What if I miss or take the pill late?
If 1 pill is late <24 hours or missed 24 to <48 hours later than the usual time, take the pill as soon as possible once you remember. Continue taking the remaining pills at the usual time, even if it means taking 2 pills on the same day. No additional contraceptive protection is needed. Additionally, an emergency contraceptive is usually not needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle.

If ≥2 consecutive pills are missed ≥48 hours later than the usual time, it is recommended that you take the most recently missed pill as soon as possible while any other missed pills should be discarded. Continue taking the remaining pills at the usual time, even if it means taking 2 pills on the same day. It is advised that you use back-up contraception or avoid any sexual intercourse until you have taken your pills for 7 consecutive days. 

If this occurred during the first week and you had unprotected sexual intercourse within the past 5 days, emergency contraception should be considered. They may also be considered at other times as appropriate.

If this occurred during the last week (eg, days 15–21 for a 28-day pill pack), skip the hormone-free interval by finishing the pills in the current pack and starting a new pack the next day. However, if you are unable to start a new pack immediately, use back-up contraception or avoid sexual intercourse until you have taken the pills from a new pack for 7 consecutive days.

What if vomiting or diarrhea occurs?
If vomiting or diarrhea occurred for any reason within 24 hours or 24 to <48 hours after taking the pill, it is unnecessary to take another pill. Continue taking pills daily at the usual time. Emergency contraceptive is usually not needed but can be considered as appropriate. No additional contraceptive protection is needed.

If vomiting or diarrhea occurred ≥48 hours after taking the pill, continue taking the pills daily at the usual time. It is recommended that back-up contraception is used or avoid any sexual intercourse until pills have been taken for 7 consecutive days after vomiting or diarrhea has resolved.

Skip the hormone-free interval by finishing the pills in the current pack and starting a new pack the next day if vomiting or diarrhea occurred during the last week (eg, days 15–21 for a 28-day pill pack). If you are unable to start a new pack immediately, use back-up contraception or avoid sexual intercourse until pills from a new pack have been taken for 7 consecutive days.

Emergency contraception should be considered if vomiting or diarrhea occurred within the first week of a new pill pack and unprotected sexual intercourse occurred in the previous 5 days. It may also be considered at other times as appropriate.

Further Information:
Centers for Disease Control and Prevention: www.cdc.gov/mmwr/preview/mmwrhtml/rr62e0614a1.htm?s_cid=rr62e0614a1_x#Tab2
U.S. Department of Health & Human Services: www.hhs.gov/opa/reproductive-health/contraception/birth-control-pills/index.html

Created July 2013