Emergency Contraception: What to Do If You Miss a Pill - Obstetrics and Gynecology

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When it comes to understanding emergency contraception and what to do if you miss a pill, it's important to first recognize how hormonal contraceptives work and the implications of missing a dose. In your case, you mentioned that you are currently on a birth control pill regimen and missed taking your 20th pill.
Generally, the effectiveness of birth control pills can be compromised if a dose is missed, especially if it is more than 12 hours late. The specific instructions can vary depending on the type of pill you are taking (combination pills vs. progestin-only pills), but here are some general guidelines:
1. Missed Pill Protocol: If you remember to take the missed pill within 12 hours of your usual time, you should take it as soon as you remember. If it has been more than 12 hours, the effectiveness of the pill may be reduced. In this case, you should take the missed pill as soon as you remember, and then continue taking your pills at the regular time. However, you should also use a backup method of contraception (like condoms) for the next 7 days to ensure you are protected against pregnancy.

2. Taking Two Pills: If you remember the missed pill after more than 12 hours, it is generally recommended to take the missed pill immediately and then continue with your regular schedule. You do not need to double up on pills unless specifically instructed by your healthcare provider. Taking two pills at once can increase the risk of side effects, such as nausea or breakthrough bleeding.

3. Backup Contraception: Since you missed a pill and it has been more than 12 hours, using a backup method for the next week is advisable. This is crucial because the risk of ovulation increases, and if you have unprotected intercourse during this time, there is a chance of pregnancy.

4. Emergency Contraception: If you had unprotected sex after missing the pill and are concerned about the possibility of pregnancy, you may consider taking emergency contraception (EC) as a precaution. EC is most effective when taken as soon as possible after unprotected intercourse, ideally within 72 hours, but some types can be effective up to 5 days after.

5. Consulting a Healthcare Provider: If you are unsure about your specific situation or have further questions about your birth control method, it is always a good idea to consult with a healthcare provider. They can provide personalized advice based on your health history and the type of contraceptive you are using.

In summary, if you miss a pill, take it as soon as you remember, and if it’s been over 12 hours, use a backup method for the next 7 days. If you have had unprotected intercourse during this time, consider emergency contraception and consult your healthcare provider for further guidance. Remember, maintaining a consistent schedule with your birth control pills is key to maximizing their effectiveness and minimizing the risk of unintended pregnancy.