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 every day (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,

It’s great that you’re taking an active role in your health (and paying attention in class!) by reading about your medications and making sure you follow the instructions as closely as possible. This is especially critical with the birth control pill, although the accuracy with which you must take the pill depends on what kind of pill you're taking. Taking the pill might be confusing at times, but when used correctly and consistently, it's extremely effective in preventing pregnancy. When taken perfectly, birth control is 99 percent effective. However, life happens and you could miss a pill, so based on typical use, it's still 91 percent effective. Whether or not you’ll need additional backup birth control can be dependent on whether or not the pill is taken late or missed completely, which week in the pill pack it happens, and the type of pill that it is. 

In general, it's advised to take the pill at the same time each day to maintain hormone levels in the body (when you wake up, when you go to bed, when you brush your teeth, etc.). 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 sleep late or forget) may not make a difference in some pills but could leave you unprotected, depending on the type of pill and which week of your cycle you're in at the time. If you're taking progestin-only pills, it's crucial that you take the pill at the same time every day (within three hours). With these pills, taking it more than three hours late may make it ineffective, so using a backup method (such as condoms) for at least 48 hours would be advised.

Missing your pill means you forget to take your pill for 24 hours or you never take it at all. In some cases, your health care provider may have been right to tell you that you're unprotected for that month, but again, it depends on the week of the pack and the type of pill. For combination pills (those that have both estrogen and progestin), if you miss one pill during week one, it’s wise to use backup for at least seven 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 may vary by formulation and type. At any point in your cycle, if you miss two or more pills, you may need backup. It's a good idea to read the label on your pill very carefully and if you're in doubt, use condoms or other backup methods to practice safer sex.

In either case, you may find it useful talk with your health care provider about your concerns. In fact, anytime you want further professional advice on the backup question, your health care provider or pharmacist is the best person to give you an answer because they could look up the specifications for the brand of pill you take. You might even consider using Planned Parenthood's missed birth control tool to put your mind at ease in the meantime. 

While your question was in relation to pregnancy prevention, it's still the case that the pill won't reduce risk forsexually transmitted infections (STIs), so you might want to consider using additional protection regardless of whether or not you've missed a pill. If you're consistently concerned about taking the pill at the same time every day and want to explore other options, speaking with a health promotion specialist or health care provider may help you explore other forms of birth control that may be more conducive to your life. You can also check out the Go Ask Alice! Sexual and Reproductive Health archives for lots of suggestions.

Hope this helps,

Alice!

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