Accidentally Took Placebo Pill On Last Day Of Week 3 Of Birth Control

In our latest question and answer, the pharmacist discusses what to do if you accidentally miss an active pill during week 3 of your birth control.

Question

On Saturday, which is the last day of week 3 before my first placebo pill in the pack, I took the placebo pill instead of the last active pill. I didn’t realize that now at 12am after I got off of work. I took the active pill (that I was supposed to take on Saturday) just now anyway. I had sex earlier today though and on Saturday when I took the placebo pill on accident. I’m afraid I might’ve messed something up. Am I safe from pregnancy or I should get EC?

Asked by Vee On Feb 18, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Feb 18, 2019
Woman Looking At Birth Control Pill

To boil your situation down, you are taking a birth control pill product that contains 21 active, hormone-containing pills and 7 placebo pills.

You missed the last active pill of your pack (the last pill of week 3), and accidentally took a placebo (non-hormone pill) instead.

While missing the active pill is of concern (and I discuss what to do in the next section), there is no need to worry about taking a placebo pill off-schedule. It contains no hormones and is merely a placeholder. It will have no effect on your period or the contraceptive effectiveness of your pills.

Missed Active Pill During The Third Week

What to do if you miss one active pill during your third week depends on which type of birth control pill you are taking, as there are two:

  • Combined Hormone Pills (which contain both an estrogen and progestin). These are the most common.
  • Progestin-Only Pills, or POPs. These only contain progestin and are often referred to as 'mini-pills'.

Combined Hormone Pills

21 Active 7 Placebo Birth Control Pill

the vast majority of resources on the matter state that as long as you take the missed dose as soon as you remember, you should not be at a significantly increased risk of pregnancy, and it is not necessary to use back-up contraception.

This is a blanket recommendation for nearly all combined hormone pill products.


The CDC (Centers for Disease Control) has a nice infographic titled 'Recommended Actions After Late or Missed Combined Oral Contraceptives' shown below:

CDC Missed Combined Oral Contraceptive

If we take a look at the prescribing information for one example combined hormone pill product, they recommend the same procedure as the CDC. Below is an excerpt from the Yaz prescribing information, a combined hormone pill.

WHAT TO DO IF YOU MISS PILLS
If you MISS 1 light pink "active" pill [In any week]:
1. Take it as soon as you remember. Take the next pill at your regular time. This means you may take two pills in one day. 2. You do not need to use a back-up birth control method if you have sex.

So, overall, if you miss one active pill of your combined hormone birth control product, regardless of the week you are in, the recommendation for what to do is as follows:

  • Take your missed pill as soon as possible, even if it is close to the time you are set to take your next dose.
  • Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day).
  • Back-up birth-control is not needed.
  • Emergency contraception (e.g. Plan-B) is not usually needed unless you have previously missed doses in the same pack.

Progestin-Only Pills

Generic Birth Control Pill Pack

Progestin-only pills are less commonly used than combined hormone pills but are still popular nonetheless. They are sometimes a better option in women with certain medical conditions, such as increased blood pressure or in those with a greater risk of stroke.

The margin for error with progestin-only pills is much smaller than with combined hormone pills as they aren't as effective in inhibiting ovulation and progestins are metabolized/eliminated from the body very quickly after taking a dose.

If you miss one dose of a progestin-only pill and it has been more than 3 hours from the time you were supposed to have taken a pill, you will need to use a back-up contraceptive. The full recommendation is:

  • If it has been more than 3 hours since missing your dose, take one pill as soon as you remember.
  • Continue your pills as scheduled, at the same time each day, even if that means you are taking two pills the same day or close together.
  • Use back-up contraception, such as condoms, until you have taken your pills on time (i.e. no missed or late doses) for 2 consecutive days.
  • Emergency contraception should be considered if you have had unprotected sex after missing a dose and have not taken at least 2 consecutive days of pills.

Answer Summary

If you are taking a combined hormone pill (COC) and have missed one pill, take the missed dose as soon as you remember. Back-up or emergency contraception is deemed not necessary by the Centers for Disease Control unless you have missed previous doses in your current pill pack.

If you are taking a progestin only pill (POP) and it has been more than 3 hours since your missed dose, you do need to use back-up birth control and emergency contraception should be considered if you have had unprotected sex.

Additional Information

If you are still unsure about what to do, or whether or not you have taken the previous portion of your pack as directed, you may want to consider an emergency contraceptive, just to be safe. Be sure to reach out to your doctor for appropriate advice for your specific medical situation.


References
  • Elsevier ClinicalKey: Yasmin Monograph (Accessed 2/18/19)
  • U.S. Selected Practice Recommendations for Contraceptive Use, 2013. CDC
  • Yaz Package Insert
  • Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence. PubMed

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor Of Pharmacy degree in 2010. He has been featured in several publications including the Huffington Post as well as a variety of health and pharmacy related blogs. Please feel free to reach out to him directly if you have any questions or want to connect! [email protected]; Office: 716-389-3076

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