Managing Missed Pills
It is easy to forget a pill or to be late in taking it. Adolescents are more likely to forget pills and so may need extra support and guidance.
COC users should know what to do if they forget to take pills. If a woman misses one or more pills, she should follow the instructions below. Use the job aid If You Miss Pills to help explain these instructions to the client.
Making Up Missed Pills With 30–35 μg Estrogen‡
| Key message |
- Take a missed hormonal pill as soon as possible.
- Keep taking pills as usual, one each day. (She may take 2 pills at the same time or on the same day.)
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| Missed 1 or 2 pills? Started new pack 1 or 2 days late? |
- Take a hormonal pill as soon as possible.
- Little or no risk of pregnancy.
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Missed pills 3 or more days in a row in the first or second week? Started new pack 3 or more days late?
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- Take a hormonal pill as soon as possible.
- Use a backup method for the next 7 days.
- Also, if she had sex in the past 5 days, can consider ECPs (see Emergency Contraceptive Pills).
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| Missed 3 or more pills in the third week? |
- Take a hormonal pill as soon as possible.
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Finish all hormonal pills in the pack. Throw away the 7 nonhormonal pills in a 28-pill pack.
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Start a new pack the next day.
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Use a backup method for the next 7 days.
- Also, if she had sex in the past 5 days, can consider ECPs (see Emergency Contraceptive Pills).
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| Missed any nonhormonal pills? (last 7 pills in 28-pill pack) |
- Discard the missed nonhormonal pill(s).
- Keep taking COCs, one each day. Start the new pack as usual.
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| Severe vomiting or diarrhea |
- If she vomits within 2 hours after taking a pill, she should take another pill from her pack as soon as possible, then keep taking pills as usual.
- If she has vomiting or diarrhea for more than 2 days, follow instructions for 3 or more missed pills, above.
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‡ For pills with 20 μg of estrogen or less, women missing one pill should follow the same guidance as for missing one or two 30–35 μg pills. Women missing 2 or more pills should follow the same guidance as for missing 3 or more 30–35 μg pills.
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How Can a Partner Help?
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The client’s partner is welcome to participate in counseling and learn about the method and what support he can give to his partner. A male partner can:
- Support a woman’s choice of COCs
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Help her to remember to take a pill each day and to start a new pack on time
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Show understanding and support if she has side effects
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Help her to make sure that she has a new pill pack on hand to start on time
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Help to make sure she has ECPs on hand in case she misses pills or starts a new pill pack late
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Use condoms consistently in addition to COCs if he has an STI/HIV or thinks he may be at risk of an STI/HIV
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