A 24-year-old woman taking a combined oral contraceptive forgets tablets on days 3, 4, 5, and 6 of her new pack. On day 7 she had unprotected sexual intercourse. She presents asking what to do. What is the MOST appropriate advice?
- A Resume the remaining pills; no further action is needed
- B Take ulipristal acetate now, then restart the pack and use condoms for 7 days ✓
- C Switch immediately to a progestin-only pill
- D Do a pregnancy test today and restart pills if negative
Correct answer: B. Take ulipristal acetate now, then restart the pack and use condoms for 7 days
Explanation
Missed pills in week 1 matter most because they extend the hormone-free interval, allowing follicular escape and possible ovulation roughly two weeks later. When pills are missed in the first week and intercourse has occurred, guidance recommends emergency contraception, ideally ulipristal acetate 30 mg taken within 120 hours. She should then restart her current pack and use condoms for the following 7 days. Simply resuming pills ignores the real pregnancy risk, and a pregnancy test on day 7 cannot yet detect conception.
Reference: Selected Practice Recommendations for Contraceptive Use, 3rd, WHO ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.