Jim Shelton's Pearls

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December 07, 2004

Missed Pills? Just Keep Going

We advise our OC clients on what to do if they miss pills. But we find the guidance on missed pills rather complicated. I suspect many clients do not remember the recommendations. Is there any help?

Yes. WHO has new guidance for the standard low-dose pills that I think is easier to understand and remember.

The key concept is: "Just keep going." Whenever a woman realizes she has missed pills, regardless of how many she has missed, she should take one as soon as possible and then continue on with another pill the next day, etc. If a client just follows this advice, it will be a major advance.

There are 2 additional points that help round out the recommendation:

1. If it is 3 or more pills that are missed, she should use a back-up method (or abstain) for 7 days.<
2. If the missed pills occur in the 3rd week of the cycle, she should skip the 7 placebo pills and just go on to a new pack.

(Part of the rationale of the guidance, is that even when women miss several pills in the middle of the pack, the probability of a viable ovulation is rather low. The risk increases if the missed pills are at the beginning or end of the 21 active pills, which in effect increases the vulnerable pill-free interval to more than 7 days.)

References:
WHO Department of Reproductive Health and Research, Selected Practice Recommendations for Contraceptive Use, Second Edition, 2004. URL as of 12/7/04.

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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

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