A 24-year-old woman on combined oral contraceptive pills (COCPs) for 2 years misses 3 consecutive pills in week 2 of her pill pack. The most appropriate advice is:

• A Take the most recent missed pill now, discard remaining missed pills, continue pack, and use barrier contraception for 7 days ✓
• B Stop the current pack, wait for withdrawal bleed, and restart a new pack
• C Take all 3 missed pills at once to 'catch up'
• D Emergency contraception is mandatory regardless of sexual activity

Explanation

Per WHO and FSRH guidance, if ≥3 combined OCP pills are missed: take the most recently missed pill as soon as remembered, discard the rest of the missed pills, continue taking the remaining pills in the pack at the usual time, and use a back-up barrier method for the next 7 days. If missed pills occurred in week 1 (days 1–7) and unprotected sex occurred in the pill-free interval or week 1, emergency contraception should also be considered. In week 2 with no unprotected sex in the previous 7 days, EC is not mandatory but barrier use for 7 days is essential.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.