No matter how hyper-organized you are, there’s bound to be a day when you forget to take your birth control pill whether it be due to a disruption in your schedule or some other event disturbs your pill-popping groove. Realizing there’s one too many pills in your pack can send even the most rational woman into a spiral of panic and despair, where the only question you want answered is: Now what?

First things first. . . Take a breath.

When you’re taking a combination pill made up of estrogen and progestogen, these hormones prevent the monthly fluctuations in hormone secretion that lead to egg development, and in turn, ovulation. The progesterone component prevents ovulation, while the estrogen component primarily prevents the selection and emergence of the dominant follicle that produces the egg. Meanwhile, the progestogen-only pills work by thickening the cervical mucus (to ward off sperm) and thinning the endometrial lining which makes it less receptive to a fertilized egg.

Pills are designed to mimic the pulsatile action of endogenous hormones so that the hormones will remain at therapeutic levels for 24 hours. Once you miss a pill, your hormone levels will drop below the therapeutic level, which makes you susceptible to pregnancy if you have intercourse during that time. You may also notice some slight hormonal changes like nausea, headaches, and some light bleeding.

When you miss a combination pill, the best course of action depends on two factors: (1) how many pills you missed and when in your cycle they were missed. If one pill is missed, you have time, and you should take the missed pill as soon as you remember, and then your next pill at the usual time. If it’s close to the time you’d normally take your next pill, take both at the same time. Backup contraception isn’t usually needed in this case, but you may want to consider it if you missed pills earlier in the pack, or in the last week of the previous pack. Continue taking the rest of the pack as usual.

If you miss two pills and miss them early in your cycle (days 1-14 of your cycle), breakthrough ovulation can occur due to the body’s inability to suppress the stimulating hormones. In this case, you should catch up by taking two pills for the next two days, taking the rest of the pack as usual, and use backup contraception for the next week.

If you miss two pills in the third week, or if more than two hormonal pills are missed at any time, you should initiate backup contraception immediately and start a new pill pack the same day.  Once the new pack is started, continue with backup contraception for the next week.

When you miss a progestin-only pill, — either a 12-hour pill that must be taken within 12 hours of the same time each day or a three-hour pill that must be taken within three hours of the same time each day. If taken outside of this timeframe, your hormones may fall below the therapeutic window, upping your risk of pregnancy. 

If you’re less than three hours late taking it—or less than 12, depending on the brand you’re taking—then take the late pill as soon as you remember, take the next pill when you normally would, and continue with the rest of the pill pack as usual. In most cases, another form of contraception isn’t necessary, but consider backup protection if you habitually forget to take your pill (or consider a different form of birth control). 

If you’re more than three hours late taking it—or more than 12—take one pill as soon as you remember (even if you’ve missed more than one), then take the next pill when you normally would, and continue with the rest of your pill pack as usual. Once you remember to take your missed pill, use backup contraception for at least the next two days, as it takes 48 hours for the progestin-only pill to take full effect. No matter where you are in your pill pack, use this strategy. 

If you think you may not be protected because you weren’t taking your pills correctly, you should take emergency contraception if you missed two or more pills in the first week of a combo-pill pack and had unprotected sex during the previous seven days, or during the two days after missing your progestogen-only pill—especially if forgetting pills is a regular thing.) Emergency contraception is available over the counter, as well as with a prescription, and should be taken within 72 hours of unprotected sex to prevent a pregnancy.

These are just general preventative guidelines—different brands of birth control have different hormonal formulations. Some pills have one continuous level of hormone throughout the pack, and other pills have three levels of hormones throughout. No matter what pill you’re taking, you should take all of the active pills at the same time each day (the only optional pills for skipping are the placebos).

Ultimately, if you’re unsure about what to do and the pamphlet in your pill pack is often hard to comprehend, it’s best check in with your provider for a consult. If you consistently have trouble remembering a daily pill no matter how many alarms you set, consider alternative birth control methods which don’t require daily compliance and is a little more freeing to the mind (and sex life).