Can a patient who stopped Oral Contraceptive Pills (OCPs) for one week with a negative pregnancy test resume taking OCPs?

Resuming Oral Contraceptive Pills After One Week Off

Yes, a patient can resume OCPs immediately after stopping for one week with a negative pregnancy test, but must use backup contraception (condoms) or abstain from intercourse for 7 consecutive days after restarting. 1, 2

Immediate Restart Protocol

• Start the pills immediately without waiting for the next menstrual period 1
• Use backup contraception (condoms) or abstain from intercourse for 7 consecutive days after restarting pills 1, 2
• Take pills at the same time each day to maintain consistent hormone levels 1

Pregnancy Testing Requirements

The FDA label specifies that if a patient has not adhered to the prescribed schedule and misses a period, pregnancy should be ruled out before continuing OCPs 3. Since this patient stopped pills for a week and has a negative pregnancy test, they meet the requirement for safe resumption.

Key Considerations for the 7-Day Gap

When pills are stopped for 7 days (equivalent to missing 7 consecutive pills), this creates a hormone-free interval longer than the standard 7-day break in traditional pill packs. This extended gap allows:

• Potential return of ovarian activity and increased pregnancy risk 2
• Loss of contraceptive protection that requires re-establishment 1

The 7-day backup contraception period after restarting is necessary because it takes approximately 7 consecutive days of pill-taking to re-suppress ovulation and restore full contraceptive effectiveness 1, 2.

Emergency Contraception Consideration

If the patient had unprotected intercourse during the week off pills or within the first 7 days after restarting, emergency contraception should be considered 4, 2:

• Copper IUD is most effective 2
• Ulipristal acetate or levonorgestrel are oral options 2
• If ulipristal acetate is used, delay restarting OCPs for 5 days after taking it 1
• If levonorgestrel or combined estrogen-progestin ECPs are used, OCPs can be restarted immediately with 7 days of backup contraception 1

Common Pitfalls to Avoid

• Do not assume immediate contraceptive protection upon restarting—the 7-day backup period is mandatory 1, 2
• Do not wait for the next menstrual period to restart pills—this unnecessarily extends the period of no contraceptive protection 1
• Do not skip the pregnancy test if there is any possibility of pregnancy during the week off 3

Follow-Up Monitoring

• Advise the patient to have a pregnancy test if they do not have a withdrawal bleed within 3 weeks of restarting 1
• Counsel about expected bleeding irregularities, which may include breakthrough bleeding or changes in cycle length after the interruption 1, 5