Missed a contraceptive pill: what to do next
There is no single rule for a missed pill, and that is the most useful thing to know before you read anything else. What you should do depends on which pill you take, how late you are, where you are in the pack and whether you have missed others. The exact time window is printed in the patient information leaflet inside your own pack, and that leaflet is the authority for your pill, not a general page online. This page explains how to read it quickly, what to think about in the meantime, and when to speak to a pharmacist or a doctor today rather than tomorrow.
First: which kind of pill are you taking?
There are two broad families, and the rules for a missed pill are genuinely different between them. A combined pill contains an oestrogen together with a progestogen; it is the type usually taken with a break or with inactive tablets in the pack. A progestogen-only pill contains only a progestogen, and it is taken continuously without a break.
Within the progestogen-only family the rules also differ between types, because the margin of tolerance for a late tablet is not the same for all of them. This is why an answer that begins "you have twelve hours" is unsafe unless the person saying it knows exactly which pill is in your hand.
If you are not sure which family your pill belongs to, the name on the pack and the leaflet will tell you, and so will a pharmacist in thirty seconds. Our page on /contraceptive-pill/ explains how the combined pill, the ring and the patch differ, and /medicines/yasmin/ describes one common combined pill in more detail.
Note that the ring and the patch, described on /medicines/nuvaring/ and /medicines/evra/, have their own rules for a delayed change, which are again in their own leaflets.
Where to find the rule that applies to you
Open the pack and find the patient information leaflet. Look for the section headed with words like "If you forget to take" or "Missed tablets". That section gives the time window for your pill, what to do with the tablet you missed, whether to use additional precautions and for how long, and what to do about the break between packs.
If the leaflet has been thrown away, do not guess. A pharmacist can look up the current information for your exact product, and pharmacies in Malta are open in every locality; the profession here is regulated by the Pharmacy Council. The Medicines Authority is the body that authorises medicines in Malta, and the leaflet approved for your product is the reference that matters.
Take the pack with you, or photograph the front and the back of it. The brand name alone is often not enough, because the same brand can exist in more than one strength or formulation.
We deliberately give no hour figures on this page. Printing one general number would be wrong for some readers, and in this particular situation being wrong has a consequence that cannot be undone.
What counts as a missed pill, and why timing matters
A pill is late when it is taken after the time you normally take it, and missed when the delay goes beyond the window set out in its leaflet. The distinction matters because a late pill usually needs nothing more than taking it and carrying on, while a missed pill may need additional precautions.
How much the delay matters depends on the mechanism. A combined pill mainly prevents ovulation, so the risk concentrates around the times when the ovaries would otherwise start up again, which is why where you are in the pack changes the advice as much as how late you are. Progestogen-only pills work partly through the mucus at the cervix, which changes back more quickly, so their windows are shorter.
Two or more missed tablets, or a missed tablet immediately before or after a break in the pack, are the situations that carry the most risk. If that is what has happened, do not average it out in your head; get the leaflet or a pharmacist.
Take the missed tablet as soon as you remember, unless the leaflet tells you otherwise, and continue the pack rather than stopping. Stopping altogether is the response that most reliably makes the situation worse.
Additional precautions and emergency contraception
Where the leaflet calls for additional precautions, that means a barrier method such as a condom, or avoiding sex, for the period it specifies. It is worth reading that period carefully, because it is counted from when you restart rather than from when you missed.
Emergency contraception is a separate question and a time-critical one. If you have had sex around the time of the missed tablets, ask about it today rather than waiting to see. Products are authorised in Malta, including ulipristal acetate, and they are supplied through community pharmacies; a pharmacist will check which is suitable for you and how it interacts with the pill you are taking. The sooner it is taken the better it works, which is the reason this paragraph is short and direct.
One interaction is worth naming because it is easy to get wrong: some emergency contraceptives and the ongoing pill can affect each other, and the advice on when to restart your usual pill afterwards differs between products. Ask the pharmacist that question at the same time rather than afterwards.
An intrauterine device is another option for emergency contraception, fitted by a clinician, and it is the most effective one. It is arranged locally and needs an appointment.
Vomiting, diarrhoea and medicines that interfere
Vomiting soon after taking a pill, or severe diarrhoea, can mean the tablet was not absorbed, and the leaflet treats that as equivalent to a missed pill. If either continues, additional precautions may be needed for longer than the illness itself.
