This guidance is consistent with that issued by the Faculty of Sexual and Reproductive Healthcare.¹

Combined oral contraceptive pills

If one pill is missed, anywhere in the pack

• 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 7-day break is taken as normal.

If two or more pills are missed (i.e. more than 48 hours late), anywhere in the pack

• 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 (e.g. condom or abstinence) should be taken for the next 7 days.
• Emergency contraception may be required if the patient had unprotected sex in the previous 7 days and they have missed two or more pills (i.e. more than 48 hours late) in the first week of a pack.
• The next pack of pills may need to be started without a break, if fewer than seven pills are left in the pack after the missed pill.

Progestogen-only contraceptives

When a woman realises she has missed a pill:²

• 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, i.e. one when she remembers and the next pill on time.
• In addition, if the pill is more than 3 hours late (12 hours with Cerazette®³) an alternative back-up method is required, e.g. a condom should be used (or abstinence) for the next 2 days, and consider the need for 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).

Document references

1. Missed Pill Recommendations, Faculty of Sexual and Reproductive Healthcare (2011)
2. Progestogen-only Injectable Contraception, Faculty of Sexual and Reproductive Healthcare (2009)
3. Summary of Product Characteristics (SPC) - Cerazette® 75 microgram film-coated tablet (desogestrel), Merck Sharp & Dohme Limited, electronic Medicines Compendium. Updated June 2008