missed dose (COC)

Last edited 05/2019 and last reviewed 01/2023

Guidance has been given by the FSRH (1):

• if one active pill is missed, there is no need to take additional precautions
  
  
• if two active pills are missed, additional precautions should be taken for the next 7 days

More detailed guidance (1):

• If one pill has been missed (more than 24 hours and up to 48 hours late)
  
  
  • Continuing contraceptive cover
    • The missed pill should be taken as soon as it is remembered
    • The remaining pills should be continued at the usual time
      
      
  • Minimising the risk of pregnancy
    • Emergency contraception (EC) is not usually required but may need to be considered if pills have been missed earlier in the packet or in the last week of the previous packet
      
      
• If two or more pills have been missed (more than 48 hours late)
  
  
  • Continuing contraceptive cover
    • The most recent missed pill should be taken as soon as possible
    • The remaining pills should be continued at the usual time
    • Condoms should be used or sex avoided until seven consecutive active pills have been taken. 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
      
      
  • Minimising the risk of pregnancy

    • If pills are missed in the first week (Pills 1-7)	If pills are missed in the second week (Pills 8-14)	If pills are missed in the third week (Pills 15-21)
      EC should be considered if unprotected sex occurred in the pill-free interval or in the first week of pill-taking.	No indication for EC if the pills in the preceding 7 days have been taken consistently and correctly (assuming the pills thereafter are taken correctly and additional contraceptive precautions are used).	OMIT THE PILL-FREE INTERVAL by finishing the pills in the current pack (or discarding any placebo tablets) and starting a new pack the next day.

Notes:

• definition of a missed pill
  • a missed pill is defined as one that is more than 24 hours late. If more than one pill is missed, the rule applies to consecutive pills. The rule applies to active pills, not to placebo pills in ED preparations. Further guidance for professionals on how to advise women is given in the flow chart on page 3 produced by the CEU
• Qlaira®
  • this formulation is a quadriphasic pill containing the estrogen estradiol valerate instead of ethinylestradiol. In view of the limited clinical experience with this product to date, it is suggested that the pharmaceutical company's advice should be followed for the time being

Reference:

• Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Missed Pill Recommendations.Clinical Effectiveness Unit; May 2011.