We all now know that the pill is a form of birth control taken by orally, every single day. On top of that, it needs to be taken at the same time every day to maintain effectiveness. We’re all human and sometimes we forget, or something comes up and we aren’t able to take it on time — all of these things affect the effectiveness of birth control.

When accounting for human error the effectiveness of the pill is 91%. However, theoretically, when taken as directed, birth control should be 99% effective. Let’s discuss how to ensure that the pill is as effective as possible.

What is the Birth Control Pill?

There are typically two types of pills. The first is the combination pill, which contains both estrogen and progestin and typically come in a 21-day, 24-day, or 28-day pack — which includes four to seven days of placebos. The second is the progestin-only pills (or mini-pills) which usually comes with a lower dose of progestin than the combination pill and is taken every day without a break. Neither pill protects against sexually transmitted infections.

How Does the Pill Work?

The combination pill is a type of hormonal contraceptive that introduces synthetic estrogen and progestin hormones into the body to inhibit ovulation and prevent sperm from fertilizing an egg. However, the progestin-only pills (mini-pills) do not always prevent the ovaries from releasing an egg. About 40% of women on the mini-pill still ovulate. The hormones in both types of pills, however, also work to thicken the fluid in the cervix to make it difficult for sperm to reach an egg, and thin the lining of the uterus to help prevent a fertilized egg from implanting in the case that sperm somehow gets through.

Why is it important that I take the pill on a schedule?

Taking the pill correctly increases your chances of preventing pregnancy to 99% while taking it typically has a 91% success rate of preventing pregnancy. A success rate of 91% means that out of 100 women, 9 women have a chance of getting pregnant despite using the pill. On the other hand, taking the pill on a schedule, as directed, means out of 100 women, only 1 has a chance of getting pregnant while taking birth control.

The best way to effectively use the pill as a birth control is to take it the same time every day. We all know that people aren’t perfect, however, and even when it comes to birth control, it’s easy to forget. Further, even if you are taking the pill consistently, it is still recommended that you use a condom to prevent STIs. Taking the pill at the exact same time everyday may not be realistic for many women but keeping to a schedule is important for developing a good habit of taking your birth control. Taking the pill on time is especially important for those using the mini-pill. Taking the mini-pill even three hours off schedule is considered late.

What can interfere with the pill working perfectly?

According to current research, the following medicines or supplements can interfere with the effectiveness of the pill:

• The antibiotic Rifampin (other antibiotics don’t make the pill less effective)
• The antifungal Griseofulvin (other antifungals don’t make the pill less effective)
• Certain HIV medicines
• Certain anti-seizure medicines
• The herb St. John’s Wort

Excessive vomiting and diarrhea can also interfere with the effectiveness of the pill. This means laxatives, dieters’ or detox teas, and bowel cleanse supplements — anything that induces bowel movements can affect your birth control. Vomiting, especially around the time you’ve taken the pill, can reduce the pills effectiveness. This is because the pill will not have been effectively absorbed by your body. If you are experiencing these symptoms, due to illness or otherwise, the use of other contraceptives is recommended.

Some medications that alter hormone production, such as certain classes of antidepressants, may also compromise the pill’s effectiveness. Conversely, the pill may also compromise the effectiveness of antidepressants. If you are taking any medications and you are concerned may interact with your birth control, make sure to discuss it with your doctor or nurse practitioner.

Like other medications, the pill is also affected by extreme heat or cold. Keep your birth control out of direct sunlight and make sure to keep an eye on the expiration date.

With all that said, the biggest reason for birth control failure is still, unsurprisingly, not taking the pill every day.

What can I do if I’ve forgotten to take the pill?

If you have forgotten to take the pill, don’t worry, it happens. If you forget to take the pill for one day, you can take it as soon as you remember, even if that means taking two in one day. If you forget to take it twice, you can take two pills for two days. After three days of forgetting to take the pill, however, let your period pass and start a new pack. If you forget to take the pill, be sure to use other forms of protection.

It’s easy to forget, especially in our busy daily lives, but try your best to make it a part of your daily routine. Some suggestions to remember to take the pill are:

• Set an alarm
• Make it a part of your morning routine — such as doing your makeup or brushing your teeth
• Visual reminders — tape it to your mirror or something you look at every day
• Put it in a case with your other vitamins or medications
• Apps — there are lots of scheduling apps available, and even apps just to remind you to take your birth control

The Best Way to Maintain Birth Control Efficacy

In conclusion, taking the pill consistently as directed — meaning everyday at the same time (or as close to it as possible) is the best way to maximize the effectiveness of your birth control and reduce your chances of an unwanted pregnancy. If you have any further questions, or are ever unsure about what to do concerning your medication, always consult your clinician.