The pill, patch and vaginal ring: Missed

Birth control pills, patches and vaginal rings are considered effective methods of contraception when used as prescribed. If you're very late taking a pill, applying a patch or inserting a vaginal ring or you miss a pill or patch completely, you may not be protected from pregnancy.

If you've missed any of your pills or patches or use a vaginal ring more than a week past its change date and you don't have your next period as expected, consult your doctor to determine if you're pregnant.


Missed combination pills (estrogen and progesterone)
If you miss a pill, it's important to get back on track as soon as possible.
Missed pills from a 21- or 28-day pack


If you miss one pill during the first three weeks of the pack, take it as soon as you remember. Then, take your next pill at your usual time -- even if this means taking two pills in one day. Finish this pack and restart your new pack as scheduled. If you were more than 12 hours late, use a backup method of birth control for the next seven days.

If you miss two pills during the first or second week of the pack, take two pills a day for the next two days. Take the first two pills as soon as you remember. The next day, take another two pills. This may cause you to feel nauseated or queasy, but by the end of the second day you'll be caught up with your regular schedule. Finish this pack and restart your new pack as scheduled. Do not take more than two pills in one day. Use a backup method of birth control for the next seven days.

If you miss two pills during the third week of the pack and you don't start new packs on Sundays, throw away your current pack of pills and start a new pack of pills today. If you're a Sunday starter, continue taking a pill every day until Sunday and then start a new pack. Use a backup method of birth control until you've been back on birth control pills for seven days.

If you miss three pills during the first three weeks of the pack and you don't start new packs on Sundays, throw away your current pack of pills and start a new pack of pills today. If you're a Sunday starter, continue taking a pill every day until Sunday and then start a new pack. Use a backup method of birth control until you've been back on birth control pills for seven days.

If you miss any number of pills from the last week of a 28-day pack, don't worry. These pills are usually sugar pills meant to help you remember to consistently take a pill every day. Missing these pills doesn't increase the risk of pregnancy and doesn't require a backup method of birth control. Simply throw away the missed pill(s) and resume your regular schedule.
Missed pills from a 91-day pack

If you miss one pill during the first 12 weeks of the pack, take it as soon as you remember. Then, take your next pill at your usual time, even if this means taking two pills in one day. Finish this pack and restart your new pack as scheduled. You don't need a backup method of birth control.

If you miss two pills during the first 12 weeks of the pack, take two pills a day for the next two days. Take the first two pills as soon as you remember. The next day, take another two pills. This may cause you to feel nauseated or queasy, but by the end of the second day you'll be caught up with your regular schedule. Finish this pack and restart your new pack as scheduled. Do not take more than two pills in one day. Use a backup method of birth control for the next seven days.

If you miss three or more pills during the first 12 weeks of the pack, don't take the missed pills. Leave those pills in the pack and continue taking the rest of the pills until the pack is finished. Use a backup method of birth control for the next seven days.

If you miss any number of pills from the last week of a 91-day pack, don't worry. These pills are usually sugar pills meant to help you remember to consistently take a pill every day. Missing these pills doesn't increase the risk of pregnancy and doesn't require a backup method of birth control. Simply throw away the missed pill(s) and resume your regular schedule.

Missed mini-pills (progestin-only)
If you're more than three hours late taking your pill, take it as soon as you remember. Then, take your next pill at the usual time. Use a backup method of birth control for 48 hours.

If you miss one or more pills, take one pill as soon as you remember. Then, take your next pill at the usual time, even if it means taking two pills in one day. Use a backup method of birth control until your next period.

Missed patch
If you forget to apply your patch the first week of your cycle, apply it as soon as you remember and use a backup method of birth control for seven days. The day you apply the patch will be your new "patch change day" for subsequent weeks.

If you forget to change your patch during the second or third week for one or two days, change it as soon as you remember and apply your next patch on your normal "patch change day." If you forget to change your patch for more than two days, start a new four-week cycle as soon as you remember. The day you apply the patch will be your new "patch change day" for subsequent weeks. Use a backup method of contraception for the first seven days of the new cycle.

Missed vaginal ring change
If you leave the vaginal ring in place up to one week longer than directed, remove the ring, wait one week and insert a new ring.

If you leave the ring in place for more than one week longer than directed, insert a new ring right away but use a backup method of birth control until the new ring has been in place for seven full days.

If the ring should fall out or is displaced during sex, rinse it with water and reinsert it within three hours. If you wait more than three hours, use a backup method of contraception until the ring has been in place continuously for seven days.

Emergency contraception
If you have unprotected sex and don't want to become pregnant, call your doctor immediately. Emergency hormonal contraception (commonly referred to as the "morning after pill") may help prevent pregnancy. It's taken in two doses. It's best to take the first dose as soon as possible after unprotected sex -- there's no need to wait until the next morning. Treatment will most likely be ineffective if you wait more than 72 hours after sex.

Considerations
There's no documented benefit to taking an occasional break from hormonal contraceptives. Pill-free intervals won't decrease the side effects you may experience once you begin taking the pill again, and being off the pill may result in an unplanned pregnancy.
Any episode of vomiting or severe diarrhea increases the risk of oral contraceptive failure. If you take the combination pill and experience this type of illness, be sure to use a backup form of birth control while you're sick through seven days after the illness. If you take the mini-pill and have diarrhea or vomiting, use a backup method of birth control while you're sick through two days after the illness. Diarrhea or vomiting shouldn't alter the effectiveness of the patch or the vaginal ring.


Pregnancy-specific information
According to the American College of Obstetricians and Gynecologists, birth control pills do not increase the risk of birth defects in an unborn child, whether you were on the pill before becoming pregnant, unintentionally took the pill early in a pregnancy or conceived immediately after discontinuing the pill. Specific data linking the patch or vaginal ring to birth defects is not available, but they don't appear to increase the risk.