Maybe you were rushing one morning and forgot to take it. Maybe you didn’t refill your prescription before a trip and missed a week. Or maybe you’ve decided now’s the time to start trying for a baby.
Whatever the reason, almost every person who takes birth control pills skips or stops at some point. But it’s a little scary: You’ve been faithfully swallowing that little pill every day for years. What’s happening in your body when you miss one, two, or more?
Relax. “All of us have missed a pill or two — we’re only human!” says Sherry Ross, MD, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. Here’s what you need to do based on how many pills you’ve accidentally skipped.
What to do if you’ve missed one birth control pill
Take it as soon as you remember or take two pills the next day at the same time. “The chance of you getting pregnant is really unlikely if you get back on track quickly,” Ross says.
What to do if you’ve missed two birth control pills
Double up on pills the next day and the day after that. Still, according to Ross, the chance of pregnancy is very small, so no need for a backup method.
There’s a chance you’ll notice nausea or breakthrough bleeding, adds Alyssa Dweck, MD, a gynecologist in NYC and assistant clinical professor at Mount Sinai School of Medicine.
What to do if you’ve missed three or more pills
Here’s where it gets complicated. At this point, your hormone levels are disrupted, which lowers the pill’s effectiveness.
If you had sex on any of the days you missed pills, Dweck recommends taking emergency contraception, also called “the morning-after pill.” Then throw out your old pack of pills and start a new one. Contact your healthcare provider if you need a new pack.
“You must use a backup form of contraception, such as condoms, for one week,” Dweck says.
There’s no waiting period to bring your body back to its baby-making ways. Once you stop taking the pill, the extra hormones leave your body and you can start ovulating again — meaning you can get pregnant right away, Dweck explains.
As for other effects, the way your body reacts really depends on why you started taking the pill in the first place, Dweck says. Doctors prescribe the pill for many reasons.
In addition to preventing pregnancy, the pill can help:
- regulate your cycle
- give you lighter periods
- diminish cramps
- improve premenstrual syndrome (PMS)
- clear up hormonal acne
The pill can also be used to help lessen symptoms of endometriosis or treat polycystic ovary syndrome (PCOS).
If you were taking birth control pills to ease certain symptoms, you’ll likely experience the same issues you dealt with before once you stop taking them, Dweck says.
This could mean period cramps, acne, or other PMS problems like headaches, cravings, and breast tenderness return in full force. But as long as your periods were regular before the pill, your cycle, including ovulation, will resume as soon as you stop.
If you had an unpredictable cycle before taking birth control, though, you may once again have irregular periods after stopping the pill.
Note that some women experience what’s called post-pill amenorrhea, Dweck says. That means you may not get a period for two to three months after stopping the pill as your body readjusts to normal hormone production.
If you’ve stopped your pills for more than three months and your period is MIA, take a pregnancy test and see your doc.
You may actually be able to feel yourself ovulating. “Mittelschmerz” is the German name for what’s described as a slight cramping, twinge, or discomfort in the lower abdomen when the ovary gets ready to release or releases an egg.
Another sign of ovulation is an increased amount of cervical mucus — that fluid that looks like egg whites — on your underwear.
Deciding to stop taking the pill is an individual choice. Maybe you’re ready to get pregnant. Maybe the pill has caused unwanted side effects. Or maybe you’re worried about risks.
“In some cases, women report upsides of going off the pill, including a better libido, weight loss, and more stable moods,” says Jennifer Wider, MD, women’s health expert and author of “The Doctor’s Complete College Girls’ Guide to Health.”
But this really varies from person to person. In other words, just because your friend says she feels fantastic off the pill, it doesn’t necessarily mean you should stop taking it.
Quitting the pill means you may miss out on health benefits, including — according to the American Cancer Society — a decreased risk of ovarian, endometrial, and possibly colorectal cancer. But taking certain birth control pills also comes with an increased risk of cervical and breast cancers and blood clots.
Talk to your doctor about the pill you’re on and any risks or benefits specific to you.
Birth control pills work to prevent pregnancy by preventing ovulation, Dweck says.
Most pills contain synthetic forms of two female hormones: estrogen and progestin. But one type, called a mini-pill, has progestin only.
These synthetic hormones stabilize your natural hormones and prevent the peak of estrogen that would otherwise signal your body to ovulate, or release eggs from the ovaries to be fertilized.
If you’re looking to get off the pill altogether, first talk to your doctor about an alternative method of birth control — if you need one — or another way to treat symptoms of PMS or other conditions.
Missing pills is common, but here’s what you need to know if you want to avoid pregnancy: If you’ve missed one or two pills, make them up ASAP. Three or more? All bets are off. Start a new pill pack and use a backup method for seven days.