A 30-year-old woman taking a 21-day combined oral contraceptive pill realizes she has missed two consecutive active pills on days 19 and 20 of her current packet. She had no unprotected intercourse earlier in this packet. Correct advice is:

• A Stop the packet, have a 7-day break, then start a new packet
• B Take emergency contraception and restart a new packet the next day
• C Discard the packet, wait for withdrawal bleeding, and restart after 7 days
• D Finish the remaining pills, omit the pill-free interval, and start the next packet immediately ✓

Explanation

When two or more pills are missed in week 3 (days 15 to 21), the risk lies not in the missed days themselves but in extending the hormone-free interval, which allows follicular escape. Standard guidance is to finish the active pills, skip the 7-day break, and start the next packet at once. Emergency contraception is considered only if pills were missed in week 1 or the pill-free interval was extended. Stopping early would create exactly the danger being avoided.

Reference: FSRH Clinical Guidance: Combined Hormonal Contraception, 2020 update ed.

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Written and medically reviewed by the StethoPrep medical team.