Dear Doctor, I missed my pill!

For anyone that is on the contraceptive pill and has forgotten to take one, or anyone on the pill that has yet to manage this state of panic… Today’s post is for all you pill takers. Bookmark this page and come back to it if it  happens to you. I’ll try to keep the post to the point and as straight forward as possible. If you have any questions feel free to comment below.

What type of pill am I taking?

First things first, you need to know which pill you are on in order to get the rules right. There are two type of pill. 

Firstly the progesterone only pill, aka the mini pill. This has one hormone in it and you take in continuously without any breaks. Most people find after a few months they stop having periods. 

The other pill is the combined pill, which as you may guess is a combination of two hormones, progesterone and oestrogen. This pill is taken for 21 days and then you have a seven day pill break in which time you have your breakthrough bleed. Some combined pills come with seven days of ‘placebo pills’ for the break so be careful, ask your gp or pharmacist if you are not entirely sure.

Also for reference, in this article as an example we will use 7am as a pretend pill taking time. Obviously adjust it for whatever time you take your own pill.

When is a Progesterone only pill (POP) classed as a missed pill?

If you are on a pill called cerazette or desogestrel 75mcg pill, you have missed a pill if you take one more than 12 hours late. So if you take your pill at 7am then it is only a missed pill if you haven’t taken it by 7pm that day (36 hours since taking the last pill).

For all other POPs, your pill is missed if it is more than 3 hours late. So if you usually take it at 7am, it’s classed as missed if you haven’t taken it by 10am (27 hours since taking the last pill).

What do I do if I have missed a POP?

1. Take a pill as soon as possible.

2. Take the next pill at the normal time. This can mean taking two pills in one day. 

3. For 48 hours consider yourself not covered for contraception and use a barrier method of contraception eg. condoms

4. If you have unprotected intercourse within those 48 hours of a missed pill you may need emergency contraception, so contact a health professional. 

What if I take my pill on time but then start vomiting or get diarrhoea?

If you vomit within 2 hours of taking a POP take another pill as soon as possible.

If the vomiting or diarrhoea continues for more than 3 hours (or 12 hours for desogestrel pill), then follow the instructions for a missed pill.

If vomiting or diarrhoea persists for more than 24 hours continue to follow the instructions for missed pills, counting each day of illness as a missed pill.

Avoid sexual intercourse or use a barrier method during the illness and for 48 hours afterwards.

When is a Combined pill classed as a missed pill?

These missed pill rules apply to all main combined oral contraceptives except Qlaira and Zoely. If you are on those two pills, I am not covering those here so please speak to a health professional.

A missed combined pill is when one pill has been missed 48 hours late. eg if you take it at 7am then miss a pill the next day at 7am, it is a missed pill if you don’t take it before the day after at 7am. So effectively you have missed a whole day and one pill. Also if a new pack has been started 24-48 hours late it’s a missed pill.  

What do I do if I have missed one combined pill? 

1. Take the missed pill as soon as possible.

2. Keep taking the rest of the pills at the usual time. You may end up taking two pills in one day. 

3. Take the 7-day pill break as normal.

4. Emergency contraception is not usually needed.

What do I do if I miss two combined pills?

So, if two or more pills have been missed , eg. two whole days missed or more than 72 hours since the last pill, or a new pack has been started more than 48 hours late. 

1. Take one missed pill as soon as possible. 

2. Continue taking the pill at the usual time. You may end up taking two in one day.

3. Avoid sexual intercourse or use a barrier method of contraception (such as condoms) until 7 consecutive pills days have been taken.

Does it matter where in the cycle I miss my pills?

For one pill it doesn’t matter. But it gets a little tricky when there are two missed combined pills. 

If pills are missed in the first week (pills 1-7): Consider emergency contraception if unprotected sexual intercourse happened in the pill break week or in the first week of pill taking. Finish the pack and have the usual 7-day break.

If pills are missed in the second week (pills 8-14): Emergency contraception is not needed if pills day 1-7 have been taken correctly (additional barrier contraceptive still needed for 7 days when back on the pill). Finish the pack and have the usual 7-day break.

If pills are missed in the third week (pills 15-21): Don’t take the pill break. Finish the pills in the current pack and start a new pack the next day. Emergency contraception is not required if the pill break is not taken.

If more than seven pills have been missed, restart as a new user. 

Remember, no more than 2 pills should be taken in any one day.

If combined pills have been missed and no withdrawal bleed occurs at the end of the pill break, consider the possibility of pregnancy.

What about vomiting and diarrhoea on the combined pill?

If you vomit within 2 hours of taking a combined pill, take another pill as soon as possible.

If vomiting or diarrhoea goes on for longer than 24 hours, follow the instructions for missed pills, counting each day of vomiting and diarrhoea as a missed pill.

Avoid sexual intercourse or use a barrier method of contraception (such as condoms) during the illness and for 7 days after.

If the illness occurs while taking the last 7 pills, don’t take the pill break and start the next cycle immediately.

In summary…

If you miss a pill don’t panic! It is easily done. Check through the above information for your pill, check the information leaflet that comes with your pill, and if you are still not sure speak to your community pharmacist, nurse or doctor. Hope this helps! 

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