Ask the Sexpert

Dear Sexpert,

I went on the pill about a year ago when I started dating my boyfriend. I’m usually really good about taking it at the same time every day, but I’ve been slipping up for the past couple of weeks because I haven’t had a regular schedule with break and exams. I’ve forgotten to take it several times and missed more than one pill in a row once or twice. My friend said that it’s fine to miss a pill as long as I make up for it by taking two the next day, but is that really effective? What if I miss a few in a row? If I do miss a bunch of pills, should I be using backup protection, and for how long?

—Forgetful

Dear Forgetful,

You’re not alone in forgetting to take the pill occasionally — it’s harder to remember than it seems! The risk for unwanted pregnancy depends on what type of pill you’re taking. The hormones commonly contained in birth control are progestin and estrogen, both of which are responsible for preventing ovulation. Although most women take combination pills, which contain both of these hormones, some take progestin-only pills. If you are taking combination pills, clinicians at Sexual Health and Wellness Services recommend using a backup birth control method, such as a condom, a female condom or a diaphragm, for seven days if you miss two or more consecutive pills anywhere in a pack. If you miss taking one pill, you should be fine without backup, as long as you take a pill as soon as you remember and then take the next pill at the usual time.

Progestin-only pills are a different story — you really do need to take them at the same time every day! If you take the progestin pill three or more hours late, it is recommended that you use a backup method for the next two days. Make sure you know what type of pill you are taking — if you are at all unsure, ask your healthcare provider or make an appointment with Sexual Health and Wellness Services at University Health Services to figure it out.

That being said, these guidelines only speak to the risk of pregnancy, not the risk of STIs. Even if you take birth control pills regularly, they do not protect you from STIs. If you have a single sexual partner, and you both tested negative for STIs, you may not require additional protection against STIs. However, if you have more than one partner, you can reduce your risk of contracting an STI by using a barrier method, such as a condom. Condoms are available for free from most RCAs and Peer Health Advisers, and are distributed by UHS at McCosh Health Center.

If you continue to find a daily schedule of birth control pills difficult to maintain, you may want to consider switching to a different form of hormonal birth control. There are many highly effective options that do not require daily action such as the Depo-Provera shot, NuvaRing, birth control patches and IntraUterine Devices. Again, none of these hormonal methods provide protection from STIs.

Remember that while the efficacy of birth control pills relies on your using them correctly, other birth control methods such as IUDs and birth control implants (e.g. Nexplanon) do not, as they are inserted by a healthcare provider. The “best” method depends on each individual, so be sure to speak with your healthcare provider or see a Sexual Health and Wellness Services clinician at UHS to discuss which birth control method (or combination of methods) is best for you!

—The Sexpert