Clinical Notes : Women's Health

56. Missed Pill

Incorrect use of Combined Oral Contraceptive Pill

 

Qlaira® and Zoely®

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

Qlaira®

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.

Progestogen-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 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).

 

FSRH Clinical Guidance: Combined Hormonal Contraception - January 2019

Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, UK

Access

FSRH Clinical Guidance: Quick Starting Contraception - April 2017

Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, UK

Access

Selected practice recommendations for contraceptive use

Third edition 2016

World Health Organisation

Access

CEU Clinical Guidance: Emergency Contraception - December 2017

Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, UK

December 2017

Access

 

Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception.

Contraception. 2015 Feb;91(2):97-104

Access

 

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