You just started taking the birth control pill and your doc mentioned you should take it at the same time every day. Meanwhile, your friend has a blaring alarm on her phone and gets a notification from an app to tell her to take hers and you’re wondering how seriously you should take this “same time of day” thing. If you usually take it at noon but forget until 3 pm one day, can you get pregnant?
“When a woman tells her doctor that she got pregnant on the pill, we stay quiet but we’re thinking ‘okay, you probably didn’t take it at the same time every day or you missed doses,’” says Jessica Shepherd, an OB/GYN and assistant professor of clinical obstetrics and gynecology at the University of Illinois.
So yes, you should take the pill at the same time daily, for a few different reasons. First, let’s dive into how birth control pills work, because there are a couple different types you may take and the timing affects them a little differently. (And even before that, remember that no method of birth control besides condoms helps prevent STDs, so you’ll want to wrap it up anyway if you’re not in a mutually monogamous relationship.)
One type of birth control pill is the combined oral contraceptive pill (or COC), which is the kind most pill-users take. These pills contain the hormones estrogen and progestin, which “work by thickening cervical mucus to block sperm, as well as preventing ovulation,” or the release of an egg from the ovaries, says Chicago-based OB/GYN Wendy Goodall McDonald, who also runs the blog Dr. Every Woman. “In a way, they trick the body into thinking it’s pregnant,” she says.
Many brands of combined pill have four to seven inactive pills at the end of the pack that are a different color—these are placebos and some women choose not to take them. (You get your period while taking the placebo pills.) However, for certain brands, these last pills contain estrogen-only or iron-only, and you may choose to take them. Talk to your doctor about what she recommends. (All of this info also applies to “extended cycle” pills where you only get your period four times a year.)
The other, less-common type of oral contraceptive is the “mini pill,” or progestin-only pill (POP), and popular brands include Camila and Micronor. Women who are breastfeeding, have migraines, or have a history of blood clots may be taking this kind of pill, McDonald says. The mini pill doesn’t always prevent the ovaries from releasing an egg: In fact, about 40 percent of women still ovulate, according to the American College of Obstetricians and Gynecologists, or ACOG. However, it does thicken cervical mucus to prevent sperm from reaching an egg and thin out the uterine lining to help prevent a fertilized egg from implanting in the uterus in case sperm somehow gets through. It’s worth noting that, unlike the combined pill, the mini pill has no placebo pills in the pack, so you absolutely need to take all 28 pills.
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While it’s important to take both types of pills at the same time daily, it’s especially critical to do so if you’re on the mini pill. Why? Because it only works its magic on cervical mucus and the uterine lining for 24 hours at a time, McDonald says. Do not miss a pill. We repeat: Do not miss a pill. If you do miss a mini pill by more than three hours, take it ASAP—even if that means taking two pills in one day—and then use condoms as backup protection or don’t have sex for the next two days, ACOG says. Yes, mere hours count with this pill, so set those phone alarms.
When it comes to the combined pill, you have a little bit more leeway. If you forget an active pill, taking it within the next 24 hours is still pretty effective, McDonald says. But that doesn’t mean you should do this. Assuming you don’t want to get pregnant right now, your goal should be to pop that pill on time. Using the combined pill “perfectly” (a.k.a. on time) means it’s 99 percent effective. That’s pretty great. However, you exist in the real world; you forget, you take it at different times, or you blank and have no idea if you took it at all. That’s known as “typical use,” and it translates to the pill being 91 percent effective, meaning 9 out of 100 women taking it will become pregnant in one year, per ACOG.
If you miss a pill, take the missed one as soon as you remember, and then take the next pill at your normal time. (If you realized you skipped an entire day, you can take two pills at once.) But if you missed two pills in a row, you should take the most recent one you missed ASAP, then take your next pill on schedule, and use a backup method like condoms until you’ve taken the active pill for seven days in a row. If those seven days takes you into the placebo pills, you should finish all the active pills in your pack, throw it out (that is, skip the inactive pills) and start a new pack the next day.
Another problem linked to not taking combined pills consistently: You may notice that you’re spotting, as the uterine lining begins to break down. “You can get back on track by taking it at the same time every day,” McDonald says. If you don’t do this and you’ve been spotting for a prolonged time, stop taking the pill, let your period come (use backup birth control!), and when you restart the next pill pack, you won’t be spotting anymore, she says.
Have problems remembering to take your pill? Make pill-popping part of your routine (like when you brush your teeth at night) or set an alarm. The Bedsider app (for iPhone or Android) will also send you a reminder. It can be especially tough if your schedule is different every day, so think about what method is right for you.
If you’re a serial pill-forgetter, then you might want to consider longer-acting forms of birth control, like the ring, patch, or IUD, which release small amounts of hormones exactly when your body needs it, without you having to remember to take something daily. The ring and patch are worn for 21 days with a week off to get your period before starting a new ring or patch; the IUD is inserted into your uterus and lasts for up to five years, or longer for the non-hormonal IUD.
“Be honest with yourself about the process and what you’re good at and not. If taking something at the same time of day is a weakness, a daily pill is probably not your best choice,” Shepherd says. She had to face the music, too. “When I switched to long-acting reversible contraception, my life changed,” she says.
Pills have their place. They’re a great way to get started with birth control, and doctors also prescribe them for conditions like PCOS, endometriosis, heavy periods, and acne, Shepherd says. “I want women to realize all the different resources available to them. If you know forgetting your pill is a habit, reassess your options,” she says.
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