A 27-year-old woman on a combined oral contraceptive pill (30 mcg ethinylestradiol plus levonorgestrel) realizes she missed two active tablets during the third week of the pack. She took them together with today's pill as soon as she remembered. What additional advice should she receive?

• A Stop the current pack, take a 7-day pill-free interval, then restart
• B Finish the current pack, take the usual 7-day break, then start the next pack
• C No extra precautions are needed because pills were taken within 24 hours
• D Continue the current pack, omit the pill-free interval, and start the next pack immediately, using condoms for the next 7 days ✓

Explanation

With two or more missed active pills, ovulation risk rises and condoms are advised for 7 days. When the missed pills fall in the third week, the pill-free interval must be omitted so the new pack starts the day after the last active pill; this maintains hypothalamic-pituitary suppression across the vulnerable window. Taking a 7-day break (options A and B) extends the hormone-free interval and permits an LH surge, defeating the purpose.

Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.