Missed one pill and had unprotected sex? Here's what you need to do

(Medically reviewed on: 12.09.19) So you had sex last night and you’re about to take your daily birth control pill when a panic hits you like a pile of rocks: there are too many pills in the packet, which means you’ve missed one or more than one.

Does that mean you’re at risk of an unplanned pregnancy? Should you take the morning after pill? We spoke to Dr. Emma Chan, a workshop facilitator at Sexplain*, and Julia Hogan, Marie Stopes UK’s contraceptive and sexual health nurse specialist*, to find out more.

It’s easier said than done, but before you start googling pregnancy symptoms take a deep breath and figure out how many pills you’ve missed.

“Missing one pill anywhere in your pack or starting the new pack one day late isn’t necessarily a problem if you’re using combined pills and you should still have contraceptive cover, ” says Julie Hogan, “however, missing two or more pills or starting the pack two or more days late may leave you unprotected. You’ve ‘missed a pill’ if you take it more than 24 hours later than your chosen time.”

The advice is slightly different depending on whether you are taking the combined pill or the progestogen-only pill (POP), otherwise known as the mini pill.

The combined pill contains a synthetic version of both oestrogen and progesterone, whereas the mini pill only contains progesterone. The combined pill is taken for 21 days with a seven day break, while the mini pill is taken every day.

“If you’re on the ‘combined’ pill and realise you’ve missed one, you should take it as soon as you realise,” says Emma. This may mean taking two pills in one day but while you should take the missed pill as soon as possible, you should take the second one at the time you would usually take it. If you’ve just missed one combined pill, it shouldn’t affect your chances of getting pregnant and you can carry on as normal once you’ve taken the missed pill.”

The rules are slightly different for the mini pill. “On a ‘traditional’ mini-pill with progesterone only, you’re covered if you take it within three hours of when you usually would,” Emma says,  “ but some newer pills also contain desogestrel. The window you have to take these is 12 hours of when you usually would.”

If you take your pill within these ‘windows’, then you should still be covered. If you miss your window, you should still take your contraceptive pill as soon as possible and then continue to take it normally.

“Use extra protection for the next 48 hours (e.g. condoms),” Emma recommends, “if you’ve had unprotected sex within the last 48 hours of forgetting to take the mini pill then you’re not covered and you may want to seek emergency contraception.“

This information is all well and good if you’ve just missed one pill, but what if you’ve skipped two or more?

“If you’ve missed two or more combined pills, you should use condoms for the next seven days as you will need extra contraceptive protection for this time,” says Emma.

It is also advisable to take the most recent missed pill as soon as possible and then return to taking your pill at the regular time.

If you missed two or more combined pills and there are less than seven pills in your packet you should take the next packet back to back and avoid the pill free week.

If you have missed two or more pills, and if there are seven or more pills left in your packet, you should take the seven day break as normal.

Emma adds that “if the missed pills were from the first week of the pack and you have had unprotected sex in the last seven days, you are at risk of getting pregnant and may seek additional emergency contraception.”

What if you were more than three or twelve hours late taking the mini pill? As soon as you realise, you should take a pill. You only need to take one, even if you have missed more than that.

“You should use condoms for the next 48 hours and continue taking the mini pill as normal,” Emma adds. “If you’ve had sex in this 48 hour time frame and without using barrier contraception then you are at risk of pregnancy and should consider emergency contraception if you do not want to conceive.”

If you are at risk of an unplanned pregnancy, you may want to use emergency contraception to help protect yourself. There are two different types of emergency contraception: the morning after pill, i.e. ellaOne and levonorgestrel, and the intrauterine device, i.e. the coil or IUD.

ellaOne is the most effective morning after pill * and contains ulipristal acetate which works by delaying ovulation. ellaOne can be taken up to five days after unprotected sex.

Levonorgestrel is a synthetic version of the hormone progesterone and it works by delaying ovulation. Levonorgestrel is effective for up to three days after unprotected sex.

While neither morning after pill has to be taken in the morning, they are most effective when taken as soon as possible after unprotected intercourse. Both morning after pills are intended for single use only and cannot be used as a regular contraceptive.

The intrauterine device (IUD) is a small, t-shaped device inserted into the womb by a medical professional. It works by releasing copper into the womb which make it more difficult for sperm to reach an egg and survive. It can also prevent a fertilized egg from implanting itself.

The IUD can be fitted up to five days after unprotected sex and can continue to be used as a regular contraceptive.

If, after reading this, you realise that you are at risk of an unplanned pregnancy and you decide to take emergency contraception, remember that you have nothing to be embarrassed of and no one has a right to judge you for making this decision.

To find out more about other people’s experiences with the morning after pill, read our #MyMorningAfter stories. If you have taken the morning after pill, and you feel comfortable sharing your experience, share your story below and help us end the unnecessary stigma which still surrounds emergency contraception and female sexuality.

ellaOne® 30mg film-coated tablet contains ulipristal acetate and is indicated for emergency contraception within 120 hours (5 days) of unprotected sex or contraceptive failure. Always read the label.