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Contraception - Management
Vomiting or diarrhoea while on a progestogen-only pill (POP): what should be done?

  • A woman who vomits (for any reason) within 2 hours of taking a progestogen-only pill (POP) should repeat the dose as soon as possible.
    • If she is now more than 3 hours late (or 12 hours for desogestrel), continues to vomit or has very severe diarrhoea, the woman should follow the instructions for missed pills.
  • If vomiting or severe diarrhoea persists for more than 24 hours, the woman should follow the instructions for missed pills, counting each day of vomiting and/or severe diarrhoea as a missed pill:
    • Additional contraceptive cover is required during the illness and for 48 hours afterwards.
Clarification / Additional information
  • These recommendations may differ from those detailed in the patient leaflet or package insert.
Basis for recommendation
  • There is concern that vomiting and/or severe diarrhoea can reduce the efficacy of progestogen-only pills (POPs) by interfering with its absorption [BNF 53, 2007].
  • These recommendations follow guidelines issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2002; FSRH, 2008b]. The FFPRHC guidelines reflect those issued by the World Health Organization (WHO) [WHO, 2002; WHO, 2004a]. The WHO recommendations are based on expert opinion:
    • The WHO expert working group found no direct evidence to address the issue of vomiting and/or severe diarrhoea while using POPs [WHO, 2004a].
    • Although it is uncertain whether the effect of severe vomiting and/or diarrhoea is sufficient to warrant use of the missed pill regimen, the WHO working group considered the effects of vomiting or diarrhoea to be similar to that of missing pills [WHO, 2004a].

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