What to Do If You Missed a Birth Control Pill on Day 20? - Obstetrics and Gynecology

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When you miss a birth control pill, especially during the third week of your cycle, it can be concerning regarding its effectiveness. In your case, missing the 20th pill of your pack and then taking two pills on the following day is a common scenario that many women face. Here’s how to handle it and what you need to know.


Immediate Steps After Missing a Pill
1. Take the Missed Pill as Soon as You Remember: Since you missed the pill on July 16 and took two pills on July 18, you have done the right thing by compensating for the missed dose. It’s generally advised to take the missed pill as soon as you remember, even if it means taking two pills in one day.

2. Continue with Your Regular Schedule: After taking the missed pill, continue taking the remaining pills in your pack at the usual time. This helps maintain the hormone levels in your body and ensures continued contraceptive effectiveness.


What to Do Next
1. Consider Starting a New Pack: According to the guidelines for combination birth control pills, if you miss a pill during the third week, you have two options:
- Option 1: You can continue taking the remaining pills in your current pack and then start a new pack immediately after finishing the current one, skipping the placebo week. This method is often recommended to maintain contraceptive coverage.

- Option 2: If you prefer to take the placebo week, you can wait for your period to arrive and then start the new pack. However, this may leave you unprotected during the placebo week.

2. Evaluate Your Contraceptive Needs: If you choose to skip the placebo week and start the new pack immediately, you will maintain contraceptive protection. If you decide to wait for your period, you should use backup contraception (like condoms) during that time to prevent unintended pregnancy.


Effectiveness and Risks
- Effectiveness: If you take the missed pill as soon as you remember and continue with the rest of the pack correctly, your contraceptive effectiveness should remain intact. However, if you miss pills frequently or do not follow the guidelines, your risk of pregnancy may increase.

- Backup Contraception: If you miss a pill and have unprotected intercourse, consider using emergency contraception if you are concerned about pregnancy. It’s also wise to use backup methods (like condoms) for at least seven days after a missed pill, especially if you missed a pill in the third week.


Conclusion
In summary, since you missed the 20th pill and took two the next day, you should continue with your current pack and consider starting a new pack immediately after finishing the current one to maintain contraceptive protection. If you choose to wait for your period, ensure you use backup contraception during that time. Always consult with your healthcare provider for personalized advice, especially if you have any concerns about your birth control method or if you experience any unusual symptoms.