Case Study: Amanda A.
Amanda is currently taking birth control pills to prevent pregnancy. She has been using them for about 9 months. Her problem is that she forgets to take her pill everyday. She usually forgets taking them on the weekends when her routine is not the same as during the week. She's been experiencing menstrual spotting in the mornings and some cramping throughout the month.
What do I do if I miss a day taking the pill?
This question comes up very often in my practice. Birth control pills are one of the most widely used form of birth control. They are easy to take, have low side effects, are generally not expensive, and if taken correctly, are very effective. However, one of the most common problems with using birth control pills is not taking them consistently. This leads to irregular bleeding, increased menstrual cramping and most unfortunately, unintended pregnancies.
Amanda's Office Visit:
Initially, Amanda stated that she likes taking the pill but misses her pills about 3-4 times per month. She is unsure about what she should do when she misses a pill. She is concerned that she may become pregnant but is not aware of what else she can use for birth control. A urine pregnancy test was performed in the office, which takes only 15 minutes, was fortunately negative. We discussed in length how to handle missing a birth control pill. We also talked about alternative forms of birth control that she could consider using.
Each pack of birth control pills you receive have specific instructions on what to do if you miss a pill. You can also call your provider who can also instruct you on what to do if this happens.
Follow the instructions that came with your birth control about using back-up birth control (such as a condom and spermicide). You also can follow these recommendations from the Centers for Disease Control and Prevention:
If you are late or miss one day taking your pill:
Take the late or missed pill as soon as possible.
Continue taking the rest of your pills at your normal time, even if it means taking two pills on the same day.
You do not need other forms of birth control, such as a condom, unless you need to protect against STIs.
If you miss two or more days in a row:
Take only the most recent missed pill as soon as possible.
Continue taking the rest of your pills at your normal time, even if it means taking two pills on the same day.
Use back-up birth control, such as a condom and spermicide, or do not have sex until you have taken a pill for seven days in a row.
If you missed pills during days in the last week of active pills (days 15–21 for 28-day pill packs), start a new pack the next day. If you are not able to start a new pack right away, use back-up birth control or avoid sex until hormone pills from a new pack have been taken for 7 days in a row.
Consider emergency contraception, which is available over the counter or from your healthcare provider, if you missed pills during the first week and had sex.
Amanda's Treatment Plan:
After our discussion, Amanda wants to stick with taking the birth control pills. We talked about ways to help her to remember her pill everyday. She plans to set an alarm on her phone to remind her to take her pill at the same time each day.
Talk to your healthcare provider if you continue to miss taking your birth control pill or find it hard to take the pill at the same time each day. You may want to consider a different type of birth control, such as an IUD, an implant, shot, ring, or patch that you don't have to remember to take every day.
Amanda's Followup:
Amanda returned 3 months later to followup on how well she was doing with her birth control pills. She stated that she was getting better with remembering with her phone but still missed taking the pills about 2 times each month. At this point, we discussed changing her birth control method to one she does not need to remember each day. She chose a Nuvaring.
Misconceptions:
Using emergency birth control pills that are available over the counter can be used for birth control every time you have sex to prevent birth control. This is not true. OTC emergency birth control should be used only occasionally- in situations where there is a strong risk of pregnancy. Using these high dose hormones should not be used all the time as they can cause complications with frequent use. Talk to a provider about what is a good option for birth control that you can use consistently.
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