Missed Contraceptive Pills

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oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Advice regarding missed pills depends on the preparation the woman is taking. It varies depending on whether she is taking the combined or progestogen-only pill. She will need to know what to do with the rest of her packet, whether she needs to use additional contraceptive precautions and for how long, and whether she needs emergency contraception. Patient information leaflets within the packet should give this information.

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If one pill is missed, anywhere in the pack (ie more than 24 and up to 48 hours late)

  • The last pill missed should be taken now, even if it means taking two pills in one day.
  • The rest of the pack should be taken as usual.
  • No additional contraception is needed.
  • The seven-day break is taken as normal.

Emergency contraception is not needed if just one pill has been missed. However, it should be considered if other pills have been missed recently, either earlier in the current packet, or at the end of the previous packet.

If two or more pills are missed (ie more than 48 hours late)

  • The last pill missed should be taken now, even if it means taking two pills in one day.
  • Any earlier missed pills should be left.
  • The rest of the pack should be taken as usual and additional precautions (eg, condoms or abstinence) should be taken for the next seven days.
  • The next step then depends on where in the packet the pills are missed:
    • In the pills are missed in the first week of a pack (pills 1-7): emergency contraception should be considered if the patient had unprotected sex in the pill-free interval or the first week of the pill packet. She should finish the packet and have the usual pill-free interval.
    • If the pills are missed in the second week of a pack (pills 8-14): there is no need for emergency contraception as long as the pills in the preceding seven days have been taken correctly. The packet should be finished and the usual pill-free interval taken.
    • If the pills are missed in the third week of a pack (pills 15-21): the next pack of pills should be started without a break - ie the pill-free interval is omitted. If taking a packet with dummy/placebo pills, these should be discarded, and the new packet started. Emergency contraception is not required.

If more than seven pills are missed, the woman should start again as if starting for the first time. (Exclude pregnancy, and start a new pack on the first day of the next menstrual period.)[2] 

Missed pill advice differs from the above for the newer combined oral contraceptive pills (COCPs) Qlaira® and Zoely®.

Qlaira®[2][3] 

Qlaira® is currently the only quadriphasic COCP in the UK. It contains estradiol valerate and dienogest in 26 active tablets with sequential dose changes, followed by just two inactive tablets. The manufacturer's missed pill advice is as follows:

  • If the missed pill is less than 12 hours late, the pill should be taken immediately. Further pills should be taken as usual. Emergency contraception is not needed.
  • If the missed pill is more than 12 hours late, advice depends on where in the cycle it was missed:
    • Day 1-17: take the missed pill immediately and the next pill as usual. (Even if this means taking two pills on the same day. Do not take MORE than two pills on the same day.) Continue the packet. Use additional contraceptive measures (eg, condoms) or abstain from sexual intercourse for nine days.
    • Day 18-24: discard the rest of the current packet. Start the next packet immediately. Use additional contraceptive measures (eg, condoms) or abstinence for nine days.
    • Day 25-26: take the missed pill immediately and the next pill at the usual time. (Even if this means taking two pills on the same day. Do not take MORE than two pills on the same day.) Additional contraceptive precautions are not necessary.
    • Day 27-28: discard the forgotten pill, and continue taking pills in the usual way. Additional contraceptive precautions are not necessary.
  • If pills have been missed and no withdrawal bleed occurs at the end of the packet, pregnancy should be excluded.
  • Pregnancy and emergency contraception should be considered if more than one pill is missed.

Zoely®[2][4] 

Zoely® is a monophasic COCP containing 17 beta-estradiol and nomegestrol with 24 active tablets, and 4 inactive tablets. The manufacturer's missed pill advice is as follows:

  • If the missed pill is less than 12 hours late, the pill should be taken immediately. Further pills should be taken as usual. Emergency contraception is not needed.
  • If the missed pill is more than 12 hours late, the advice depends on where in the cycle it was missed:
    • Days 1-7: take the missed pill immediately and the next pill as usual (even if this means taking two pills on the same day). Continue with the rest of the packet in the normal way. Use additional contraceptive measures (eg, condoms) or abstain from sexual intercourse for seven days.
    • Days 8-17: take the missed pill immediately and the next pill as usual (even if this means taking two pills on the same day). Continue with the rest of the packet in the normal way. No extra contraceptive precautions are required as long as the seven preceding pills have been taken correctly.
    • Days 18-24: take the missed pill immediately and the next pill at the usual time (even if it means taking two tablets on the same day). Continue with the active pills in the normal way (pills are active from day 1-24 and inactive from day 25-28). Omit the inactive pills and start the next packet of pills. A withdrawal bleed is likely to be absent. OR, an alternative option is to discard the remainder of the active pills in the current pack and take the remaining four inactive pills in the normal way, then start the next packet of pills. If no withdrawal bleed occurs, the possibility of pregnancy should be considered.
    • Days 25-28: discard the missed pill and continue to the end of the packet in the normal way. Additional contraception is not necessary.
  • Advise the woman that if pills have been missed and no withdrawal bleed occurs at the end of the packet, she should consider a pregnancy test.

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 the same day, ie one when she remembers and the next pill on time.
  • In addition, if the pill is more than three hours late (12 hours for desogestrel pills such as Cerazette®) other contraceptive precautions are required (eg, condoms) or abstinence for the next 48 hours.
  • Consider emergency contraception if there was unprotected sexual intercourse 2-3 days prior to the missed pills, or there has been intercourse since the missed pill(s).

Further reading & references

  1. Combined Hormonal Contraception; Faculty of Sexual and Reproductive Healthcare (2011 updated August 2012)
  2. Contraception - combined hormonal methods; NICE CKS, June 2012 (UK access only)
  3. FSRH Clinical Effectiveness unit statement: estradiol valerate/diegnogest combined pill Qlaira; Faculty of Sexual and Reproductive Healthcare, September 2009
  4. FSRH Faculty statement from the clinical effectiveness unit: estradiol/nomegestrol combined pill, Zoely; Faculty of Sexual and Reproductive Healthcare, May 2013
  5. Contraception - progestogen-only methods; NICE CKS, June 2012 (UK access only)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Huw Thomas
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Document ID:
2460 (v24)
Last Checked:
24/11/2014
Next Review:
23/11/2019