A woman starts taking combined oral contraceptive pills (COCPs) on day 5 of her menstrual cycle. She misses a pill on day 14. According to WHO Medical Eligibility Criteria, what is the CORRECT action?
- A Take the missed pill as soon as remembered, continue the pack normally; no additional precautions needed if missed by <48 hours ✓
- B Discard the missed pill, take the next pill on time, and use barrier contraception for 7 days
- C Stop the pack immediately and start a new pack after a 7-day break
- D Use emergency contraception (levonorgestrel 1.5 mg) immediately
Correct answer: A. Take the missed pill as soon as remembered, continue the pack normally; no additional precautions needed if missed by <48 hours
Explanation
For combined oral contraceptive pills, if one pill is missed (up to 48 hours late), the recommendation is to take the missed pill as soon as remembered (even if it means taking two pills on the same day), then continue the pack normally. No additional contraceptive precautions are required, and emergency contraception is not needed. Additional precautions (barrier method for 7 days) are only required if 2 or more consecutive pills are missed in the first week of the pack, or >48 hours late in the first week, when ovarian suppression may be compromised.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.