Community-generated resource library-Recommended Actions After Late or Missed Combined Oral Contraceptives

Recommended Actions After Late or Missed Combined Oral Contraceptives

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This document provides guidelines for managing late or missed doses of combined hormonal contraceptives, which include oral pills, patches, and vaginal rings. 

<strong>Oral Contraceptives:</strong>
- <strong>One Pill Late (Less than 24 hours)</strong>: Take the missed pill as soon as possible and continue with the next pill at the usual time. No additional contraceptive methods or emergency contraception are needed.
- <strong>One Pill Missed (24-48 hours)</strong>: Follow the same procedure as for a late pill. Emergency contraception isn't typically required unless pills were missed earlier in the cycle or during the last week of the previous cycle.
- <strong>Two or More Pills Missed (Over 48 hours)</strong>: Take the most recent missed pill immediately, skip other missed pills, and use additional contraception (e.g., condoms) for the next 7 days. If pills were missed in the last week, skip the hormone-free interval and start a new pack immediately.

<strong>Hormonal Patch:</strong>
- <strong>Delayed Application or Detachment (Less than 48 hours)</strong>: Reapply or replace the patch and maintain the same schedule. Additional methods aren’t necessary, but emergency contraception might be considered.
- <strong>Delayed Beyond 48 Hours</strong>: Apply a new patch as soon as possible, use additional contraceptive methods for 7 days, and consider emergency contraception if needed.

<strong>Vaginal Ring:</strong>
- <strong>Delayed Placement or Replacement (Less than 48 hours)</strong>: Insert a new ring regardless of the schedule. No extra contraception is needed.
- <strong>Delayed Beyond 48 Hours</strong>: Insert the ring immediately, abstain from sex, or use additional methods for 7 days. Emergency contraception should be assessed based on timing and unprotected sex history.

For each method, emergency contraception (excluding ulipristal acetate) may be warranted based on specific circumstances, notably during the first week of hormonal use after unprotected intercourse in the prior 5 days. Always consult updated guidelines from the U.S. Selected Practice Recommendations for comprehensive details.

Keywords

combined hormonal contraceptives

oral contraceptives

hormonal patch

vaginal ring

missed dose guidelines

emergency contraception

additional contraceptive methods

U.S. Selected Practice Recommendations

unprotected intercourse

contraceptive management