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Contraception - Management
What advice should I give on what to do when progestogen-only pills (POPs) have been missed?

  • Check which progestogen-only pill (POP) the woman is taking and the time since the last pill was taken.
    • For the desogestrel pill (Cerazette®): a pill is missed if she is more than 12 hours late (i.e. more than 36 hours since taking the last pill).
    • For any other progestogen-only pills: a pill is missed if she is more than 3 hours late (i.e. more than 27 hours since taking the last pill).
  • If the woman has missed any POPs, she should:
    • Take a POP as soon as possible.
    • Continue taking the pills daily, one each day. This may mean taking two pills in 24 hours: the missed pill and the next one at the usual time.
    • Use additional contraceptive protection for the next 48 hours, unless she is less than 6 months postpartum, fully breastfeeding, and amenorrhoeic.
    • Consider emergency contraception if unprotected sexual intercourse has taken place while contraceptive protection from the POP is doubtful. See the CKS topic on Contraception - emergency.
Clarification / Additional information
  • For the desogestrel pill (Cerazette®), the manufacturer advises that contraceptive protection may be reduced if more than 36 hours have elapsed between two tablets [ABPI Medicines Compendium, 2004b].
Basis for recommendation
  • These recommendations are based on guidance issued by the World Health Organization [WHO, 2004a] and are supported by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2005b; FSRH, 2008b]:
    • The World Health Organization expert working group considered the inconsistent or incorrect use of pills to be a major reason for unintended pregnancy and highlighted the importance of taking the progestogen-only pill at approximately the same time each day [WHO, 2004a]:
      • An estimated 48 hours of progestogen-only pill use was deemed necessary to achieve the contraceptive effects on cervical mucus.

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