contraception for the next 7 days, until a week of regular doses has passed.
- Consider using emergency contraception. This is especially important if a person has had sex in the past 5 days and the missed dose or doses were in the first week of the cycle.
- If using a 28-day pack, and the missed doses took place on days 15–21 of the cycle, skip the hormone-free doses and start a new pack right away. If this is not possible, a person should use additional methods of contraception until they have taken doses that contain hormones for 7 days.
What to do if you lose a progestin-only pill
Progestin-only pills are also called POPs or mini-pills. A person must take them within the same 3-hour period every day to prevent pregnancy.
Progestin-only pills take effect more quickly than combined pills, typically within about 2 days, but the effects also wear off more quickly. This means that there is less room for error.
If a person misses their 3-hour window, and it has been 27 hours or more since their last dose, the CDC recommend:
- taking the next dose as soon as possible
- returning to a regular dosage schedule, even if it means taking two pills in a day
- using additional methods of contraception for 48 hours, until a person has taken the pill regularly for at least 2 days
- considering using emergency contraception if a person has had sex before 2 days of regular doses have passed
Possible effects on pregnancy and medical conditions
Although they are 99 percent effective, a person can still become pregnant while taking the pill.
If a person takes birth control pills correctly, they are 99 percent effective for preventing pregnancy. The pill is much less effective if a person does not follow the instructions. Typical use generally results in a 9 percent failure rate.
A person can still become pregnant while taking the pill. This can occur on purpose or by accident.
Many wonder if the hormones in the pill can affect the fetus. A study from 2016, which looked at more than 880,000 live births in Denmark, reported no link between birth control pills and birth abnormalities.
Missing doses of birth control pills or taking them too far apart can also result in unscheduled bleeding, which can be bothersome.
It is important to note that some people take birth control pills for reasons other than contraception. Birth control pills can also help to treat medical conditions, including:
- polycystic ovary syndrome (PCOS)
- menorrhagia (heavy periods)
- dysmenorrhea (painful periods)
If a person taking birth control pills to manage PCOS or endometriosis loses a pill or misses a dose, they should follow the relevant advice from the CDC above.
PCOS is an endocrine disorder that is closely linked with hormonal imbalances. It affects about 10 percent of women of childbearing age, and it is associated with a wide variety of health problems.
In people with PCOS, birth control pills can help to reduce:
For people with endometriosis, hormonal birth control pills can help to reduce pain and make periods lighter, shorter, and more regular.
Losing a pill or missing a dose may cause a slight increase in these symptoms. It will last until the dosage is back on track.
Like any medication, birth control pills work best if a person follows a doctor's instructions. In the case of these pills, this involves taking one a day.
If a person has missed a pill and is wondering what to do, Planned Parenthood's information quiz can provide information about options and next steps.
The best guidance will depend on:
- the type and brand of pill
- whether it was a combination or a progestin-only pill
- whether the pills came in a 21-, 28-, or 91-day pack
- when the missed dose occurred in a person's cycle
- how many doses they missed
- whether the person has had sex after missing a dose
Healthcare providers can provide personalized advice.