What should I do if I miss a dose of the Progestin-Only Pill (POP) or a combined hormonal pill?

Management of Missed Hormonal Contraceptive Pills

If you miss a dose of either a progestin-only pill (POP) or combined hormonal pill, take the missed pill as soon as possible and follow specific backup contraception guidelines based on the type of pill and duration of delay. 1

Progestin-Only Pills (POPs)

Missed Dose (>3 hours late)

• Take one pill as soon as you remember 1, 2
• Continue taking pills daily at the same time, even if it means taking two pills on the same day 1, 2
• Use backup contraception (e.g., condoms) or avoid sexual intercourse until pills have been taken correctly for 2 consecutive days 1, 2
• Consider emergency contraception if you had unprotected intercourse 1, 2

Vomiting or Severe Diarrhea Within 3 Hours of Taking POP

• Take another pill as soon as possible 1, 2
• Continue taking pills daily at the regular time 1
• Use backup contraception until 2 days after vomiting or diarrhea has resolved 1
• Consider emergency contraception if you had unprotected intercourse 1

Important Considerations for POPs

• POPs inhibit ovulation in only about half of cycles, making consistent timing crucial 1, 2
• Peak serum levels are reached about 2 hours after taking the pill, followed by rapid elimination 1
• By 24 hours after administration, serum steroid levels are near baseline 1
• An estimated 48 hours of POP use is necessary to achieve contraceptive effects on cervical mucus 1, 2

Combined Hormonal Pills

Missed Dose (<48 hours late and only one pill missed)

• Take the missed pill as soon as possible 1
• Continue taking remaining pills at the usual time 1
• No backup contraception needed 1
• Emergency contraception not usually needed 1

Missed Dose (≥48 hours late or two or more pills missed)

• Take the most recent missed pill as soon as possible 1
• Discard other missed pills 1
• Continue taking remaining pills at the usual time 1
• Use backup contraception for 7 consecutive days 1
• Consider emergency contraception if appropriate, especially if pills were missed during the first week and unprotected intercourse occurred in the previous 5 days 1

Vomiting or Severe Diarrhea

• If vomiting or severe diarrhea occurs, take the next pill as soon as tolerated 1
• Follow the same guidelines as for missed pills based on duration of delay 1

Emergency Contraception Options

• Consider emergency contraception if unprotected intercourse occurred after missing pills 1, 2
• The copper IUD is the most effective emergency contraception option 2
• Ulipristal acetate (Ella) may be more effective than levonorgestrel formulations after the first 72 hours and for women who are overweight or obese 1, 2

Common Pitfalls to Avoid

• Inconsistent or incorrect use is a major reason for contraceptive failure 1, 2
• Not using backup contraception after missed pills significantly increases pregnancy risk 2
• Women who frequently miss pills should consider a less user-dependent method (e.g., IUD, implant, or injectable) 1
• Recent research suggests there may be more margin for error with some newer POPs than current guidelines indicate, but until guidelines are updated, follow the 3-hour window recommendation 3