Missed Pills (Contraception, Hormonal)
Progestin only pills Efficacy is rapidly lost if one pill is forgotten or taken >3 hours late. Recommend dual contraception for all scenarios for at least 7 days. LoE:IVb 23 Scenario Action One pill forgotten or pill taken >3 hours late, and unprotected sexual intercourse has not occurred in the past 5 days. Take pill as soon as remembered and continue taking one pill daily at the usual tim
Progestin only pills
Efficacy is rapidly lost if one pill is forgotten or taken >3 hours late. Recommend dual contraception for all scenarios for at least 7 days.
LoE:IVb23
| Scenario | Action |
|---|---|
| One pill forgotten or pill taken >3 hours late, and unprotected sexual intercourse has not occurred in the past 5 days. | Take pill as soon as remembered and continue taking one pill daily at the usual time. |
| One pill forgotten or taken 3 hours late, and unprotected sexual intercourse has occurred in the past 5 days. | Give emergency contraception (See Contraception, emergency). Take one pill the next day and continue taking one pill daily at the usual time. |
Combination of progestin and estrogen in each pill
Missing active pills and extending hormone free interval leads to decreased contraceptive efficacy. Recommend dual contraception for all scenarios for at least 7 days.
LoE:IVb24, LoE:IVb25
| Scenario | Action |
|---|---|
| One active pill forgotten. | Take pill as soon as remembered and take next one at usual time |
| Two or more pills forgotten during the first 7 active pills of the pack and unprotected sexual intercourse has occurred in the past 5 days. | Give emergency contraception (See Contraception, emergency). Restart active pills 12 hours later. |
| Two or more pills forgotten during the middle 7 active pills of the pack. | Take the most recent missed pill immediately (discard the other missed pills). Continue taking remaining pills as usual. No emergency contraception required. |
| Two or more pills forgotten in the last 7 active pills of the pack and unprotected sexual intercourse has occurred in past 5 days. | Continue active pills of current pack. Omit the inactive pills and immediately start the active pills of the next pack. |
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025
Chapter 7: Family Planning_7.2.5 Missed Pills