Accidentally skipping a pill is a common event among women taking birth control pills.

Some researchers have identified as high as a 50% skip rate, each month, among BCP users.

The consequences of skipping just one pill are hard to measure, and I believe the effect is usually minimal. But some pills are more important than others.

The older, long-half-life pills, such as those containing levonorgestrel, tend to be more forgiving, since there is still plenty of progestin around, despite having skipped a pill. In contrast, many of the newer BCPs have progestins with much shorter half-lives, and these tend to be less forgiving should a pill be skipped.

Most birth control pill failures are not because of a single skipped pill. More often, they occur when someone skipped more than one pill, in the same month.

• If she just skipped one pill, she should take it as soon as she remembers, then continue the rest of the pills at the normal time.
• If she didn’t remember until the next day, take both the current day’s pill and yesterday’s pill together. Then continue with the rest of the pills in the usual way.
• If she’s forgotten two pills or more, some physicians recommend stopping the BCPs, wait a few days for a “withdrawal” menstrual flow, and then restart a fresh package of BCPs 5 days after the onset of flow. Use backup contraception during this time and for the first month after restarting the BCPs.
• Other physicians recommend the patient continue taking the pills in sequence, despite having skipped a couple of the pills, keeping in mind that contraceptive effectiveness may be diminished (but not eliminated).

If skipping pills is a recurring issue with the patient, she should consider alternative effective methods, such as IUDs, Patch, Ring, Implant or Shot.