For other conditions, when a dose is missed, we are often instructed not to take a double dose, but to skip the missed dose and take the next one at the usual time. Oral contraceptive pills or birth control pills should be taken at the same time each day after meals and missing a dose of birth control pills can reduce the contraceptive protection. However, the instructions for a missed dose is often not as simple as skipping the missed dose and continuing as per normal, sometimes a double dose is needed to make up for it. What then should be done if a dose is missed?
21-Day Pack Oral Contraceptive Pills (OCPs)
Dose is missed for less than 12 hours
Generally, if the missed dose was less than 12 hours ago, contraception protection is not reduced. The missed pill should be taken as soon as you remember and continue to take the next dose as originally scheduled. In some cases, this may mean having to take two doses in one day. Additional protection during intercourse is not needed.
Dose is missed for more than 12 hours
If the dose is missed for more than 12 hours, contraceptive protection may be reduced and the instructions get a little tricky. It must be remembered that tablet-taking should not be discontinued for more than 7 days.
Week 1
If the missed pill happened during week 1 of starting the pack, take the missed pill as soon as you remember, even if it means having to take two pills at the same time. Continue to take the rest of the pills as per the original schedule. A barrier method of contraception (eg. condoms) should also be used during the next 7 days. If you had intercourse in the week prior to the missed dose, you should consult your doctor as there is a chance for you to get pregnant.
Week 2
If the missed pill took place in week 2, the missed pill should be taken as soon as remembered, even if it means having to take two pills at the same time. Continue to take the rest of the pills as per the original schedule. However, if you missed more than one dose, or you only missed one dose but did not take the pills correctly in the 7 days before the missed dose, a barrier method of contraception is also needed for the next 7 days.
Week 3
If the missed pill took place in week 3, the risk of reduced contraceptive protection is large because of the upcoming tablet-free interval. However, by adhering to the following options, the reduction of contraceptive protection can still be avoided. There are two options that you may choose to adhere to.
Take the missed pill as soon as you remember, even if it means having to take two pills at the same time. Continue to take the rest of the pills as per the original schedule and start the next pack of active pills right away. This means you will not have the 7 hormonal free days. It is unlikely for you to experience the withdrawing bleeding, which you normally get during the 7 hormonal free days, until you have completed all 21 active pills of the second pack. However, you may still experience some bleeding, known as breakthrough bleeding or spotting, while on the active pills. This bleeding does not necessarily mean that there is a decrease in the effectiveness of the birth control pills and it usually goes away on its own. However, if you are not comfortable with the bleeding, you may consult your doctor.
Stop taking the active pills and have a hormonal-free interval (stop taking the active pills) for 7 days. These 7 days includes the day that you missed a dose. After the 7 days, a new pack should be started. If you have only missed one pill and have taken your pills correctly in the 7 days before the missed pill, extra contraception is not needed and you may choose to adhere to either option. However, if you have missed one tablet and have not taken your pills correctly in the 7 days before the missed tablet, or if you have missed more than one tablet, you would need to follow option 1 and use extra contraception for the next 7 days.
28-Day Pack Oral Contraceptive Pills (OCPs)
Missing a dose of the inactive pills can be disregarded. You may just remove the missed inactive pill from the strip and discard it.
Dose is missed for less than 24 hours
However, if an active dose is missed for less than 24 hours, you should take the pill as soon as you remember, then resume taking the next dose at the normal scheduled time. Contraceptive protection is not reduced, hence there is no need for additional protection.
Dose is missed for more than 24 hours
If an active dose is missed for more than 24 hours, contraceptive protection may be affected. The actions to be taken depends on when the dose was missed.
Day 1-7
If the missed dose happened within days 1 to 7 of the pack, you should take the missed dose as soon as you remember. The next dose should be taken at the normal scheduled time. A barrier method of contraception should also be used for the next 7 days. If you had engaged in intercourse within 7 days prior to the missed dose, you may wish to consult your doctor as there is a possibility of pregnancy.
Day 8-14
Take the missed dose as soon as you remember, the next dose can be continued as per the normal scheduled time. If you did not take your pills correctly in the 7 days prior to the missed dose, or if you missed more than one dose, a barrier method should also be used for the next 7 days. Otherwise, there is no need for extra contraceptive protection.
Day 15-24
Depending on your situation, there are two options that you may consider adhering to.
Take the missed dose as soon as you remember, then continue to take the pills as per the original schedule until you have completed all the active pills of that pack. Discard the 4 inactive pills and start on a new pack right away. Again, you are unlikely to experience withdrawal bleeding until you have completed taking the active pills of the second pack, however you may experience breakthrough bleeding or spotting.
The other option is to stop taking the active pills from the current pack and have a hormonal-free interval for up to 4 days. These 4 days includes the day of the missed dose. After the 4 hormonal-free days, you can start on a new pack.
If you have missed only one dose and had taken your pills correctly the 7 days prior to the missed dose, you can choose to adhere to either option 1 or 2 and additional contraceptive protection is not needed. However, if you have missed more than one dose, or if the pills were not taken correctly the 7 days before the missed dose, you will need to follow option 1 and a barrier method of protection should also be used for the next 7 days.
As a general guidance, regardless of what brand of birth control pills you are on, it is important to remember to take them everyday!
No withdrawal bleeding
Regardless of which kind of OCP you are on, if you are sexually active and noticed that you do not have any withdrawal bleeding during the hormonal-free intervals, especially when you have missed a dose, there is a possibility that you are pregnant. You may wish to consult your doctor before starting on the next cycle of your birth control pills.
These are just some general guidelines on the management of missed birth control pills. If you have any concerns, you may wish to consult your doctor or refer to the patient information leaflet that comes along with your birth control pills.
References
https://www.singhealth.com.sg/patient-care/medicine/oral-contraceptives/dosage
https://www-uptodate-com/contents/evaluation-and-management-of-unscheduled-bleeding-in-women-using-contraception?search=breakthrough%20bleeding%20on%20oral%20contraceptives&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3531674949
https://www.healthline.com/health/womens-health/breakthrough-bleeding#see-your-doctor
Diane-35 tablet [package inset on the internet]. Weimar, Germany: Bayer (South East Asia) Pte Ltd; 2016 [updated 5 Dec 2016; cited 4 Apr 2021]. Available from: https://eservice.hsa.gov.sg/prism/common/enquirepublic/SearchDRBProduct.do?action=getProductDetails
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