Taking birth control pills — what counts as the "same time" every day?

Originally Published: April 18, 2008
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Dear Alice,

I have two questions, first: On my birth control pill box instructions it says to take a pill each day at ABOUT the same time. I was wondering, does this mean that I should set an alarm to make sure I take it the exact minute everyday (which is what I've been doing) or can I take it within a couple of hours difference if I decide to sleep in on Saturday?

Secondly: My doctor told me that if I miss a pill to consider myself unprotected for that month. However, after I left I realized that in biology class we learned that a ovum (or egg) can only survive a few days inside the fallopian tubes and uterus and then it get absorbed into the body (or dies). If I missed a pill then wouldn't I only be unprotected for the next couple of days (if an egg was produced in the 24 hr period that I didn't take the pill)instead of the whole month?

Dear Reader,

Great job taking an active role in your health (and paying attention in class!) by reading about your medications and making sure you follow the instructions are closely as possible. This is especially important with the birth control pill, although the accuracy with which you must take the pill depends on what kind of pill you are taking.

In general, take the pill at the same time each day (when you wake up, when you go to bed, when you brush your teeth, etc.). No, you won't ruin your regimen if you take your pill at 7:15 instead of 7:00; however, setting an alarm is a good way to make sure you're taking your pill on time. Taking the pill a few hours late (because you are sleep late, or forget) may not make a difference in some pills, but could leave you unprotected, depending on the type of pill you take and which week of your cycle you are in.

If you're taking progestin-only pills it is crucial that you take the pill at the same time every day. Taking it three hours later than usual may make it ineffective and you will need to use a back up method for at least 48 hours.

"Missing" means you forget to take your pill for 24 hours or you never take it at all. In some cases, your doctor may have been right to tell you that you're unprotected for that month, but it depends on the week and the type of pill. For combination pills (pills that have both estrogen and progestin), if you miss one pill during week one, you should use backup for at least 7 days (assuming you take the "missed" pill as soon as your remember, even if it means taking two pills at once). During weeks two, three, and four, you may not need backup if you take the pill once you remember, however this can vary by brand. At any point in your cycle, miss two or more pills and you'll probably need backup. Confused yet? It's important that you read the label on your pill very carefully and, if you're in doubt, use condoms or other back up.

It's probably a good idea to talk to your health care provider about your concerns. In fact, anytime you want a definite "yes" or "no" on the back-up question, your health care provider or pharmacist is the best person to give you an answer because they can look up the specifications for the brand of pill you take. Often times you can simply call your health care provider's office, let the receptionist know your concern, and request that a provider call you back. Students at Columbia can get comprehensive women's health services, including birth control pills and backup contraception by logging onto Open Communicator or calling x4-2284.

Taking the pill can be confusing at times, but when used correctly it is extremely effective in preventing pregnancy. It won't protect against sexually transmitted infections (STIs), so you might want to consider using additional protection. Check out the Sexual Health archives for lots of suggestions.

Hope this helps,

Alice