POP_Missed_Pill_Flashcards
What are the missed pill rules for the progestogen only pill (POP)?
The missed pill rules for the progestogen only pill (POP) are simpler than those used for the combined oral contraceptive pill.
What are the ‘traditional’ POPs?
The ‘traditional’ POPs include Micronor, Noriday, Nogeston, and Femulen.
What should be done if a ‘traditional’ POP is less than 3 hours late?
If a ‘traditional’ POP is less than 3 hours late, no action is required and the pill should be continued as normal.
What should be done if a ‘traditional’ POP is more than 3 hours late?
If a ‘traditional’ POP is more than 3 hours late (i.e. more than 27 hours since the last pill was taken), action is needed.
What should be done if Cerazette (desogestrel) is less than 12 hours late?
If Cerazette (desogestrel) is less than 12 hours late, no action is required and the pill should be continued as normal.
What should be done if Cerazette (desogestrel) is more than 12 hours late?
If Cerazette (desogestrel) is more than 12 hours late (i.e. more than 36 hours since the last pill was taken), action is needed.
What action is required if a progestogen only pill is missed?
If a progestogen only pill is missed, the missed pill should be taken as soon as possible. If more than one pill has been missed, only one pill should be taken. The next pill should be taken at the usual time, which may mean taking two pills in one day. The rest of the pack should be continued and extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours.
How long should extra precautions be used after a missed progestogen only pill?
Extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours after a missed progestogen only pill.
summarise POP missed pill
Progestogen only pill: missed pill
The missed pill rules for the progestogen only pill (POP) are simpler than those used for the combined oral contraceptive pill, but it is important not to confuse the two.
‘Traditional’ POPs (Micronor, Noriday, Nogeston, Femulen) Cerazette (desogestrel)
If less than 3 hours late
no action required, continue as normal
If more than 3 hours late (i.e. more than 27 hours since the last pill was taken)
action needed - see below
If less than 12 hours late
no action required, continue as normal
If more than 12 hours late (i.e. more than 36 hours since the last pill was taken)
action needed - see below
Action required, if needed:
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
A 29-year-old female presents to her GP as she missed her Micronor pill (progestogen-only) this morning and is unsure what to do. She normally takes the pill at around 08:30 and it is now 10:00. What advice should be given?
Take missed pill now and no further action needed
Emergency contraception should be offered
Take missed pill now and advise condom use until pill taking re-established for 48 hours
Take missed pill now and omit pill break at end of pack
Perform a pregnancy test
Take missed pill now and no further action needed
The correct answer is Take missed pill now and no further action needed. The progestogen-only pill (POP), such as Micronor, has a 3-hour window in which it can be taken if a dose is missed. In this scenario, the patient has only missed her regular time by an hour and a half, so she can take the missed pill immediately without compromising contraceptive effectiveness.
The option Emergency contraception should be offered is incorrect. Emergency contraception is not necessary in this case because the progestogen-only pill was only delayed by an hour and a half, within the 3-hour window for taking a missed dose.
Take missed pill now and advise condom use until pill taking re-established for 48 hours is also not correct. This would be appropriate advice if she had gone beyond the 3-hour window for taking her POP, but in this case, she has not exceeded that time frame.
The suggestion to Take missed pill now and omit pill break at end of pack does not apply to progestogen-only pills like Micronor. This advice might be relevant for combined oral contraceptives where there’s usually a seven day break or placebo tablets at the end of each pack. The POP is taken continuously without breaks.
Lastly, advising to Perform a pregnancy test would not be necessary unless there were other reasons to suspect pregnancy (for example, other missed pills or unprotected sex). Given that she has only delayed her usual timing by an hour and a half, there’s no need for concern about potential pregnancy at this point.
A 27-year-old female presents to her GP as she missed her desogestrel contraceptive pill (progestogen only) this morning and is unsure what to do. She normally takes the pill at around 0900 and it is now 1430. What advice should be given?
Emergency contraception should be offered
Perform a pregnancy test
Take missed pill as soon as possible and omit pill break at end of pack
Take missed pill now and no further action needed
Take missed pill now and advise condom use until pill taking re-established for 48 hours
Take missed pill now and no further action needed
As desogestrel has a 12-hour window this patient should take the pill now with no further action being needed