Several medicines reduce the effectiveness of hormonal contraception, most notably some medicines used for epilepsy and for tuberculosis, and some antiretrovirals. St John's wort, sold as a herbal remedy, belongs on the same list. Most antibiotics do not have this effect, which is a common misunderstanding, but severe diarrhoea caused by one can.
The practical rule is to mention that you take a contraceptive pill whenever any new medicine is started, including something bought over the counter, and to ask specifically whether it affects contraception and for how long after stopping it.
If you have been taking an interacting medicine unknowingly for a while, that is a reason to ask about your method altogether rather than about a single missed tablet.
When to speak to someone today
Speak to a pharmacist or a doctor today if you have missed more than one tablet, if the miss was around a break in the pack, if you have had sex since, if you have been vomiting or have had severe diarrhoea, or if you simply cannot establish which rule applies to your pill.
Arrange to be seen if a period is late and you may be pregnant, if bleeding between periods has become persistent, or if you are repeatedly missing tablets, which is a reason to discuss a method that does not depend on remembering a daily time.
Some symptoms are not about contraception at all and need urgent attention: a severe or unusual headache, particularly with visual disturbance or with weakness or numbness on one side; pain or swelling in a calf; chest pain or sudden breathlessness; coughing up blood; severe abdominal pain; or yellowing of the skin or eyes. Call 112 or go to an accident and emergency department, and say that you take a combined hormonal contraceptive.
Those risks are uncommon, and they are the reason a combined pill is prescribed after an assessment rather than sold from a shelf.
Making it less likely to happen again
An alarm on your phone set for the same time every day is the intervention with the best return, and keeping the pack somewhere tied to a daily routine helps more than willpower. Some people find it easier to take the pill in the evening, some in the morning; the best time is the one you will actually keep.
Keep a spare pack and do not run to the last tablet before ordering the next one, because a gap caused by supply is a missed pill like any other. Order while you still have a week or more in hand.
If you are missing tablets regularly, that is useful information rather than a failing. Methods that do not depend on a daily action exist and include the ring, the patch, the injection, the implant and intrauterine methods; the ring and the patch are described on /medicines/nuvaring/ and /medicines/evra/, and the implant and intrauterine methods are fitted locally. A conversation about switching is a better use of a consultation than a series of emergencies.
Finally, remember that no contraceptive pill protects against sexually transmitted infections. That is a separate decision about condoms and testing.
How many hours late can I take my pill?
It depends on which pill you take, and that is why we do not print a number. The window is set out in the patient information leaflet in your pack, it is shorter for progestogen-only pills than for combined pills, and it differs between types of progestogen-only pill. If the leaflet has gone, a pharmacist can look up the current information for your exact product in a minute.
I missed one tablet. Am I still protected?
Often yes, but it depends on which pill, how late you were and where you are in the pack. Take the missed tablet as soon as you remember unless the leaflet says otherwise, and carry on with the pack. Then read the missed-tablet section of your leaflet, or ask a pharmacist, to find out whether additional precautions are needed and for how long.
Do I need emergency contraception?
If you have had sex around the time of the missed tablets, ask a pharmacist today rather than waiting. Products are authorised in Malta and supplied through community pharmacies, and effectiveness falls the longer you wait. Ask at the same time when to restart your usual pill, because that advice differs between emergency contraceptives.
Does an antibiotic stop my pill working?
Most antibiotics do not, which is a common misunderstanding. Some other medicines clearly do, including certain treatments for epilepsy and tuberculosis, some antiretrovirals and the herbal remedy St John's wort. Severe diarrhoea from any cause can prevent absorption. Mention that you take a contraceptive pill whenever a new medicine is started and ask the question directly.
I was sick shortly after taking my pill. Does it still count?
Vomiting soon after a tablet, or severe diarrhoea, may mean it was not absorbed, and leaflets generally treat that as equivalent to a missed pill. Follow the missed-tablet instructions for your product, and if the illness continues, additional precautions may be needed for longer than the illness itself. A pharmacist can confirm what applies to your pill.
Can you prescribe my contraception if I have run out?
Where your method is already established and unchanged, a doctor can often assess a request to continue it from your answers, your blood pressure and your history. We do not handle an urgent missed-pill situation and we do not supply emergency contraception: for that, go to a pharmacy today. A first prescription of a combined pill needs an examination, including blood pressure.