Missed Birth Control Pill? What to Do Now, When You Need Backup and When to Use Plan B

Written by Naurah Gaspard, DNP, FNP-C, FNP-BC · Medically reviewed by Cherlie Joseph, MSN, FNP-BC · Updated November 2026

If you missed one combined birth control pill (less than 48 hours since you should have taken it), take it as soon as you remember and keep going; you don't need backup. If 2 or more pills are missed (48+ hours), take the most recent missed pill now, use condoms or avoid sex until you've taken 7 active pills in a row, and consider emergency contraception if you had unprotected sex. Progestin-only pills have much shorter windows.

First, check which kind of pill you take

The rules depend on your pill type, so look at your pack or pharmacy label:

• Combined pills contain estrogen and a progestin (most brands, such as Sprintec, Loestrin, Yaz and their generics).
• Norethindrone or norgestrel progestin-only pills ("mini-pills," including over-the-counter Opill) have a 3-hour window.
• Drospirenone progestin-only pills (Slynd) have a 24-hour window.

The guidance below follows the CDC's U.S. Selected Practice Recommendations for Contraceptive Use (2024) and product labels. If anything differs on your pill's package insert, follow the insert or ask your pharmacist.

Combined pills: one late or missed pill

If it has been less than 48 hours since you should have taken a pill (so only one pill is late or missed):

• Take the late or missed pill as soon as you remember, even if that means taking 2 pills in one day.
• Keep taking the rest of the pack at your usual time.
• No backup method is needed, and emergency contraception usually isn't needed.

Missing a single pill rarely lowers protection enough to matter, because ovulation is suppressed by the run of pills before it.

Combined pills: two or more missed pills

If it has been 48 hours or more (2 or more pills missed in a row):

• Take the most recent missed pill as soon as possible. Throw away the other missed pills.
• Keep taking the rest of the pack at your usual time.
• Use condoms or avoid sex until you have taken active (hormone) pills for 7 days in a row.
• If the missed pills were in the last week of active pills, skip the hormone-free or placebo pills and start a new pack right away.
• If the missed pills were in the first week of the pack and you had unprotected sex in the past 5 days, consider emergency contraception.

Late patches and rings follow similar logic. A patch or ring that has been off or out for 48 hours or more generally needs 7 days of backup.

Progestin-only pills: the 3-hour rule

For norethindrone and norgestrel pills, including Opill, a pill taken more than 3 hours late counts as missed:

• Take one pill as soon as possible, then continue at your usual time (even if that means 2 pills in one day).
• Use condoms or avoid sex until you've taken pills on time for 2 days in a row.
• Consider emergency contraception if you had unprotected sex since the missed dose.

Drospirenone (Slynd) is more forgiving: it counts as missed only after 24 hours, and the package insert explains what to do based on where you are in the pack.

When to use emergency contraception and test for pregnancy

Emergency contraception works best the sooner you take it. Levonorgestrel (Plan B One-Step and generics) is sold over the counter and works best within 72 hours. Ulipristal (ella) is a prescription pill that works up to 5 days after sex. A copper or hormonal IUD placed within 5 days is the most effective option.

If you take ella, wait 5 days before restarting your hormonal birth control, and use condoms until you've been back on it for 7 days (2 days for progestin-only pills). If your period is more than a week late, or you have pregnancy symptoms, take a home pregnancy test.

Spotting or light bleeding after missed pills is common and usually not a sign of a problem.

Tips to miss fewer pills

• Set a daily phone alarm and keep the pack next to something you use every day, like your toothbrush.
• Keep an extra pack in your bag or car.
• If daily pills keep slipping, ask about a ring, patch, shot, implant or IUD.

Frequently asked questions

Can I take 2 birth control pills in one day?

Yes. If you missed a pill, taking it when you remember and the next one at your usual time is the standard advice, even if that means 2 pills in one day. You may feel mild nausea.

Do I need Plan B if I missed one pill?

Usually not. With combined pills, one missed pill (less than 48 hours late) does not require emergency contraception. It is worth considering if you missed 2 or more pills in the first week of a pack, or missed a progestin-only pill by more than 3 hours, and had unprotected sex.

What if I missed placebo (sugar) pills?

Placebo pills contain no hormones, so missing them does not affect protection. Throw them away and start your next pack on time.

Sources

• CDC: Recommended Actions After Late or Missed Combined Oral Contraceptives
• CDC: U.S. Selected Practice Recommendations for Contraceptive Use, 2024
• MedlinePlus: Birth control pills

Keep reading

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• Emergency contraception: Plan B vs ella vs IUD
• STD testing online in Florida
• Browse all conditions and treatments A to Z

Naurah Gaspard, DNP, FNP-C, FNP-BC

Board-certified family nurse practitioner licensed in Florida, New Mexico, Oregon and Washington, caring for adults online at OurTopClinic. Meet our providers.

This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.