This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical, however some people find that they add depth to the patient information leaflets. You may find the abbreviations record helpful.

Missed Contraceptive Pills

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Combined oral contraceptives¹

When a woman realises she has missed a pill:

• She should take the pill (active hormonal pill) as soon as possible and then resume her usual pill taking schedule.
• Taking two pills on same day or even at the same time is fine i.e. one when she remembers and next pill on time.

If only one 20 mcg or only two 30-35 mcg pills have been missed: Take missed pill when remembered, second pill on time, no extra measures needed. Ensure that the pill free week is not lengthened - e.g. if last pill missed, start next packet a day early.

If she misses two 20 mcg, or three 30-35 mcg ethinylestradiol pills: An alternative back-up method e.g. condom or abstinence is required for 7 days i.e. until seven active pills have been taken. If the missed pills are in the third week of active pills, the pill free week should be omitted - next packet started immediately without a gap. If pills missed in first week (effectively extending pill free interval) also consider need for emergency contraception - has she had intercourse since end of last packet?2

Progesterone-only contraceptives

When a woman realises she has missed a pill:

She should take the missed pill as soon as she remembers and resume her usual pill taking schedule - even if this means taking two pills on same day i.e. one when she remembers and next pill on time. In addition, if pill is more than 3 hours late (12 hours with Cerazette3) an alternative back-up method e.g. condom should be used (or abstinence) for next 7 days, and consider need for emergency contraception if there was UPSI 2-3 days prior to the missed pills, or there has been intercourse since the missed pill(s).

NB: The patient requires the same advice as for a missed pill if vomiting occurs within 3-4 hours of taking a contraceptive pill.

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Document references

1. Missed Pills, Faculty of Family Planning and Reproductive Health Care RCOG (2005)
2. Emergency contraception, Faculty of Family Planning and Reproductive Health Care RCOG (2006)
3. Summary of Product Characteristics - Cerazette® 75 microgram film-coated tablet (desogestrel); Organon Laboratories Limited, Updated May 2004; electronic Medicines Compendium.

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Internet and further reading

• WHO World Health Organization, 2004. Selected practice recommendations for contraceptive use .
• Contraception, Clinical Knowledge Summaries (2007)

Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing this article and to Dr Huw Thomas for earlier versions. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 2460
Document Version: 20
DocRef: bgp25030
Last Updated: 24 Dec 2007
Review Date: 23 Dec 2009

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