Combined oral contraceptive pill

Missed pill

The advice from the Faculty of Sexual and Reproductive Healthcare (FSRH) has changed over recent years. The following recommendations are now made for women taken a combined oral contraceptive (COC) pill containing 30-35 micrograms of ethinylestradiol

If 1 pill is missed (at any time in the cycle)

• take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
• no additional contraceptive protection needed

If 2 or more pills missed

• take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
• the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: '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'
• if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
• if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
• if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

*theoretically women would be protected if they took the COC in a pattern of 7 days on, 7 days off