Combined oral contraceptive pill: missed pill

Question 1

Combined oral contraceptive pill: missed pill

The advice from the Faculty of Sexual and Reproductive Healthcare (FSRH) has changed over recent years. The following recommendations are now made for women taken a combined oral contraceptive (COC) pill containing 30-35 micrograms of ethinylestradiol

Answer 1

If 1 pill is missed (at any time in the cycle):

• take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
• no additional contraceptive protection needed

Question 2

Combined oral contraceptive pill: missed pill

Answer 2

If 2 or more pills missed:

• take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
• the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
• if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
• if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
• if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
• *theoretically women would be protected if they took the COC in a pattern of 7 days on, 7 days off